Polidocanol foam sclerotherapy for patients with Goligher grade IV hemorrhoidal disease unwilling to undergo surgery: preliminary outcomes from a retrospective study with 6-month follow-up

Background Polidocanol foam (PF) sclerotherapy has shown promising results in low- and intermediate-grade hemorrhoidal disease (HD), but evidence in advanced stages remains limited. This study aimed to evaluate patient-reported outcomes following PF sclerotherapy in patients with Goligher grade IV HD who declined surgical treatment. Methods This retrospective analysis included patients with Goligher grade IV HD that declined hemorrhoidectomy after appropriate counseling and underwent 3% PF sclerotherapy between June and October 2025. Outcomes were assessed using symptom-focused subsets derived from the PROM-HISS and HDSS instruments at baseline, 7 days, 30 days, and 6 months. Primary outcome was the change in scores over time. Secondary outcomes included need for additional treatment, complications, and subsequent surgery. Results Fifteen patients were included (mean age 58 ± 11 years; 53.3% male). At 6 months, 66.7% of patients requested no further hemorrhoidal treatment. Significant improvements were observed in both scores across all follow-up timepoints ( p < 0.05). Pain, bleeding, and prolapse showed the most consistent reductions. One patient (6.7%) required hemorrhoidectomy within 30 days, four patients (26.7%) a second sclerotherapy session. No major complications were observed. Conclusions In selected patients with Goligher grade IV HD who are unwilling or unfit to undergo surgery, PF sclerotherapy may be associated with short-term symptom improvement and may represent a symptom-oriented minimally invasive option for selected patients unwilling or unfit to undergo surgery.