# Anatomical distribution of hemorrhoidal piles in advanced disease: clinical insights and correlations

## TL;DR

This study finds that hemorrhoidal piles are most commonly located in the left lateral quadrant and that their distribution changes with disease recurrence.

## Contribution

The study identifies a predictable anatomical pattern of hemorrhoidal piles and links symptom duration to pile number.

## Key findings

- Left lateral quadrant is the most common location for the largest hemorrhoidal pile.
- Prolonged symptom duration correlates with an increased number of piles.
- Left lateral predominance is more common in primary cases than in recurrent cases.

## Abstract

A precise evaluation of the positional distribution of hemorrhoidal piles has not been distinctly conducted. We hypothesized that the distribution of hemorrhoidal piles follows a predictable anatomical pattern influenced by disease duration and recurrence.

Our retrospective study analyzed the demographic data, surgical records, operative photographs, previous treatments, and associated colorectal symptoms of patients who underwent invasive procedures for advanced hemorrhoidal disease (2020–2024).

Of the 171 patients (123 male; 71.9%; median age 41 ± 12.04 years, range 18–88), 35 had prior interventions (recurrent cases). The largest pile was most commonly in the left lateral quadrant (40.14%), followed by right posterior (31.97%), right anterior (23.47%), and atypical locations (4.42%). Left lateral predominance was significantly higher in primary cases than in recurrent cases (p = 0.031). Most patients had more than one pile (87.7%). Symptom duration positively correlated with pile number (Spearman's rho = 0.229, p = 0.013), but not with hemoroid grade (p = 0.977). No significant differences in pile distribution were observed in patients with defecation disorders, labor history, or concomitant anal fissure (p > 0.05). Of the 48 patients with anal fissure had significantly shorter symptom duration compared to those without fissure (p = 0.011).

The classical three-quadrant distribution is confirmed, with the left lateral pile being predominant in primary cases. The association between prolonged symptom duration and increased pile number offers novel insights, highlighting left lateral predominance in primary cases and its reduction in recurrence, enhancing clinical understanding and management.