Comparison of applicability of Novel PNR-Bleed Classification with the traditional Goligher’s classification in the management of hemorrhoidal disease

Background: Goligher’s classification has been traditionally used to define and classify hemorrhoids and also guide their treatment, however with certain limitations, which can be overcome by the novel Prolapse-Number-Relation-Bleed/Hemorrhoid Severity Score Classification (PNR-Bleed/HSS Classification) by Khan M.A. et. al. The more comprehensive, elaborate, objective and easily reproducible nature of PNR Bleed classification makes it an ideal candidate to be used in management of hemorrhoidal disease. Purpose: To compare PNR-Bleed/HSS Classification with Goligher’s Classification for hemorrhoidal disease with respect to classification, treatment and follow-up of hemorrhoidal disease. Methods: This study was conducted at Sher-I-Kashmir Institute of Medical Sciences (SKIMS) Soura and SKIMS Medical College and Hospital (MCH), Bemina, J & K, India, from 1st September 2020 to 1st August 2022. Patients were classified according to Goligher’s classification as well as PNR-Bleed/HSS Classification and treatment administered according to most recent guidelines and surgeons experience. The association between the two classifications was compared. This study was conducted after taking permission from the original publisher of the PNR-Bleed/HSS by Khan M.A. et al. Results: A total of 112 patients who were included in the study completed it. There was a statistically significant positive correlation between Goligher’s Grade and PNRB/HSS at presentation and each follow up (P value <0.05, Pearson’s correlation coefficient 0.7). Change in pre-treatment and post treatment (6 month) Goligher’s Score as well as HSS was found to be statistically significant with respect to each treatment (P value < 0.05). Conclusion: The traditional Goligher’s method of classification of hemorrhoidal disease has a number of limitations, which is overcome by the novel PNRB/HSS classification and can help guide the treatment and follow-up of this not-so-simple disease.