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Open research questions in Anorectal Disease Treatments and Outcomes

82 gap statements mined from Anorectal Disease Treatments and Outcomes papers in our 4.5M-paper local library, which holds 371 papers on the topic — drawn mostly from each paper's own stated research gap, future-work, challenge and limitation notes, and its abstract. The ones listed below are a selection still marked open; each names the study that raised it, with a DOI link where the paper has one.

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What the literature leaves open

  • There is a lack of comprehensive reviews on the use of medicinal plants for treating hemorrhoids in Thailand. There is a need to identify the most significant medicinal plants for hemorrhoid treatment using ethnobotanical indices.

    An ethnobotanical review of medicinal plants used for treating hemorrhoids in Thailand · 2026 · DOI

  • Despite the limitations of current regenerative therapies for PFCD, the field is rapidly evolving with promising innovations that address existing challenges and offer new therapeutic paradigms.

    Needles for healing: stem cells, platelet-enriched plasma, and fat injection in perianal fistulizing Crohn’s disease · 2026 · DOI

  • For anal fistulas suspected to be complex based on clinical assessment, or when 3D-EAUS is insufficient to evaluate the complexity of the anal fistula, MRI should be used.

    Diagnostic Performance of Three-Dimensional Endoanal Ultrasound Compared with MRI in Anal Fistula: A Systematic Review and Meta-analysis · 2026 · DOI

  • Currently, insufficient data exist to explain why SP is present only in some patients or why it appears more prevalent in women. It is speculated to be a skin sequel resulting from the repeated attacks and remissions of the fissure The present study provides information on sentinel pile, a topic that remains insufficiently explored in the literature.

    Impact of sentinel pile on botulinum toxin treatment of chronic anal fissure: A comparative study · 2026 · DOI

  • Postoperative complications such as pain, edema, and prolonged recovery remain clinical challenges. The pathogenesis of hemorrhoids is a weakening of the anal cushion. Hemorrhoid disease is the fourth leading outpatient gastrointestinal diagnosis in the United States.

    Comparative study of one-step and four-step injection combined with external stripping and internal ligation for mixed hemorrhoids · 2026 · DOI

  • The optimal injection technique for combined surgery lacks systematic comparison. There is a need to determine the safety and efficacy of four-step vs one-step sclerotherapy.

    Comparative study of one-step and four-step injection combined with external stripping and internal ligation for mixed hemorrhoids · 2026 · DOI

  • There is a need for alternative treatments for fourth-degree hemorrhoids that minimize postoperative complications. Ksharasutra therapy has not been widely studied for its effectiveness in managing advanced hemorrhoids.

    KSHARASUTRA LIGATION IN THE MANAGEMENT OF FOURTH-DEGREE HEMORRHOIDS (ARSHA): A CASE REPORT · 2026 · DOI

  • Conventional surgical approaches often involve risk of incontinence, delayed healing, and recurrence. Need for a safe, effective, and sphincter-sparing modality for managing complex fistula-in-ano.

    ROLE OF IFTAK PROCEDURE IN COMPLEX FISTULA-IN-ANO-A CASE REPORT · 2026 · DOI

  • Such a transition is particularly critical for managing chronic conditions in regions where specialized healthcare infrastructure is scarce, ensuring long-term health equity and clinical stability. Consequently, while this case presents a low-cost, viable model for resource-constrained settings, structured clinical trials are warranted to benchmark this integrative approach against standard care.

    Breaking the Cycle of Recurrence: An Integrative Approach to Chronic Fistula-in-Ano Management · 2026 · DOI

  • There is a need for accurate preoperative evaluation of perianal fistulas. Prior studies may not have assessed the diagnostic accuracy of MRI for detecting perianal fistulas.

    Diagnostic Accuracy of MRI for Diagnosis of Perianal FistulaTaking Operative Findings as Gold Standard AT Tertiary Care Hospital · 2026 · DOI

  • Although platelet-rich plasma (PRP) injection has demonstrated promising outcomes, its ability to consistently reduce long-term recurrence remains uncertain.

    Use of microfragmented autologous adipose tissue (LIPOGEMS®) as a sphincter-saving therapy for complex anal fistulas: a single-center retrospective study · 2026 · DOI

  • There is a need to evaluate healing outcomes and identify factors affecting recovery following surgical treatment of chronic anal fissure. There is a lack of studies that investigate the effectiveness of lateral internal sphincterotomy as the standard surgical treatment for chronic anal fissure.

    PREDICTORS OF DELAYED HEALING FOLLOWING SURGICAL TREATMENT OF CHRONIC ANAL FISSURE · 2026 · DOI

  • Fourth, the generalizability of our findings is limited by the specific patient population studied. Larger prospective controlled studies are warranted to definitively establish the role of VET in the management algorithm for post-surgical RVF.

    Vaginal Estriol Tablet Therapy for Rectovaginal Fistula after Low Rectal Surgery: Endoscopic Evaluation of Efficacy and Healing Mechanism · 2026 · DOI

  • We describe a structured stepwise operative strategy for emergency multivisceral resection in a 79-year-old patient with CSF and a fecalized splenic abscess involving the pancreatic tail, in whom prior diversion and nonresectional strategies were insufficient for definitive source control.

    Isolation Before Manipulation: A Stepwise Strategy for Emergency Multivisceral Resection of Colosplenic Fistula · 2026 · DOI

  • The optimal sphincter-preserving technique for treating anal fistulas is still debated. There is a need to compare the LIFT procedure and elastic seton application.

    Surgical treatment of anal fistula: classic elastic seton application and LIFT method · 2026 · DOI

  • Although no studies have comprehensively grouped all conditions within this category, their prevalence is estimated at 10-15% in the general population, with up to 80% of symptoms potentially attributable to underlying anorectal pathology.

    Experience, Perceptions, and Barriers to the Management and Referral of Anorectal Disorders in Primary Healthcare: A Cross-Sectional Study in an Extreme Region of Chile · 2026 · DOI

  • There is a need for more effective and sustainable treatment options for haemorrhoids. The use of green fabricated silver nanoparticles may provide a potential solution for the treatment of haemorrhoids. The paper identifies a gap in the current literature on the use of Acacia ferruginea based silver nanoparticles for the management of haemorrhoids.

    Green Fabrication of Acacia ferruginea Based Silver Nanoparticles Targeting TNF-α and AMPK Receptors for the Management of Haemorrhoids · 2026 · DOI

  • Future research should focus on standardizing anesthesia protocols across surgical techniques to isolate the independent effect of the surgical approach on outcomes. The role of adjunctive therapies in high-risk patients with identified predictors of non-healing warrants further exploration.

    Outcomes of Closed Versus Open Lateral Internal Anal Sphincterotomy for Chronic Anal Fissure: A Randomized Controlled Trial · 2026 · DOI

  • Given this gap in the literature, we leveraged our institutional experience over a 16- year period to analyze outcomes in a large cohort of patients with complex or recurrent anal fistula who had been treated with the cutting seton technique.

    Cutting seton as salvage strategy for complex or recurrent anal fistula: Single-tertiary center 10-year experience with 207 patients · 2026 · DOI

  • Hemorrhoidal disease is a prevalent and debilitating condition. The choice of surgical modality can significantly impact patient outcomes. There is a lack of comparative studies on the outcomes of different surgical modalities.

    Comparative Study of Postoperative Outcomes and Morbidity Among Laser, Open, and Stapled Hemorrhoidectomy for the Treatment of Grade III and Grade IV Hemorrhoids · 2026 · DOI

  • There is a lack of comparative studies on the outcomes of different surgical modalities for Grade III and IV hemorrhoids. The study aims to address this gap by comparing postoperative outcomes and morbidity among laser, open, and stapled hemorrhoidectomy.

    Comparative Study of Postoperative Outcomes and Morbidity Among Laser, Open, and Stapled Hemorrhoidectomy for the Treatment of Grade III and Grade IV Hemorrhoids · 2026 · DOI

  • Further clinical studies are recommended to confirm the therapeutic efficacy of the herbal gel. Investigation of the long-term effects of the herbal gel on hemorrhoids.

    A RESEARCH ON: DEVELOPMENT AND FORMULATION AND EVALUATION OF HERBAL GEL FOR THE TREATMENT OF HEMORRHOIDS · 2026 · DOI

  • OF THIS STUDYO_LIIn this trial we utilized a novel drug repurposing approach, PheWAS, to identify fistulas as a novel pathophysiological phenotype which may benefit from a pharmacological intervention targeting the PDGF signaling pathway.

    Study protocol and statistical analysis plan for a randomized controlled trial evaluating the safety and feasibility of the recombinant human platelet-derived growth factor B (rhPDGF-BB)-enhanced collagen plug for complex perianal fistula healing · 2026 · DOI

  • The number of recurrence events was relatively small (22 events), so the multivariable logistic regression model is at risk of overfitting and sparse data bias, as reflected by the wide confidence intervals around some estimates.

    Cutting seton as salvage strategy for complex or recurrent anal fistula: Single-tertiary center 10-year experience with 207 patients · 2026 · DOI

  • Lay-open pilonidal sinus surgery outcomes are reported only in adult male populations (ages 24–27 years); none of these studies evaluates wound bed healing, pain, or recurrence in female patients, pediatric populations, or older adults, where tissue healing and disease biology may differ.

    TOTAL SURGICAL EXCISION FOR CHRONIC PILONIDAL SINUS DISEASE WITH BRANCHING TRACTS: A CASE REPORT · 2026 · DOI

Most-cited papers in Anorectal Disease Treatments and Outcomes

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Open questions raised by papers listed on this page include: (1) There is a lack of comprehensive reviews on the use of medicinal plants for treating hemorrhoids in Thailand (“An ethnobotanical review of medicinal plants used for treating hemorrhoids in…”, 2026); (2) There is a need to determine the safety and efficacy of four-step vs one-step sclerotherapy (“Comparative study of one-step and four-step injection combined with external…”, 2026); (3) There is a need for alternative treatments for fourth-degree hemorrhoids that minimize postoperative complications (“KSHARASUTRA LIGATION IN THE MANAGEMENT OF FOURTH-DEGREE HEMORRHOIDS (ARSHA): A…”, 2026); (4) Such a transition is particularly critical for managing chronic conditions in regions where specialized healthcare infrastructure is scarce, ensuring long-term health equity and clinical stability (“Breaking the Cycle of Recurrence: An Integrative Approach to Chronic…”, 2026); (5) There is a need for accurate preoperative evaluation of perianal fistulas (“Diagnostic Accuracy of MRI for Diagnosis of Perianal FistulaTaking Operative…”, 2026). 82 gap statements have been mined from Anorectal Disease Treatments and Outcomes papers in our 4.5M-paper local library, which holds 371 papers on the topic; the gaps come from whichever of those papers state one. They are mostly the research gaps the authors state and the papers' abstracts, plus future-work, limitations and challenges passages. The ones listed below are a selection still marked open; each names the study that raised it, with a DOI link where the paper has one, so you can read the original claim in context.

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