Clinical evidence and practice of moist wound healing in Hemorrhoidectomy: A narrative review

Hemorrhoidectomy creates an open perianal wound that is repeatedly exposed to contamination, mechanical irritation during defecation, and substantial postoperative discomfort. Moist wound management aims to maintain an appropriate wound interface that supports re-epithelialization while balancing hydration, exudate control, wound protection, and patient comfort. This narrative review evaluates the biological rationale, clinical evidence, dressing selection, adjunctive therapies, and practical implementation of moist wound management after hemorrhoidectomy. A structured literature search prioritized randomized controlled trials, systematic reviews, meta-analyses, clinical guidelines, and recent comparative studies directly involving hemorrhoidectomy, while broader wound-healing evidence was used when procedure-specific data were unavailable. Current evidence suggests that selected dressing strategies may shorten epithelialization time, although direct hemorrhoidectomy-specific comparative evidence remains limited. In contrast, dressing-specific effects on postoperative pain are less certain, whereas topical pharmacological and sphincter-targeted interventions have separate evidence supporting analgesic benefit. Available studies provide some reassurance regarding early safety outcomes but are generally insufficiently powered to exclude differences in uncommon complications. Formal cost-effectiveness evidence comparing postoperative dressing strategies is also lacking. Moist dressings should therefore be considered within a multimodal postoperative approach that also addresses pain, sphincter spasm, hygiene, bowel regulation, and defecation-related mechanical stress. Future multicenter randomized trials should use standardized pain, epithelialization, complication, patient-reported, and health-economic outcomes to define which dressing strategies benefit specific patient groups.