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Review
. 2025 Jul 27;17(7):107099.
doi: 10.4240/wjgs.v17.i7.107099.

TONEFACT: Can even advanced hemorrhoids be treated without surgery? A paradigm shift in the management of hemorrhoids

Pankaj Garg  1 , Inna Tulina  2 , Dong-Lin Ren  3 , Kaushik Bhattacharya  4 , Vipul D Yagnik  5 , Garg Mahak  6
Affiliations
Review

TONEFACT: Can even advanced hemorrhoids be treated without surgery? A paradigm shift in the management of hemorrhoids

Pankaj Garg et al. World J Gastrointest Surg. .

Abstract

Hemorrhoids are one of the most common anorectal disorders. Early hemorrhoids are treated conservatively, but advanced hemorrhoids are usually treated with surgery. However, in the last decade, we have worked extensively in the field of conservative management of hemorrhoids. From our experience, we could manage a large proportion of advanced hemorrhoids without surgery by a treatment concept (TONEFACT) with a high satisfaction rate. Evidence for the TONEFACT approach primarily comes from observational studies and a prospective, non-randomized study of 85 patients. This has been shown to improve defecation time and reduce prolapse symptoms in early-stage hemorrhoids, leading to fewer surgical interventions. Although promising, these observations lack validation from more extensive randomized controlled trials to draw firm conclusions. In this opinion review, without using much data, we will discuss our viewpoint based on our experience as specified by the journal guidelines.

Keywords: Conservative management; Fiber; Hemorrhoids; Non-surgical; Water intake.

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Conflict of interest statement

Conflict-of-interest statement: The authors have nothing to disclose.

Figures

Figure 1
Figure 1
Overview of TONEFACT treatment.
Figure 2
Figure 2
Flow chart to implement TONEFACT.
See this image and copyright information in PMC

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