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We hypothesized that the distribution of hemorrhoidal piles follows a predictable anatomical pattern influenced by disease duration and recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u20132024).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 171 patients (123 male; 71.9%; median age 41\u2009\u00b1\u200912.04\u00a0years, range 18\u201388), 35\u00a0had 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\u00a0(\n                      <jats:italic>p\u00a0=\u00a00.031).<\/jats:italic>\n                      \u00a0Most patients had more than one pile (87.7%). Symptom duration positively correlated with pile number (Spearman's rho\u00a0=\u00a00.229,\u00a0\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013), but not with hemoroid grade (\n                      <jats:italic>p\u00a0=\u00a00.977)<\/jats:italic>\n                      .\u00a0No significant differences in pile distribution were observed in patients with defecation disorders, labor history, or concomitant anal fissure (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05). Of the 48 patients with anal fissure\u00a0had significantly shorter symptom duration compared to those without fissure (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.011).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10151-025-03184-6","type":"journal-article","created":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T16:08:29Z","timestamp":1753200509000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Anatomical distribution of hemorrhoidal piles in advanced disease: clinical insights and correlations"],"prefix":"10.1007","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4133-9823","authenticated-orcid":false,"given":"\u0130.","family":"Osmanov","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5289-3718","authenticated-orcid":false,"given":"E.","family":"Erg\u00fcder","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4013-6735","authenticated-orcid":false,"given":"J.","family":"Ahmadov","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9658-6063","authenticated-orcid":false,"given":"C.","family":"Ersak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0680-0589","authenticated-orcid":false,"given":"S.","family":"Levento\u011flu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6417-8949","authenticated-orcid":false,"given":"B. 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