Hemorrhoids surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]

Overview

Surgery is not the first-line treatment option for patients with hemorrhoids. Surgical intervention is usually reserved for patients with either complicated or large hemorrhoids (beyond grade III).

Surgery

Some people require the following medical treatments for chronic or severe hemorrhoids:

Rubber band ligation

  • Rubber band ligation is sometimes called Baron ligation.
  • Elastic bands are applied onto an internal hemorrhoid to cut off its blood supply.[1]
  • Within several days, the withered hemorrhoid is sloughed off during a normal bowel movement.

Hemorrhoidolysis/Galvanic Electrotherapy

Sclerotherapy (injection therapy)

  • The idea behind sclerotherapy is that a sclerosant or hardening agent is injected into the hemorrhoids. This causes the vein walls to collapse and the hemorrhoids to shrivel up.

Cryosurgery

  • During cryotherapy, a frozen tip of a cryoprobe is used to destroy hemorrhoidal tissues.[3]
  • Rarely used currently because of side effects.

Laser, infrared, or BICAP coagulation

  • Laser, infrared beam, or electricity is used to cauterize the affected tissues.
  • Lasers are now much less popular.
  • Infrared coagulation has been studied in comparison with RBL and found to be as effective in hemorrhoids up to grade III.
  • These are the most readily available non-surgical procedures in the US.[4]

Hemorrhoidectomy

  • Hemorrhoidectomy is a true surgical procedure to excise and remove hemorrhoids.
  • Hemorrhoidectomy has a possible correlation with incontinence issues later in life and many patients complain that pain during recovery is severe. For these reasons, it is often now recommended only for severe (grade IV) hemorrhoids.

Stapled Hemorrhoidectomy

  • Also called the procedure for prolapse and hemorrhoids, it is designed to resect soft tissue proximal to the dentate line, which disrupts the blood flow to the hemorrhoids.
  • It is generally less painful than complete removal of hemorrhoids and allows for a faster recovery time. The procedure is meant for hemorrhoids that fall out or bleed and is not helpful for painful outside conditions.[5]

Doppler Guided Hemorrhoidal Artery Ligation

  • The only evidence-based surgery for all grades of hemorrhoids.
  • It does not involve cutting tissues or even a stay at the hospital; patients are usually back to work on the same day.
  • It is the best treatment for bleeding piles, as the bleeding stops immediately.[6]

Recto-anal Repair

  • It is also known as mucopexy or mucosal lifting. The procedure is used for managing prolapse of mucosa or hemorrhoids.

References

  1. Longman RJ, Thomson WH (2006). "A prospective study of outcome from rubber band ligation of piles". Colorectal Dis. 8 (2): 145–8. PMID 16412076. doi:10.1111/j.1463-1318.2005.00873.x. 
  2. Bleday R, Pena JP, Rothenberger DA, Goldberg SM, Buls JG (1992). "Symptomatic hemorrhoids: current incidence and complications of operative therapy". Dis. Colon Rectum. 35 (5): 477–81. PMID 1568400. 
  3. MacLeod JH (1982). "In defense of cryotherapy for hemorrhoids. A modified method". Dis. Colon Rectum. 25 (4): 332–5. PMID 6979469. 
  4. Greenspon J, Williams SB, Young HA, Orkin BA (2004). "Thrombosed external hemorrhoids: outcome after conservative or surgical management". Dis. Colon Rectum. 47 (9): 1493–8. PMID 15486746. doi:10.1007/s10350-004-0607-y. 
  5. Tjandra JJ, Chan MK (2007). "Systematic review on the procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy)". Dis. Colon Rectum. 50 (6): 878–92. PMID 17380367. doi:10.1007/s10350-006-0852-3. 
  6. Scheyer M, Antonietti E, Rollinger G, Mall H, Arnold S (2006). "Doppler-guided hemorrhoidal artery ligation". Am. J. Surg. 191 (1): 89–93. PMID 16399113. doi:10.1016/j.amjsurg.2005.10.007. 

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