Selection of Patients to the Surgical Treatment of Hemorrhoids

Abstract

Some patients with prominent hemorrhoids will present with symptoms requiring some kind of treatment. Although a majority of patients will be successfully managed by conservative treatment and office procedures, some will need an operation. Surgical indication is mainly settled after failure or contraindication of local treatments or in Grade III and IV hemorrhoids. Several surgical strategies have been proposed and can be graded by their effectiveness and complications rates. Patients need to be informed on those on the basis of their main symptoms and general and proctologic baseline health. After a full assessment of patients and their haemorrhoidal condition, a number of issues have to be considered and discussed in order to plan a tailored strategy for each specific scenario that balances benefits and risks with adjusted patient expectations. General concepts that need to be understood by patients and surgeons when dealing with hemorrhoids are summarized. Different criteria to assess patients' condition and to choose surgical operation are discussed. Finally, the rationale to individualize treatment strategies for different grades of hemorrhoids is presented.