Surgical management of hemorrhoids

Abstract

Hemorrhoids are common human afflictions known since the dawn of history. Surgical management of this condition has made tremendous progress from complex ligation and excision procedures in the past to simpler techniques that allow the patient to return to normal life within a short period. Newer techniques try to improve on the post-operative complications of older ones. The surgical options for the management of hemorrhoids today are many. Capturing all in a single article may be difficult if not impossible. The aim of this study therefore is to present in a concise form some of the common surgical options in current literature, highlighting some important post operative complications. Current literature is searched using MEDLINE, EMBASE and the Cochrane library. The conclusion is that even though there are many surgical options in the management of hemorrhoids today, most employ the ligature and excision technique with newer ones having reduced post operative pain and bleeding.

Recent trends in management of haemorrhoids

“…1 Many factors have been alleged to be the incidences of hemorrhoidal development, including constipation and prolonged straining. 2 About half of the population of age above 50 years had this clinical problem. They can occur at any age and affects both the sexes.…”

“…In severe conditions the mainstay of treatment was surgery. 2 Operative hemorrhoidectomy is one of the effective method for treating hemorrhoids but it is usually associated with significant postoperative complications, including pain, bleeding, anal stricture and infections. 5 This has therefore stimulated continuing efforts to develop new techniques with less painful course and faster recovery.…”

Stapled haemorrhoidopexy: is it time to move on?

“…It is interesting to note that there is hardly any agreement on what should be the 'ideal' treatment of haemorrhoids 2 despite the fact that mankind has known the disease for centuries and treatment attempts have been recorded as early as 1700BC in Egyptian papyrus. Hippocrates (460BC) suggested intervention that is comparable with the current rubber band ligation, Celcus (25BC-AD14) recommended ligation and excision while Galen (AD131-201) proposed severing the connection of the arteries to the veins.…”

“…Hippocrates (460BC) suggested intervention that is comparable with the current rubber band ligation, Celcus (25BC-AD14) recommended ligation and excision while Galen (AD131-201) proposed severing the connection of the arteries to the veins. 2 The modern era in haemorrhoid treatment was started by the founder of St Mark's Hospital, Fredrick Salmon, in 1888 when he proposed a combination of excision and ligation of haemorrhoids by incising the perianal skin, dissecting the haemorrhoidal plexus with ligation of the haemorrhoid pedicle. Following this, the technique has seen several modifications, including the Ferguson method, the Milligan-Morgan technique and diathermy haemorrhoidectomy, 2 in an attempt to reduce the associated postoperative pain with a limited degree of success.…”

“…2 The modern era in haemorrhoid treatment was started by the founder of St Mark's Hospital, Fredrick Salmon, in 1888 when he proposed a combination of excision and ligation of haemorrhoids by incising the perianal skin, dissecting the haemorrhoidal plexus with ligation of the haemorrhoid pedicle. Following this, the technique has seen several modifications, including the Ferguson method, the Milligan-Morgan technique and diathermy haemorrhoidectomy, 2 in an attempt to reduce the associated postoperative pain with a limited degree of success. 3,4 In 1998 Longo proposed what sounded, at the time, like an ideal solution: a procedure for haemorrhoidectomy with minimal postoperative pain, no perianal wound requiring postoperative wound care and a relatively short operative time.…”