Surgical treatment of hemorrhoidal disease

Abstract

Hemorrhoidal disease (HD) is a condition characterized by enlarged normally present anal cushions or nodules accompanied by clinical symptoms. HD of grade I and II, is primarily treated conservatively with medication (creams and phlebotonics) as well as by office-based procedures, such as rubber band ligation, injection sclerotherapy, infrared coagulation, cryotherapy, and radiofrequency ablation. Indications for a surgical treatment of hemorrhoidal disease are: persistent and recurrent bleeding that does not respond to conservative treatment and office-based interventions, prolapse of hemorrhoids causing significant difficulties and discomfort (Grade III and IV), failure of conservative treatment methods, presence of complications (anemia, infection, or fistula). There are two types of surgical interventions, non-excisional and excisional. The group of non-excisional surgical procedures includes: stapled hemorrhoidopexy, Doppler-guided ligation of hemorrhoidal arteries and laser treatment of hemorrhoids. The group of excisional surgical procedures includes: open (Milligan-Morgan) hemorrhoidectomy, closed (Ferguson’s) hemorrhoidectomy Ligasure and Harmonic hemorrhoidectomy and Park’s hemorrhoidectomy. Non-excisional surgical methods represent potential options in the treatment of stage III hemorrhoids and patients with early stage IV disease. Non-excisional methods are characterized by lower postoperative pain intensity, faster recovery, and fewer postoperative complications, but they are also associated with a significantly higher rate of recurrence.Excisional methods in surgical treatment represent the method of choice for stage IV hemorrhoidal disease. They are characterized by intense postoperative pain and a higher frequency of complications such as bleeding, urinary retention, anal canal stenosis or stricture, and anal incontinence. There is no single best and most effective method for treating hemorrhoids.