Surgical treatment for hemorrhoids is indicated to patients who fail conservative or nonoperative methods. Most of the patients are referred to surgery, because of extreme conditions, such as – large prolapsed hemorrhoids, thrombosed hemorrhoids or excessive bleeding, which can lead to anemia. If you don’t have any of these problems, then you shouldn’t opt for surgical treatment. The good news is that under 10% of the patients would require operative treatment for hemorrhoids. Surgical treatment consists of several procedures as follow: hemorrhoidectomy, stapled hemorrhoidopexy (PPH) and doppler-guided artery ligation (DG-HAL or THD).
The gold standard
Surgical hemorrhoidectomy is an old procedure, but it’s still regarded as the gold standard in surgical treatment of hemorrhoids. Clinical trials have shown that hemorrhoidectomy is very effective (in above 95% of the cases) and recurrences in the long-term are rare (less than 5%). However, postoperative pain remains a major complication for both the patient and the surgeon alike. Most patients require 4-6 weeks before returning to normal activities. That’s why surgical hemorrhoidectomy is only indicated in severe cases, such as:
- Grade III or IV hemorrhoids with excessive bleeding and other chronic symptoms;
- Presence of another anorectal condition (anal fissure or fistula);
- Painful thrombosed internal hemorrhoids;
- Patient preference.
There are several modifications of excisional hemorrhoidectomy, but we will only list the most used ones: the Milligan-Morgan (open) hemorrhoidectomy, the Ferguson (closed) hemorrhoidectomy and the Whitehead (circumferential) technique.