Abstract
IntroductionSurgical treatment of hemorrhoids is still a dilemma. New techniques have been developed leading to a lower rate of postoperative pain; however, they are associated with a greater likelihood of recurrence.AimTo review current indications as well as the results and complications of the main techniques currently used in the surgical treatment of hemorrhoidal disease.MethodsA systematic search of the published data on the options for treatment of hemorrhoids up to December 2012 was conducted using Medline/PubMed, Cochrane, and UpToDate.ResultsCurrently available surgical treatment options include procedure for prolapse and hemorrhoids (PPH), transanal hemorrhoidal dearterialization (THD), and conventional hemorrhoidectomy techniques. Excisional techniques showed similar results regarding pain, time to return to normal activities, and complication rates. PPH and THD were associated with less postoperative pain and lower complication rates; however, both had higher postoperative recurrence rates.ConclusionConventional surgical techniques yield better long-term results. Despite good results in the immediate postoperative period, PPH and THD have not shown consistent long-term favorable results.
Highlights
Hemorrhoidal disease is a common disorder, affecting 4% of the world population
This study aimed to review current indications as well as the results and complications of the main techniques currently used in the surgical treatment of hemorrhoidal disease
Hemorrhoidectomy remains the treatment of choice and the gold standard for most cases
Summary
Hemorrhoidal disease is a common disorder, affecting 4% of the world population. The most widely accepted theory attributes this disorder to the prolapse of the anal cushions. Hemorrhoids are not varicose veins, but rather vascular cushions composed of fibroelastic tissue, muscle fibers, and vascular plexuses with arteriovenous anastomoses. Hemorrhoids may be internal, external or mixed. Internal hemorrhoids are classified by the degree of prolapse of the anal canal. External may be classified as acute (hemorrhoidal thrombosis) or chronic (anal skin tags). Patients with hemorrhoids often seek treatment because of painless bleeding, prolapse, pain associated with hemorrhoidal thrombosis or itching. Conservative medical treatment, which is initially indicated in most cases, includes increased dietary fiber and fluid intake and use of topical agents. When there is no initial clinical improvement, more invasive treatment methods are warranted, such as rubber band ligation, infrared coagulation and sclerotherapy
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