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==Overview==
==Overview==
Surgery is not the first-line treatment option for patients with hemorrhoids. Surgical intervention is usually reserved for patients with either complicated or large hemorrhoids (beyond grade III).


==Surgery==
==Surgery==
Some people require the following medical treatments for [[chronic]] or severe hemorrhoids:


Some people require the following medical treatments for chronic or severe hemorrhoids:
=== Rubber band ligation ===
;Rubber band ligation
:* [[Rubber band ligation]] is sometimes called Baron ligation.  
: sometimes called Baron ligation. Elastic bands are applied onto an internal hemorrhoid to cut off its blood supply.<ref name="pmid16412076">{{cite journal |author=Longman RJ, Thomson WH |title=A prospective study of outcome from rubber band ligation of piles |journal=Colorectal Dis |volume=8 |issue=2 |pages=145–8 |year=2006 |pmid=16412076 |doi=10.1111/j.1463-1318.2005.00873.x}}</ref> Within several days, the withered hemorrhoid is sloughed off during normal bowel movement.
:* Elastic bands are applied onto an internal hemorrhoid to cut off its blood supply.<ref name="pmid16412076">{{cite journal |author=Longman RJ, Thomson WH |title=A prospective study of outcome from rubber band ligation of piles |journal=Colorectal Dis |volume=8 |issue=2 |pages=145–8 |year=2006 |pmid=16412076 |doi=10.1111/j.1463-1318.2005.00873.x}}</ref>  
;Hemorrhoidolysis/Galvanic Electrotherapy
:* Within several days, the withered hemorrhoid is sloughed off during a normal bowel movement.
: desiccation of the hemorrhoid by electrical current.<ref name="pmid1568400">{{cite journal |vauthors=Bleday R, Pena JP, Rothenberger DA, Goldberg SM, Buls JG |title=Symptomatic hemorrhoids: current incidence and complications of operative therapy |journal=Dis. Colon Rectum |volume=35 |issue=5 |pages=477–81 |year=1992 |pmid=1568400 |doi= |url=}}</ref>
{{#ev:youtube|z2hqoeS0oXA}}
;Sclerotherapy (injection therapy)
{{#ev:youtube|GSKUNFqNY8w}}
: sclerosant or hardening agent is injected into hemorrhoids. This causes the vein walls to collapse and the hemorrhoids to shrivel up.
;Cryosurgery
: a frozen tip of a cryoprobe is used to destroy hemorrhoidal tissues.<ref name="pmid6979469">{{cite journal |author=MacLeod JH |title=In defense of cryotherapy for hemorrhoids. A modified method |journal=Dis. Colon Rectum |volume=25 |issue=4 |pages=332–5 |year=1982 |pmid=6979469 |doi=}}</ref> Rarely used anymore because of side effects.
;Laser, infrared or BICAP coagulation
: [[laser]], infrared beam, or [[electricity]] is used to cauterize the affected tissues. Lasers are now much less popular. Infrared coagulation has been studied in comparison with RBL and found to be as effective in hemorrhoids up to grade III.  These are the most readily available non-surgical procedures in the US.<ref name="pmid15486746">{{cite journal |vauthors=Greenspon J, Williams SB, Young HA, Orkin BA |title=Thrombosed external hemorrhoids: outcome after conservative or surgical management |journal=Dis. Colon Rectum |volume=47 |issue=9 |pages=1493–8 |year=2004 |pmid=15486746 |doi=10.1007/s10350-004-0607-y |url=}}</ref>
;Hemorrhoidectomy
: a true surgical procedure to excise and remove hemorrhoids.  Has possible correlation with incontinence issues later in life; in addition, many patients complain that pain during recovery is severe.  For this reason is often now recommended only for severe (grade IV) hemorrhoids.
;Stapled Hemorrhoidectomy
: Also called the procedure for prolapse and hemorrhoids, it is designed to resect soft tissue proximal to the dentate line, which disrupts the blood flow to the hemorrhoids. It is generally less painful than complete removal of hemorrhoids and also allows for faster recovery times. It's meant for hemorrhoids that fall out or bleed and is not helpful for painful outside conditions.<ref name="pmid17380367">{{cite journal |vauthors=Tjandra JJ, Chan MK |title=Systematic review on the procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy) |journal=Dis. Colon Rectum |volume=50 |issue=6 |pages=878–92 |year=2007 |pmid=17380367 |doi=10.1007/s10350-006-0852-3 |url=}}</ref>
;Enema
: This Practice is used to clean the rectum.  While it is a simple procedure, it can be complicated by hemorrhoids, so in such cases, it should be done by a doctor. In an enema, water is injected into the rectum and then flushed out, cleaning the area.
;Doppler Guided Hemorrhoidal Artery Ligation
: The only evidence based surgery for all grades of hemorrhoids. It does not involve cutting tissues or even a stay at the hospital; patients are usually back to work on the same day. It is the best treatment for bleeding piles, as the bleeding stops immediately. <ref name="pmid16399113">{{cite journal |author=Scheyer M, Antonietti E, Rollinger G, Mall H, Arnold S |title=Doppler-guided hemorrhoidal artery ligation |journal=Am. J. Surg. |volume=191 |issue=1 |pages=89–93 |year=2006 |pmid=16399113 |doi=10.1016/j.amjsurg.2005.10.007}}</ref>
;RectoAnal Repair : Also known as mucopexy or mucosal lifting is used for managing prolapse of mucosa or hemorrhoids


=== Hemorrhoidolysis/Galvanic Electrotherapy ===
:* [[Hemorrhoidolysis/Galvanic Electrotherapy|Hemorrhoidolysis]] means desiccation of the hemorrhoid by electrical current.<ref name="pmid1568400">{{cite journal |vauthors=Bleday R, Pena JP, Rothenberger DA, Goldberg SM, Buls JG |title=Symptomatic hemorrhoids: current incidence and complications of operative therapy |journal=Dis. Colon Rectum |volume=35 |issue=5 |pages=477–81 |year=1992 |pmid=1568400 |doi= |url=}}</ref>
===Sclerotherapy (injection therapy)===
:* The idea behind [[sclerotherapy]] is that a sclerosant or hardening agent is injected into the hemorrhoids. This causes the [[vein]] walls to collapse and the hemorrhoids to shrivel up.
{{#ev:youtube|tHEboifBEfI}}
{{#ev:youtube|QAvKl2P0Ou0}}
=== Cryosurgery ===
:* During [[cryotherapy]], a frozen tip of a cryoprobe is used to destroy hemorrhoidal tissues.<ref name="pmid6979469">{{cite journal |author=MacLeod JH |title=In defense of cryotherapy for hemorrhoids. A modified method |journal=Dis. Colon Rectum |volume=25 |issue=4 |pages=332–5 |year=1982 |pmid=6979469 |doi=}}</ref>
:* Rarely used currently because of side effects.
=== Laser, infrared, or BICAP coagulation ===
:* [[Laser]], infrared beam, or [[electricity]] is used to cauterize the affected tissues.
:* Lasers are now much less popular.
:* Infrared coagulation has been studied in comparison with RBL and found to be as effective in hemorrhoids up to grade III. 
:* These are the most readily available non-surgical procedures in the US.<ref name="pmid15486746">{{cite journal |vauthors=Greenspon J, Williams SB, Young HA, Orkin BA |title=Thrombosed external hemorrhoids: outcome after conservative or surgical management |journal=Dis. Colon Rectum |volume=47 |issue=9 |pages=1493–8 |year=2004 |pmid=15486746 |doi=10.1007/s10350-004-0607-y |url=}}</ref>
{{#ev:youtube|0aNTFMQrthE}}
{{#ev:youtube|c-YqCJLz5-Y}}
=== Hemorrhoidectomy ===
:* [[Hemorrhoidectomy]] is a true surgical procedure to excise and remove hemorrhoids.
:* [[Hemorrhoidectomy]] has a possible correlation with incontinence issues later in life and many patients complain that pain during recovery is severe. For these reasons, it is often now recommended only for severe (grade IV) hemorrhoids.
{{#ev:youtube|fQ18G5WIo-0}}
{{#ev:youtube|iil3jeRiLrw}}
=== Stapled Hemorrhoidectomy ===
:* Also called the procedure for [[prolapse]] and hemorrhoids, it is designed to resect soft tissue proximal to the dentate line, which disrupts the [[blood flow]] to the hemorrhoids.
:* It is generally less painful than complete removal of hemorrhoids and allows for a faster recovery time. The procedure is meant for hemorrhoids that fall out or bleed and is not helpful for painful outside conditions.<ref name="pmid17380367">{{cite journal |vauthors=Tjandra JJ, Chan MK |title=Systematic review on the procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy) |journal=Dis. Colon Rectum |volume=50 |issue=6 |pages=878–92 |year=2007 |pmid=17380367 |doi=10.1007/s10350-006-0852-3 |url=}}</ref>
{{#ev:youtube|Xv2y8XtGCCY}}
=== Doppler Guided Hemorrhoidal Artery Ligation ===
:* The only evidence-based surgery for all grades of hemorrhoids.
:* It does not involve cutting tissues or even a stay at the hospital; patients are usually back to work on the same day.
:* It is the best treatment for bleeding piles, as the bleeding stops immediately.<ref name="pmid16399113">{{cite journal |author=Scheyer M, Antonietti E, Rollinger G, Mall H, Arnold S |title=Doppler-guided hemorrhoidal artery ligation |journal=Am. J. Surg. |volume=191 |issue=1 |pages=89–93 |year=2006 |pmid=16399113 |doi=10.1016/j.amjsurg.2005.10.007}}</ref>
{{#ev:youtube|TLM_FSw_DME}}
=== Recto-anal Repair  ===
:* It is also known as mucopexy or mucosal lifting. The procedure is used for managing [[prolapse]] of [[mucosa]] or hemorrhoids.
{{#ev:youtube|LcBU_Xf0C9k}}
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}


[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Surgery]]
[[Category:Surgery]]
[[Category:Primary care]]
[[Category:Needs overview]]
[[Category:Needs overview]]
{{WH}}
{{WS}}

Latest revision as of 22:04, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]

Overview

Surgery is not the first-line treatment option for patients with hemorrhoids. Surgical intervention is usually reserved for patients with either complicated or large hemorrhoids (beyond grade III).

Surgery

Some people require the following medical treatments for chronic or severe hemorrhoids:

Rubber band ligation

  • Rubber band ligation is sometimes called Baron ligation.
  • Elastic bands are applied onto an internal hemorrhoid to cut off its blood supply.[1]
  • Within several days, the withered hemorrhoid is sloughed off during a normal bowel movement.

{{#ev:youtube|z2hqoeS0oXA}} {{#ev:youtube|GSKUNFqNY8w}}

Hemorrhoidolysis/Galvanic Electrotherapy

Sclerotherapy (injection therapy)

  • The idea behind sclerotherapy is that a sclerosant or hardening agent is injected into the hemorrhoids. This causes the vein walls to collapse and the hemorrhoids to shrivel up.

{{#ev:youtube|tHEboifBEfI}} {{#ev:youtube|QAvKl2P0Ou0}}

Cryosurgery

  • During cryotherapy, a frozen tip of a cryoprobe is used to destroy hemorrhoidal tissues.[3]
  • Rarely used currently because of side effects.

Laser, infrared, or BICAP coagulation

  • Laser, infrared beam, or electricity is used to cauterize the affected tissues.
  • Lasers are now much less popular.
  • Infrared coagulation has been studied in comparison with RBL and found to be as effective in hemorrhoids up to grade III.
  • These are the most readily available non-surgical procedures in the US.[4]

{{#ev:youtube|0aNTFMQrthE}} {{#ev:youtube|c-YqCJLz5-Y}}

Hemorrhoidectomy

  • Hemorrhoidectomy is a true surgical procedure to excise and remove hemorrhoids.
  • Hemorrhoidectomy has a possible correlation with incontinence issues later in life and many patients complain that pain during recovery is severe. For these reasons, it is often now recommended only for severe (grade IV) hemorrhoids.

{{#ev:youtube|fQ18G5WIo-0}} {{#ev:youtube|iil3jeRiLrw}}

Stapled Hemorrhoidectomy

  • Also called the procedure for prolapse and hemorrhoids, it is designed to resect soft tissue proximal to the dentate line, which disrupts the blood flow to the hemorrhoids.
  • It is generally less painful than complete removal of hemorrhoids and allows for a faster recovery time. The procedure is meant for hemorrhoids that fall out or bleed and is not helpful for painful outside conditions.[5]

{{#ev:youtube|Xv2y8XtGCCY}}

Doppler Guided Hemorrhoidal Artery Ligation

  • The only evidence-based surgery for all grades of hemorrhoids.
  • It does not involve cutting tissues or even a stay at the hospital; patients are usually back to work on the same day.
  • It is the best treatment for bleeding piles, as the bleeding stops immediately.[6]

{{#ev:youtube|TLM_FSw_DME}}

Recto-anal Repair

  • It is also known as mucopexy or mucosal lifting. The procedure is used for managing prolapse of mucosa or hemorrhoids.

{{#ev:youtube|LcBU_Xf0C9k}}

References

  1. ↑ Longman RJ, Thomson WH (2006). "A prospective study of outcome from rubber band ligation of piles". Colorectal Dis. 8 (2): 145–8. doi:10.1111/j.1463-1318.2005.00873.x. PMID 16412076.
  2. ↑ Bleday R, Pena JP, Rothenberger DA, Goldberg SM, Buls JG (1992). "Symptomatic hemorrhoids: current incidence and complications of operative therapy". Dis. Colon Rectum. 35 (5): 477–81. PMID 1568400.
  3. ↑ MacLeod JH (1982). "In defense of cryotherapy for hemorrhoids. A modified method". Dis. Colon Rectum. 25 (4): 332–5. PMID 6979469.
  4. ↑ Greenspon J, Williams SB, Young HA, Orkin BA (2004). "Thrombosed external hemorrhoids: outcome after conservative or surgical management". Dis. Colon Rectum. 47 (9): 1493–8. doi:10.1007/s10350-004-0607-y. PMID 15486746.
  5. ↑ Tjandra JJ, Chan MK (2007). "Systematic review on the procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy)". Dis. Colon Rectum. 50 (6): 878–92. doi:10.1007/s10350-006-0852-3. PMID 17380367.
  6. ↑ Scheyer M, Antonietti E, Rollinger G, Mall H, Arnold S (2006). "Doppler-guided hemorrhoidal artery ligation". Am. J. Surg. 191 (1): 89–93. doi:10.1016/j.amjsurg.2005.10.007. PMID 16399113.

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