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Surgical treatment of hemorrhoidal disease

David E Rivadeneira, MD, MBA, FACS, FASCRS
Scott R Steele, MD, FACS, FASCRS
Section Editor
Martin Weiser, MD
Deputy Editor
Wenliang Chen, MD, PhD


Hemorrhoids are normal vascular structures in the anal canal. Approximately 5 percent of the general population is affected by symptoms related to hemorrhoidal disease [1]. The cardinal features of hemorrhoidal disease include bleeding, anal pruritus, prolapse, difficulty with hygiene, and pain due to thrombosis. Although these symptoms may strongly suggest the diagnosis, confirmation by flexible sigmoidoscopy, anoscopy, or colonoscopy should be performed in most patients who present with bleeding, especially those deemed at higher risk for malignancy or additional symptoms (ie, weight loss, changes in bowel habits).

This topic will review common surgical techniques used to treat hemorrhoids. The anatomy and clinical features of hemorrhoids, and nonsurgical treatment options are discussed separately. (See "Hemorrhoids: Clinical manifestations and diagnosis" and "Home and office treatment of symptomatic hemorrhoids".)


The initial approach to treating most patients with hemorrhoids is conservative. Patients who fail medical management may be candidates for a nonsurgical office-based procedure prior to requiring surgical treatment. Ongoing symptoms in spite of conservative or office-based treatment usually require surgical intervention. (See "Home and office treatment of symptomatic hemorrhoids", section on 'Conservative treatment for all patients'.)

Surgical excision of hemorrhoids remains a very effective approach for treatment of symptomatic hemorrhoids but is reserved for selected patients [2]. A formal hemorrhoidectomy in appropriately-selected patients can resolve the patient's symptoms and minimizes recurrent disease when performed properly. Patients with grade III or IV hemorrhoids, and those with severe external disease, appear to benefit the most from surgery. Patients who are unable to tolerate office-based procedures due to significant comorbidities or taking anticoagulation medication would also benefit from an excisional hemorrhoidectomy. Some patients may prefer surgical treatment sooner rather than later, after a frank discussion of other treatment options, and benefits and risks of surgery. (See "Hemorrhoids: Clinical manifestations and diagnosis", section on 'Classification' and "Home and office treatment of symptomatic hemorrhoids".)

A surgical procedure is generally limited to those with the following clinical conditions [3]:

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Literature review current through: Nov 2017. | This topic last updated: Nov 14, 2016.
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