• Terrah J. Paul OlsonEmail author
  • Gregory D. Kennedy


Hemorrhoids, the mucosal vascular cushions in the anal canal, can lead to pain and bleeding when they become enlarged, prolapsed, or thrombosed. The locations of hemorrhoids are discussed, along with pertinent elements of the history and physical. Differences between the four degrees of hemorrhoids are also described. Preoperative preparation and positioning is outlined, including preoperative bowel preparation. The various methods for hemorrhoidectomy are described. Non-surgical procedures include injection of sclerosing agents, photocoagulation, and rubber-band ligation. Currently rubber-band ligation is the preferred non-excisional procedure. Various excisional techniques for hemorrhoidectomy exist, including open Milligan-Morgan procedure, closed Ferguson hemorrhoidectomy, excision with tissue sealing devices (Ligasure or Harmonic Scalpel), stapled hemorrhoidopexy, and transanal hemorrhoidal dearterialization. Additional study of long-term results of vessel sealing device hemorrhoidectomy, stapled hemorrhoidopexy and transanal hemorrhoidal dearterialization are needed to definitively say whether these are improvements on the traditional open or closed hemorrhoidectomies. Postoperative management including pain control, wound care, and bowel regimen is discussed.


Hemorrhoidectomy Degrees of hemorrhoids Non-surgical management of hemorrhoids Outcomes of excisional hemorrhoidectomy Stapled hemorrhoidopexy Transanal hemorrhoidal dearterialization 


  1. 1.
    Digestive Diseases Statistics. NDDIC. NIDDK. NIH Publication No. 13–3873. Sept 2013. Accessed 20 May 2014.
  2. 2.
    Brunicardi FC, et al., editors. Schwartz’s principles of surgery. 9th ed. Columbus: The McGraw-Hill Companies, Inc; 2010.Google Scholar
  3. 3.
    Kaidar-Person O, Person B, Wexner SD. Hemorrhoidal disease: a comprehensive review. J Am Coll Surg. 2007;204(1):102–17.CrossRefPubMedGoogle Scholar
  4. 4.
    Townsend CM, et al., editors. Sabiston textbook of surgery: the biological basis of modern surgical practice. 19th ed. Philadelphia: Elsevier Saunders; 2012.Google Scholar
  5. 5.
    Alonso-Coello P, Guyatt GH, Heels-Ansdell D, et al. Laxatives for the treatment of hemorrhoids. Cochrane Database Syst Rev. 2005;(4):CD004649. doi: 10.1002/14651858.CD004649.pub2. Edited, no change to conclusions, published Issue 4, 2008.
  6. 6.
    Fischer JE, et al., editors. Fischer’s mastery of surgery. 6th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2011. p. 1616–20.Google Scholar
  7. 7.
    ASGE Technology Committee. Devices for the endoscopic treatment of hemorrhoids. Gastrointest Endosc. 2014;79(1):8–14.CrossRefGoogle Scholar
  8. 8.
    Giamundo P, Salfi R, Geraci M, et al. The hemorrhoid laser procedure technique vs rubber band ligation: a randomized trial comparing two mini-invasive treatments for second- and third-degree hemorrhoids. Dis Colon Rectum. 2011;54(6):693–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Shanmugam V, Hakeem A, Campbell KL, et al. Rubber band ligation versus excisional haemorrhoidectomy for haemorrhoids. Cochrane Database Syst Rev. 2005;(1):CD005034. doi: 10.1002/14651858.CD005034.pub2. Edited, no change to conclusions, published Issue 3, 2011.
  10. 10.
    Johanson JF, Rimm A. Optimal nonsurgical treatment of hemorrhoids: a comparative analysis of infrared coagulation, rubber band ligation, and injection sclerotherapy. Am J Gastroenterol. 1992;87:1600–6.PubMedGoogle Scholar
  11. 11.
    Nienhuijs SW, de Hingh IHJT. Conventional versus LigaSure hemorrhoidectomy for patients with symptomatic hemorrhoids. Cochrane Database Syst Rev. 2009;(1):CD006761. doi: 10.1002/14651858.CD006761.pub2. Edited, no change to conclusions, published Issue 7, 2011.
  12. 12.
    Khan S, Pawlak SE, Eggenberger JC, et al. Surgical treatment of hemorrhoids: prospective, randomized trial comparing closed excisional hemorrhoidectomy and the Harmonic Scalpel technique of excisional hemorrhoidectomy. Dis Colon Rectum. 2001;44(6):845–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Chung CC, HA JP, Tai YP, et al. Double-blind, randomized trial comparing Harmonic Scalpel hemorrhoidectomy, bipolar scissors hemorrhoidectomy, and scissors excision: ligation technique. Dis Colon Rectum. 2002;45:789–94.CrossRefPubMedGoogle Scholar
  14. 14.
    Chen H-L, Woo X-B, Cui J, et al. Ligasure versus stapled hemorrhoidectomy in the treatment of hemorrhoids: a meta-analysis of randomized control trials. Surg Laparosc Endosc Percutan Tech. 2014;24(4):285–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Lumb KJ, Colquhoun PH, Malthaner R, Jayaraman S. Stapled versus conventional surgery for hemorrhoids. Cochrane Database Syst Rev. 2006;(4):CD005393. doi: 10.1002/14651858.CD005393.pub2. Edited, no change to conclusions, published Issue 9, 2010.
  16. 16.
    Ratto C. THD Doppler procedure for hemorrhoids: the surgical technique. Tech Coloproctol. 2014;18:291–8.PubMedCentralCrossRefPubMedGoogle Scholar
  17. 17.
    Giordano P, Overton J, Madeddu F, et al. Transanal hemorrhoidal dearterialization: a systematic review. Dis Colon Rectum. 2009;52(9):1665–71.CrossRefPubMedGoogle Scholar
  18. 18.
    De Nardi P, Capretti G, Corsaro A, Staudacher C. A prospective, randomized trial comparing the short- and long-term results of Doppler-guided transanal hemorrhoid dearterialization with mucopexy versus excision hemorrhoidectomy for grade III hemorrhoids. Dis Colon Rectum. 2014;57:348–53.CrossRefPubMedGoogle Scholar
  19. 19.
    Elmer SE, Nygren JO, Lenander CE. A randomized trial of transanal hemorrhoidal dearterialization with anopexy compared with open hemorrhoidectomy in the treatment of hemorrhoids. Dis Colon Rectum. 2013;56:484–90.CrossRefPubMedGoogle Scholar
  20. 20.
    Zampieri Z, Castellani R, Andreoli R, Geccherle A. Long-term results and quality of life in patients treated with hemorrhoidectomy using two different techniques: Ligasure versus transanal hemorrhoidal dearterialization. Am J Surg. 2012;204:684–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of General SurgeryUniversity of Wisconsin Hospital and ClinicsMadisonUSA
  2. 2.Department of SurgeryUniversity of Alabama at BirminghamBirminghamUSA

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