Hemorrhoids pp 103-111 | Cite as

Critical Aspects of Modern Surgical Approach to Hemorrhoids

  • Jean-Luc Faucheron
  • Bertrand Trilling
  • Pierre-Yves Sage
Reference work entry
Part of the Coloproctology book series (COLOPROCT, volume 2)


Debate still continues in 2017 as to which is the best surgical procedure for the treatment of symptomatic hemorrhoids. Hemorrhoidectomy, first published by Milligan and Morgan, has been the only surgical treatment for hemorrhoids during nearly 50 years and is still considered as the main option. However, this “conventional” hemorrhoidectomy is associated with significant postoperative pain, perianal discharge, irritation, and late complications such as anal incontinence and stenosis.

In an effort to decrease postoperative complications and to better respond to hemorrhoids pathophysiology, several procedures have emerged in the end of the twentieth century and can be considered as modern surgical approach to hemorrhoids.

These procedures are thermofusion hemorrhoidectomy, Doppler-guided hemorrhoidal artery ligation, suture ligation and mucopexy without Doppler guidance, stapled hemorrhoidopexy, and embolization. In summary, the less painful the procedure, the more likely it is to be associated with recurrence, so that there is not a “one-size-fits-all” option.

The aim of this chapter is to present the technique, advantages, drawbacks, and results of all these procedures, based on a recent review of the literature and our personal experience. The main question when facing a patient with hemorrhoids should be: which surgical options for which patients and which hemorrhoids…


Hemorrhoids Hemorroidectomy Hemorrhoidopexy Anopexy Hal-RAR DGHAL Anal mucopexy Embolization 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Jean-Luc Faucheron
    • 1
    • 2
  • Bertrand Trilling
    • 1
    • 2
  • Pierre-Yves Sage
    • 1
  1. 1.Colorectal Unit, Department of SurgeryGrenoble University HospitalGrenobleFrance
  2. 2.University Grenoble AlpesGrenobleFrance

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