Ultimate Info on Surgery for Hemorrhoids


This page will review , in detail, the current interventions which become necessary when hemorrhoids do not respond to simple remedies and self-care.
Although this page is entitled "SURGERY", we also discuss here physician - directed , non surgical treatments for bothersome hemorrhoids :

  • (Scalpel) Hemorrhoidectomy

    This type of work is reserved for 4th degree hemorrhoids and some 3rd degree hemorrhoids (both involve prolapse).
    There is a trend away from this type of intervention because of the post operative pain encountered, post op complications and the more lengthy recovery time. Severe symptoms / intractable hemorrhoid problems will continue to warrant its use.
    We can see borderline situations, however, in which combination medical therapy/non surgical hemorrhoid destruction can be an option for patients who do not this kind of management. This issue deserves further discussion, and the advice of your surgeon will be highly influenced by his/her skills in surgical and non surgical approaches.

  • Hemorrhoid Stapling

    Gaining in popularity, this treatment has been well studied (see info in the NEWS section), involves minimal postoperative pain and leads to timely healing. Complications are rare in good hands, BUT MUST BE CONSIDERED WHEN CONTEMPLATING USING THIS TECHNIQUE.
    "The surgery is done with a stapling device, manufactured by Ethicon Endo-Surgery, which has been approved by the Food and Drug Administration. The procedure returns the dilated veins to their normal location and staples them in place, which eliminates symptoms such as bleeding, protrusion and itching. The stapling occurs inside the rectum, where there are no sensory nerves, whereas the traditional hemorrhoidectomy leaves up to three wounds in the highly sensitive area around the anus."
    (A quote from UIC News tips 8/2001).
    Also check out info at The Colorado Center for Colon and Rectal Surgery.

    Ethicon Endo-Surgery, Inc. (makers of Hemorrhoid Stapling equipment)

    Potential Risks of Stapled Hemorrhoidectomy (with a list of important questions for a potential hemorrhoid surgeon)

  • Rubber Banding of Hemorrhoids

    Another form of treatment usually for internal hemorrhoids, involves encircling the base of the hemorrhoids with a tight rubber band (special device used). The banded hemorrhoids simply die, fall off an the area heals. Complication rate is low and it is an office procedure. It is also becoming a popular modality when hemorrhoids have not become too severe.
    See the ILLUSTRATION of the procedure at Dr Joseph F. Smith Medical Library.

  • Hemorrhoid Artery Ligation

    This is a Doppler-guided procedure which does not have much presence on the Internet but will likely become better known. It is not new. Instead of destroying the internal hemorrhoids (those too large for rubber banding) you take a way the arterial perfusion that supplies them. It appears to be a safe procedure with minor discomfort.
    An often cited Reference for a clinical study of "HAL" :
    (A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter.) Am J Gastroenterol 1995 Apr;90(4):610-3 (ISSN: 0002-9270) Morinaga K; Hasuda K; Ikeda T Department of Surgery, Saiseikai Karatsu Hospital, Saga, Japan.

  • Infrared Coagulation

    Infrared coagulation (IRC), also called photocoagulation,involves use of a hand-held applicator which emits pulses of infrared radiation. High intensity light from a tungsten-halogen source is reflected from a 24-karat gold surface through a solid quartz column to a special contact tip of sapphire or teflon. The infrared pulses destroy the hemorrhoid at its base, taking away blood flow to the hemorrhoid and securing it to the rectal lining to keep it from prolapsing. The destroyed hemorrhoidal tissue sloughs off with healing , leaving a small scar in its place.
    Although the patient may occasionally feel a little warmth in the treated area, generally minimal pain or discomfort is experienced using infrared coagulation to treat hemorrhoids.
    IRC is indicated for first and second degree hemorrhoids as an alternative to rubber banding.
    Multiple hemorrhoids typically require a few repeated visits, treating a limited area each time. Some mild post procedure bleeding can occur days following the procedure.
    There has been comment in literature we reviewed to suggest that hemorrhoid recurrences may be more likely with IRC as compared to Rubber Banding. No formal studies have yet been seen to confirm this

  • Bipolar Electrosurgery (Bicap)


  • Botox Injections (anal sphincter treatment)


  • Sclerotherapy (injection technique)


    The injection of chemicals into veins to make them "sclerose" and shrink has been around for along time, and is still a fairly popular alternative for varicose veins, which are bulging veins just like hemorrhoids.
    It is not a popular therapy at this time , however, except in cases where risk for bleeding is an issue. The following comments come from an E-mail Listserve commication by Paul Shelito , M.D. regarding a patient with hemorrhoids, cirrhosis of the liver and bleeding risk :
    "Subject: Re: hemorrhoidal bleeding in portal hypertension .
    He probably does have cirrhosis, and hemorrhoidectomy might be a disaster. Also, oversewing or rubber band ligation in this situation can be complicated by very troublesome secondary hemorrhage. This is one of the rare situations when I think injection sclerosis is safest. I use 1/2 to 1 cc of sodium morrhuate injected via a retroflexed sigmoidoscope, placed just above the dentate line in each of the hemorrhoids you can see. Paul C. Shellito Dept. of Surgery Massachusetts General Hospital Boston, MA.

    Two of the more popular sclerosing agents at this time are ethanolamine and 5% sodium morrhuate . Feedback from our readers regarding sclerosing therapy would be most welcome.

  • Cryotherapy (freezing destruction)

    (not to be confused with cooling remedies like Anurex)

    Hypercooling destruction of hemorrhoids has gained disfavor in the United States because of post op complications. It is interesting that an East Indian study in cited in a 1998 journal article cited favorable results :
    J Indian Med Assoc 1998 Jan;96(1):16-8 (ISSN: 0019-5847) Singh DJ Department of Surgery, Military Hospital, Jodhpur.
    "Cryotherapy is one of the available modalities for the management of primary haemorrhoids. It is a simple non-invasive procedure conducted without anaesthesia, ideal for surgery outpatients' department. Though practically given up in the west due to a distressing side-effect in the local population, it was evaluated for its efficacy and acceptability in the Indian population. The study of 174 patients revealed the procedure to be well accepted, extremely cost effective and with a low complication rate in the Indian population, in contrast to the western experience."

    One wonders if the Indian population is simply more tolerant of post procedure problems. Here is an example of needing to know MUCH more detail regarding the design, execution, monitoring and follow up interviewing method involved in this study.

    An E-mail was received from Darrell Stoddard, Founder Pain Research Institute, who comments on a very positive experience with NEEDLE-INJECTED Cryotherapy :
    " Dear Friends at Well News, Surgery etc., You asked for more information regarding "Cryohemorrhoidectomy."
    What follows is not just freezing the hemorrhoid with liquid nitrogen but in China is called "Cryoneedlehemorrhoidectomy." A needle cooled with liquid nitrogen is injected into the hemorrhoid and the hemorrhoid dies from the inside out."

    See a more detailed discussion of personal experience with this modality at http://healpain.net/articles/bey-acu.html


    Back to previous page.....

    "Home" page.

    Back to Geocities.

    Shortsville Family Health Center
    md_duba@yahoo.com