Hemorrhoid Surgery Types Explained

In most cases, hemorrhoid symptoms can be relieved by dietary changes and of over-the-counter creams and ointments. However, for some individuals, these treatments are insufficient, requiring procedures to shrink or remove the hemorrhoids.

Types of Hemorrhoid Procedures

Hemorrhoid procedures differ in complexity; non-surgical treatments like hemorrhoid banding, are minimally invasive, do not require anesthesia, and can often be performed in a clinical setting. 

On the other hand, surgical procedures require regional or general anesthesia, but are typically more effective for severe or recurrent hemorrhoids.

Non-Surgical

Types: Hemorrhoid banding, sclerotherapy (injection therapy), and coagulation.

These methods work by cutting off the blood supply to the hemorrhoid, causing it to shrink and eventually fall off. They are associated with less pain and side effects than surgery, but are less effective, with a higher likelihood of recurrence, often requiring multiple treatments. (1)

1. Hemorrhoid Banding:some text
   • Suitable for internal hemorrhoids only.
   • The doctor uses an anoscope to place a small rubber band at the base of the hemorrhoid, cutting off its blood supply. This causes the hemorrhoid to fall off within about a week.
   • If several hemorrhoids are present, you may need repeat treatments every few weeks to address remaining hemorrhoids. (2)

2. Sclerotherapy (Injection Therapy):some text
   • Also performed with an anoscope, where a chemical solution is injected into the hemorrhoid, causing it to gradually shrink.
   • The procedure is done over multiple sessions spaced a few weeks apart. (3)

3. Coagulation:some text
   • Used exclusively for internal hemorrhoids.
   • Techniques like laser, heat, or infrared light are directed at the hemorrhoid, causing it to harden and shrink.
   • This procedure is safe and rarely causes side effects or discomfort but may require multiple sessions to achieve optimal results. (4)

Surgical 

Types: Hemorrhoidectomy, laser hemorrhoid surgery, stapled hemorrhoidopexy, and Doppler-guided hemorrhoid artery ligation (THD).

While non-surgical techniques have advanced significantly and benefit many patients, surgical procedures remain the most effective and lasting option, particularly for:

•  severe internal hemorrhoids.
•  external hemorrhoids.
• recurring cases. 

The primary drawback is post-surgical pain, which can often be managed with prescribed painkillers. (1)

1. Hemorrhoidectomy:some text
   • This is the traditional and most commonly performed surgical method for treating prolapsed hemorrhoids.
   • Hemorrhoids are removed using a scalpel or laser, and the wound is either left open or closed with stitches.
   • Regardless of the technique, most patients experience moderate to severe pain in the anal area for several days, especially during bowel movements and while sitting. Pain relief is typically managed with analgesics. (3)

2. Laser Hemorrhoid Surgery:some text
   • A small incision is made at the base of the hemorrhoid, and laser energy is applied to shrink its size without fully removing it.
   • This technique causes less pain than traditional surgery, leaves no scars, and allows for faster recovery.
   • Limitations: Less effective for large or prolapsed hemorrhoids, with a higher recurrence rate in severe cases compared to other surgical methods. (5)

3. Stapled Hemorrhoidopexy:some text
   • Stapled hemorrhoidopexy focuses on removing a ring of tissue above the hemorrhoids rather than removing the hemorrhoids themselves, then the remaining tissue is stapled back into its normal position inside the anal canal. This reduces blood flow to the hemorrhoids, causing them to shrink.
   • Primarily used for internal hemorrhoids, especially large ones (Grade 3 and 4). 
   • Associated with less pain compared to traditional hemorrhoidectomy.
   • Drawbacks: Higher recurrence rates, with about 9 in 100 patients experiencing recurrence compared to 3 in 100 after traditional surgery. (3)

4. Doppler-Guided Hemorrhoid Artery Ligation (THD):some text
   • The latest surgical technique for treating internal hemorrhoids.
   • The surgeon uses a Doppler device to locate the arteries supplying blood to the hemorrhoids and ties them off, reducing blood flow and repositioning the prolapsed hemorrhoids.
   • The procedure takes about 30 minutes, is performed in a less pain-sensitive area, and results in less pain compared to traditional surgery. Patients can usually return home the same day. (6)

Summary

The table below highlights key differences between various hemorrhoid procedures: (3)

Choose the general surgery department at Dr. Soliman Fakeeh Hospital for Hemorrhoid Treatment:

1. Exceptional Medical Team: Our team includes highly skilled surgeons with extensive experience in diagnosing and treating hemorrhoids.
2. Advanced Techniques: We utilize cutting-edge surgical methods to ensure safe and effective results.
3. Comprehensive Care: From precise diagnosis to recovery, we provide holistic patient care.
4. Academic Medical Center: As part of an academic medical facility, we have access to the latest research and medical advancements.
5. Patient-Centric Experience: We focus on providing a comfortable and seamless patient experience for swift recovery.

References

1. Cleveland Clinic - Hemorrhoids: The Definitive Guide to Medical and Surgical Treatment
2. Mayo Clinic - Hemorrhoids
3. NIH NLM - Enlarged hemorrhoids: Learn More – What surgical procedures can be used to treat hemorrhoids?
4. The American Society of Colon and Rectal Surgeons - Hemorrhoids
5. NIH - Laser hemorrhoidoplasty in the treatment of symptomatic hemorrhoids: a pilot Australian study
6. THD - THD® Doppler Method