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World J Gastroenterol. Dec 7, 2014; 20(45): 16976-16983
Published online Dec 7, 2014. doi: 10.3748/wjg.v20.i45.16976
Hemorrhoidectomy - making sense of the surgical options
Danson Yeo, Kok-Yang Tan
Danson Yeo, Kok-Yang Tan, Department of Surgery, Alexandra Health, Khoo Teck Puat Hospital, Singapore 768828, Singapore
Author contributions: Yeo D and Tan KY equally contributed to this paper.
Correspondence to: Kok-Yang Tan, MBBS (Melb), MMed (Surg), FRCS, FAMS, Department of Surgery, Alexandra Health, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore. kokyangtan@gmail.com
Telephone: +65-6-5558000 Fax: +65-6-6023700
Received: March 1, 2014
Revised: May 27, 2014
Accepted: July 22, 2014
Published online: December 7, 2014
Abstract

While debate continues as to which is the best surgical method for the treatment of hemorrhoids, none of the currently available surgical methods approach the ideal surgical option, which is one that is effective while being safe and painless. In reality, the less painful the procedure, the more likely it is to be associated with recurrence post-op. Where hemorrhoids surgery is concerned, there isn’t a “one size fits all” option. Most of the randomized controlled trials performed to date include hemorrhoids of various grades and with a focus on only comparing surgical methods while failing to stratify the outcomes according to the grade of hemorrhoid. We believe that surgery needs to be tailored not only to the grade of the hemorrhoids, but also to the size, circumferential nature of the disease, and prevailing symptomatology.

Keywords: Hemorrhoidectomy, Doppler-guided hemorrhoidal artery ligation, Stapler, LigaSure, Conventional

Core tip: While the debate continues as to which is the best surgical method for the treatment of hemorrhoids, none of the currently available surgical methods approach the ideal surgical option, which is one that is effective while being safe and painless. In reality, the less painful the procedure, the more likely it is to be associated with recurrence post-op. Where hemorrhoids surgery is concerned, there isn’t a “one size fits all” option. Most of the randomized controlled trials performed to date include hemorrhoids of various grades and with a focus on only comparing surgical methods while failing to stratify the outcomes according to the grade of hemorrhoid. We believe that surgery needs to be tailored not only to the grade of the hemorrhoids, but also to the size, circumferential nature of the disease, and prevailing symptomatology.