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World J Surg Proced. Nov 28, 2014; 4(3): 55-65
Published online Nov 28, 2014. doi: 10.5412/wjsp.v4.i3.55
Recent advances in the management of hemorrhoids
Mahmoud Sakr, Khaled Saed
Mahmoud Sakr, Khaled Saed, Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria 21500, Egypt
Author contributions: Both of the authors solely contributed to this paper.
Correspondence to: Mahmoud Sakr, MD, PhD, FACS, Professor of Surgery, Faculty of Medicine, University of Alexandria, Champillion St., Azarita, Alexandria 21500, Egypt.
Telephone: +2-3-5899420 Fax: +2-3-4841189
Received: March 20, 2014
Revised: September 16, 2014
Accepted: October 28, 2014
Published online: November 28, 2014

Hemorrhoids are considered one of the most common anorectal diseases with a prevalence of 4.4% up to 36.4% of the general population, and a peak incidence between 45 and 65 years. Hemorrhoidal disease presents with a prolapsed lump, painless bleeding, discomfort, discharge, hygiene problems, soiling, and pruritus. Sliding anal canal lining theory is the most accepted theory as a cause of hemorrhoidal disease; however, it is also associated with hyper-vascularity, and, recently, with several enzymes or mediators involved in the disintegration of the tissues supporting the anal cushions, such as matrix metalloproteinase. A comprehensive search in published English-language literature till 2013 involving hemorrhoids was performed to construct this review article, which discusses advances in the management of hemorrhoids. This includes conservative treatment (life style modification, oral medications, and topical treatment), office procedures (rubber band ligation, injection sclerotherapy, infrared and radiofrequency coagulation, bipolar diathermy and direct-current electrotherapy, cryosurgery, and laser therapy), as well as surgical procedures including diathermy hemorrhoidectomy, LigaSure hemorrhoidectomy, Harmonic scalpel hemorrhoidectomy, hemorrhoidal artery ligation, stapled hemorrhoidopexy (SH), and double SH. Results, merits and demerits of the different modalities of treatment of hemorrhoids are presented, in addition to the cost of the recent innovations.

Keywords: Hemorrhoids, Rubber band, Infrared, Photocoagulation, Cryosurgery, LigaSure, Harmonic, Anopexy, Hemorrhoidal artery ligation, Stapled hemorrhoidopexy

Core tip: Patients with Grades I-II hemorrhoids can be treated with medical treatment or office procedures. For Grades III-IV, surgical treatment should be offered and individually tailored to each patient. Conventional hemorrhoidectomy is the gold-standard, albeit with severe post-operative pain. LigaSure and harmonic scalpel hemorrhoidectomy offer shorter operative time, less post-operative pain and less time off work. Stapled hemorrhoidopexy provides similar results. However, though rare, devastating complications may occur, and so, should be performed only by experienced surgeons. Hemorrhoidal artery ligation is a potential non-excisional technique for the treatment of Grades II-III hemorrhoids with minimal postoperative pain and quick recovery.