Review

Modern surgical management of haemorrhoids

  • CHARLES F.M. EVANS
  • SYED A. HYDER
  • SIMON B. MIDDLETON

Pelviperineology 2008;27(4):139-142

Haemorrhoidal disease is one of the commonest anorectal disorders. Treatment options are dependent upon the severity of symptoms and the extent of haemorrhoidal prolapse with up to 10% of patients requiring surgical intervention. The traditional surgical treatment for haemorrhoids is excisional haemorrhoidectomy. The Milligan Morgan technique, first described in 1937, is the most popular technique and remains the gold standard for surgical intervention. However haemorrhoidectomy is recognised as a painful procedure with a risk of significant complications and remains unpopular with the general population. Using advances in medical equipment and an understanding of the pathophysiology of haemorrhoidal disease new approaches to the surgical treatment of haemorrhoids have now been developed. Stapled haemorrhoidopexy reduces haemorrhoidal tissue prolapse by excising a ring of the prolapsed anal mucosa above the dentate line, using a specific circular stapling device. Haemorrhoidal artery ligation (HAL) uses a Doppler transducer to identify haemorrhoidal arteries which can then be ligated, reducing haemorrhoidal venous plexus pressures and haemorrhoidal artery ligation with recto anal repair (HAL-RAR) combines HAL with a procedure to plicate and draw up prolapsing haemorrhoidal tissue. This article reviews the evidence for the different surgical techniques; focussing on treatment outcomes including rates of recurrent disease and post operative complications.

Keywords: Internal haemorrhoids; Haemorrhoidectomy; Stapled haemorrhoidopexy; Doppler-guided hemorrhoidal artery ligation; Recto-anal repair