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Hemorrhoids
Published in Stephen M. Cohn, Matthew O. Dolich, Kenji Inaba, Acute Care Surgery and Trauma, 2016
Clarence E. Clark, Jacquelyn Turner
If nonoperative management fails, surgery may be required. Specific technical aspects of various hemorrhoid procedures have been prospectively analyzed, including open versus closed hemorrhoidectomy (CH), stapled hemorrhoidectomy or hemorrhoidopexy, and hemorrhoidectomy with bipolar diathermy (BSH) or harmonic scalpel (HSH) [15–25]. In addition to these well-studied surgical modalities, transanal hemorrhoidal dearterialization (THD) has recently emerged as an alternative approach in the surgical armamentarium [26–34].
Treatment of uncomplicated hemorrhoids
Published in P Ronan O’Connell, Robert D Madoff, Stanley M Goldberg, Michael J Solomon, Norman S Williams, Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
Both rubber band ligation and sclerotherapy are simple, inexpensive procedures and quick to perform. The instruments required are simple and universally available in their various forms. Coagulative therapies include infrared photocoagulation, electrocoagulation, radiofrequency ablation, and cryotherapy. These techniques are most suited to bleeding first-and small second-degree hemorrhoids. They all rely on the coagulation, occlusion, or sclerosis of the hemorrhoidal vascular pedicle. Following tissue destruction, the area sloughs leaving an ulcer that forms fibrotic tissue at the treatment site. Their main limitation is the need for specialized more expensive equipment which tends to be available only in more major centers or those which have developed an interest in the technique. Of the coagulative therapies, infrared coagulation is the most widely used. It can be used in hepatitis B or C, or HIV-positive patients as it does not cause bleeding, and is particularly useful in patients who are receiving anticoagulants, who are immunocompromised or are pregnant.Doppler-guided transanal hemorrhoidal artery ligation, also called the hemorrhoidal artery ligation operation (HALO), or transanal hemorrhoidal dearterialization (THD), is relatively new minimally invasive therapeutic technique, which can be performed in the outpatient setting, and appears to be a potential treatment option for second-and third-degree hemorrhoids.
Recommendations and best practice on the management of hemorrhoidal disease in Saudi Arabia
Published in Hospital Practice, 2022
Mohamed Zaki El-Kelani, Raouf Kerdahi, Samir Raghib, Mohamed Ashraf Shawkat, Naser Abdelnazer, Ishag Mudawi, Magdy Mahmoud, Wassim Abi Hussein, Mohamed Tawfik, Waleed Wahdan
In case of failure of conservative treatment, a safe anal surgery should be performed according to the grade of the hemorrhoidal disease, available medical resources, patient’s fitness and preferences, and surgeon’s experience.The existence of several procedures for one pathology means that none is completely effective yet. Hemorrhoidectomy can be used in patients with Grade I to III hemorrhoidal disease who failed the outpatient procedures. It is also indicated in circumferential prolapsing Grade III and IV hemorrhoidal disease. It can be done using an open (Milligan–Morgan) or closed (Ferguson) method [13], and performed using energy devices like Harmonic Scalpel™ and LigaSure™.Doppler-guided hemorrhoidal artery ligation (DG-HAL)/transanal hemorrhoidal dearterialization (THD) can be done with or without mucopexy. It can be used in patients with Grade II and III hemorrhoidal disease, is effective and safe [23].Stapled hemorrhoidopexy can be used in patients with Grade II and III hemorrhoidal disease or in hemorrhoid refractory to outpatient procedures. This technique requires special expertise to avoid major complications.New surgical procedures like stapled hemorrhoidopexy and DG-HAL are more effective with less side effects than classic open hemorrhoidectomies as the new procedures are done above the dentate line and cause less pain and less complications.Surgical hemorrhoidectomy results in fewer recurrences than stapled hemorrhoidopexy [24].Lord’s manual dilatation must be avoided as it might lead to fecal incontinence and it is not related to any evidence-base practice.