Surgical and Other Hemorrhoid Treatments
A number of techniques have been developed to remove or destroy hemorrhoids (also haemorrhoids or piles). These include:
- Rubber band ligation (Baron ligation). Elastic bands are applied to an internal hemorrhoid to cut off its blood supply. The hemorrhoid withers in a few days and sloughs off during normal bowel movement.
- Hemorrhoidolysis (Galvanic electrotherapy). An electrical current is used to desiccate the hemorrhoid.
- Sclerotherapy. In this procedure a hardening agent (sclerosant) is injected into the hemorrhoid, causing the walls to collapse and the hemorrhoid shrivels up.
- Cryosurgery. In this procedure the frozen tip of a cryoprobe is used to destroy hemorrhoidal tissues. Now rarely used due to side effects.
- Laser, infrared, BICAP, or radiofrequency coagulation. The affected tissues are cauterised by laser (now much less popular), infrared beam or electricity. Infrared coagulation has been proven to be as effective as rubber band ligation in hemorrhoids up to Grade III.
- Hemorrhoidectomy. This is a surgical procedure to excise and remove hemorrhoids. It may be associated with incontinence issues later in life, and many patients complain of severe pain during recovery. It is usually now only recommended for Grade IV hemorrhoids.
- Stapled hemorrhoidectomy. This is a surgical procedure that disrupts blood flow to the hemorrhoids. It is generally less painful than complete removal and allows faster recovery. It is also generally used for prolapsed or bleeding internal hemorrhoids.
- Doppler Guided Hemorrhoidal Artery Ligation / HAL-RAR. This is the only evidence-based surgery for all grades of hemorrhoids, and the best treatment for bleeding ones, as the bleeding stops immediately. It does not involve cutting tissues or even a stay in hospital, and patients are usually back at work the same day. Previously only used up to Grade III, but the development of HAL Recto Anal Repair has extended the treatment to Grade IV hemorrhoids.
- Transanal Hemorrhoidal Dearterialisation (THD). This is similar to HAL, but more standardisable and therefore safer, less painful and has a shorter recovery time.
These treatments are only appropriate for severe cases of hemorrhoids and are generally used as a last resort when other, less aggressive treatments have failed. However, hemorrhoid surgery is often accompanied by side effects and complications, such as scarring and damage to the anal sphincter muscles.
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