Hemorrhoids

The management of symptomatic hemorrhoidal disease is based on the severity of symptoms and preexisting medical conditions that may preclude one treatment option over another. The majority of patients can be managed in the office setting with nonexcisional methods including injection sclerotherapy, rubber band ligation, and infrared coagulation. The small percentage of patients that fail this management warrant evaluation for surgical excisional hemorrhoidectomy. In recent years, newer techniques such as advanced energy devices for excision, circular stapled hemorrhoidopexy, and Doppler-guided hemorrhoidal artery ligation have been introduced. The purported advantage of these device-driven surgical options is similar efficacy with less pain. Unfortunately, although there are proponents for each approach, the device costs remain problematic, and the outcome improvement has been limited, especially in terms of long-term efficacy. Surgeons are urged to learn the standard techniques so that they can assess the newer options for themselves. This review contains 9 figures, 4 tables, and 71 references. Key Words: bipolar diathermy, direct current electrocautery, Doppler-guided hemorrhoidal artery ligation, excisional hemorrhoidectomy, harmonic, infrared coagulation, LigaSure, rubber band ligation, stapled hemorrhoidopexy