Treatment of hemorrhoids

Treatment strategies for haemorrhoids are various and can be divided into conservative therapies (either pharmacological or instrumental) and surgery. Surgical therapy guaranties satisfactory results, which are significantly better than those obtained with conservative therapies, especially for grade III and IV hemorrhoids. Traditional surgery for hemorrhoids aims to remove the hemorroids, with closure (Fergusson's technique) or without closure (Milligan-Morgan procedure) of the ensuing defect. This traditional approach is effective, but causes significant postoperative pain because of wide external wounds in the innervated perianal skin. Stapled hemorrhoidopexy, proposed by Longo, has gained a vast acceptance because of less postoperative pain and faster return to normal activities. In the recent literature a significant incidence of recurrence after stapled hemorrhoidopexy was reported, when compared with conventional hemorrhoidectomy. The higher recurrence rate may be sometimes the result of inappropriate patient selection.