Hemorrhoids, the mucosal vascular cushions in the anal canal, can lead to pain and bleeding when they become enlarged, prolapsed, or thrombosed. The locations of hemorrhoids are discussed, along with pertinent elements of the history and physical. Differences between the four degrees of hemorrhoids are also described. Preoperative preparation and positioning is outlined, including preoperative bowel preparation. The various methods for hemorrhoidectomy are described. Non-surgical procedures include injection of sclerosing agents, photocoagulation, and rubber-band ligation. Currently rubber-band ligation is the preferred non-excisional procedure. Various excisional techniques for hemorrhoidectomy exist, including open Milligan-Morgan procedure, closed Ferguson hemorrhoidectomy, excision with tissue sealing devices (Ligasure or Harmonic Scalpel), stapled hemorrhoidopexy, and transanal hemorrhoidal dearterialization. Additional study of long-term results of vessel sealing device hemorrhoidectomy, stapled hemorrhoidopexy and transanal hemorrhoidal dearterialization are needed to definitively say whether these are improvements on the traditional open or closed hemorrhoidectomies. Postoperative management including pain control, wound care, and bowel regimen is discussed.
