Venara A, Podevin J, Godeberge P, Redon Y, Barussaud ML, Sielezneff I, et al. Prospective Randomized Trial Comparing HAL-RAR Versus Excisional Hemorrhoidectomy: Postoperative Pain, Clinical Outcomes, and Quality of Life. 58 (11):1083-90.Ĭarvajal López F, Hoyuela Alonso C, Juvany Gómez M, Troyano Escribano D, Trias Bisbal MA, Martrat Macià A, et al. ![]() A Randomized Trial Comparing Stapled Rectal Mucosectomy Versus Open and Semiclosed Hemorrhoidectomy. Ripetti V, La Vaccara V, Greco S, Arullani A. Long-term outcomes after circular stapled hemorrhoidopexy versus Ferguson hemorrhoidectomy. 18 (12):1224-30.Īytac E, Gorgun E, Erem HH, Abbas MA, Hull TL, Remzi FH. Practice parameters for the management of hemorrhoids (revised 2010). Rivadeneira DE, Steele SR, Ternent C, Chalasani S, Buie WD, Rafferty JL, et al. The ASCRS Textbook of Colon and Rectal Surgery. Steele SR, Hull TL, Read TE, Saclarides TJ, Senagore AJ, Whitlow CB, eds. Keighley and Williams' Surgery of the Anus, Rectum & Colon. Sagar PM, Hill AG, Knowles CH, Post S, Bemelman W, Roberts PL, et al, eds. Gordon and Nivatvongs' Principles and Practice of Surgery for the Colon, Rectum, and Anus. Other surgical procedures that may be considered are stapled hemorrhoidopexy (sometimes referred to as stapled hemorrhoidectomy or circumferential mucosectomy) and hemorrhoid artery ligation (HAL).īeck DE. This procedure is indicated for patients who do not improve after multiple attempts of nonoperative management or office-based procedures and for patients who have markedly prolapsed hemorrhoidal disease (grade 3 and 4). The classic operative approach is excisional hemorrhoidectomy. ![]() ![]() When conservative management is inadequate, surgical treatment is necessary. This is generally a good initial approach for reducing hemorrhoidal bleeding and is ideal for grade 1 and some grade 2 hemorrhoids. Adequate hydration must be encouraged as well. If compliance is problematic, doctors may prescribe psyllium seed extract or methylcellulose to facilitate consumption of fiber in a more convenient way. However, compliance is an issue because many people are not motivated to adhere to a high-fiber diet over the long term. Adding bulking agents in the form of fiber is the recommended first-line therapy, and a high-fiber diet should be encouraged.
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