Surgical treatments for haemorrhoidal disease: from haemorrhoidectomy to thermofusion
Seance of wednesday 14 may 2025 (Chirurgie proctologique)
DOI number : 10.26299//2025.18.01
Abstract
Hemorrhoidal surgery comes after the failure of medical management of transit disorders and treatment by photocoagulation and rubber band ligation. Hemorrhoidectomy (Milligan and Morgan, 1937) remained the only surgical treatment for a long time. Early postoperative and post-defecatory pain are a major obstacle to this procedure. Since 2000, the use of pudendal block allows control of postoperative pain for more than 12 hours and allows ambulatory surgery.
Surgery has evolved to correct internal hemorrhoidal symptoms: defecatory bleeding and post-defecatory hemorrhoidal prolapse. The goal is to improve patients' quality of life. Minimally invasive procedures are based on the principle of reducing blood flow to the hemorrhoids and "lifting" the hemorrhoidal clusters in the anal canal. These include stappled hemorrhoidopexy (Longo procedure 2000), Doppler-guided arterial ligation with mucopexy (DGHAL 2005), and internal hemorrhoidal thermofusion. The aftermath is less painful, particularly during the first defecation. A return to normal life is possible within a few days instead of three weeks after hemorrhoidectomy. In "expert" centers, postoperative morbidity is equivalent for all techniques. If internal hemorrhoids are permanently exteriorized or if external hemorrhoids have been complicated by thrombosis, there is no alternative to hemorrhoidectomy. The risk of recurrence is very low after hemorrhoidectomy, but scar shrinkage of the anus is a rare and serious complication. After minimally invasive techniques, the recurrence rate is 20% at 2 years.
Surgery has evolved to correct internal hemorrhoidal symptoms: defecatory bleeding and post-defecatory hemorrhoidal prolapse. The goal is to improve patients' quality of life. Minimally invasive procedures are based on the principle of reducing blood flow to the hemorrhoids and "lifting" the hemorrhoidal clusters in the anal canal. These include stappled hemorrhoidopexy (Longo procedure 2000), Doppler-guided arterial ligation with mucopexy (DGHAL 2005), and internal hemorrhoidal thermofusion. The aftermath is less painful, particularly during the first defecation. A return to normal life is possible within a few days instead of three weeks after hemorrhoidectomy. In "expert" centers, postoperative morbidity is equivalent for all techniques. If internal hemorrhoids are permanently exteriorized or if external hemorrhoids have been complicated by thrombosis, there is no alternative to hemorrhoidectomy. The risk of recurrence is very low after hemorrhoidectomy, but scar shrinkage of the anus is a rare and serious complication. After minimally invasive techniques, the recurrence rate is 20% at 2 years.