What surgical procedures can be used to treat hemorrhoids?

Photo of a patient and visitors at the hospital

Sometimes the symptoms of enlarged are so bad that treating the symptoms alone is no longer enough. There are then various surgical treatment options.

Hemorrhoids are “cushions” of blood vessels and supporting tissue, found at the end of the rectum, just inside the anus. If they become enlarged, they can cause unpleasant symptoms. The decision of whether surgery is needed and, if so, which kind, will mainly depend on the size of the and the severity of symptoms.

For grade 1 and grade 2 , and rubber band ligation ("banding") are considered first. These two treatments can also be combined.

If these procedures don't help enough, then the need to be removed surgically. Doctors also often recommend surgery if someone has very enlarged grade 3 or grade 4 that are sticking out. As well as conventional surgery to remove (known as hemorrhoidectomy), there's a special surgical technique known as stapled hemorrhoidopexy or "stapling."

All of the approaches have their pros and cons. These are summarized in the following tables:

Table: Non-surgical procedures
Approach Sclerotherapy (injections) Rubber band ligation (banding)
Who is the treatment suitable for? For people with grade 1 and 2 . For people with grade 1, 2 or 3 .
What does the treatment involve? A drug is injected into the area under the . They shrink and stabilize. This procedure is usually repeated after a few weeks. A small rubber band is tied around the base of the . The tissue dies and falls off. The procedure is often repeated after a few weeks.
Is anesthesia or a hospital stay needed? No, you can go home after the procedure and anesthesia is not used.
What complications commonly occur? Mild pain, A feeling of pressure or like there's something there Occasional pain, Light bleeding
How likely are the to grow again? This happens in a lot of people. Then they need treatment or surgery again. This happens in some people. Then they need treatment or surgery again.
Table: Surgical procedures
Approach Surgical removal (hemorrhoidectomy) Stapling
Who is the treatment suitable for? For people
  • with grade 3 or grade 4
  • if their symptoms don't improve after non-surgical treatment.
For people with grade 3 .
What does the treatment involve? The are removed using scissors, a scalpel or a laser. The surgical wound is fully or partially closed with stitches, or left open. The are removed using an instrument, and the rest of the tissue is attached to the lining of the anus.
Is anesthesia or a hospital stay needed? Yes, the procedure is done in a hospital under regional or general anesthesia. You may have to stay in the hospital and take sick leave from work.
What complications commonly occur? Pain, Bleeding, Problems urinating (peeing) Pain, but probably less likely than after hemorrhoidectomy,Bleeding,Problems urinating (peeing)
How likely are the to grow again? The will probably grow again within one year in about 3 out of 100 people. The will probably grow again within one year in about 9 out of 100 people.

Sclerotherapy (injections)

Rubber band ligation (banding)

Hemorrhoidectomy (hemorrhoid removal)

Stapling

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Updated on December 9, 2021

Next planned update: 2025

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Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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