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Hemorrhoids pp 243-252 | Cite as

Main Disadvantages of Hemorrhoidectomy

  • Carlos Walter Sobrado
  • Marcelo Mester
  • Lucas Sobrado
  • Andressa Cristina Sposato Louzada
Reference work entry
Part of the Coloproctology book series (COLOPROCT, volume 2)

Abstract

Hemorrhoids are one of the most common anorectal disorders. Surgical treatment is usually indicated for the more advanced cases (grades III and IV). Numerous surgical techniques have been described, yet there is still an ongoing debate over the best operation regarding efficiency, safety, pain reduction, low complication and recurrence rates, earlier return to work, and overall cost. For us, the most efficient technique to treat fourth degree hemorrhoids is still conventional hemorrhoidectomy (CH). However, CH is also associated with a number of disadvantages: postoperative pain, prolonged healing time, longer time of return to regular activities, and complications such as urinary retention, bleeding, anal stenosis, and fecal incontinence. These may occur when the indication is inappropriate or when serious technical errors are made. Other surgical procedures have been developed to circumvent these pitfalls (stapled hemorrhoidopexy, transanal hemorrhoidal dearterialization with or without rectal pexy, etc.), and prospective randomized trials have shown they may reduce pain and permit an earlier return to work, but they are associated with higher rates of prolapse and bleeding recurrences. Thus we believe CH remains the best treatment option for grades III and IV hemorrhoids, and as long as it is well perfomed.

Notes

Acknowledgments

We thank Dr. Afonso Henrique da Silva Sousa, Jr. for useful thoughts and comments.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Carlos Walter Sobrado
    • 1
  • Marcelo Mester
    • 1
  • Lucas Sobrado
    • 2
  • Andressa Cristina Sposato Louzada
    • 2
  1. 1.Discipline of Gastrointestinal Surgery, Department of GastroenterologyUniversity of São Paulo Medical SchoolSão PauloBrazil
  2. 2.Department of SurgeryUniversity of São Paulo Medical SchoolSão PauloBrazil

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