Comparative analysis of surgical methods for the treatment of hemorrhoidal disease stages III–IV: a literature review
https://doi.org/10.17238/2072-3180-2026-2-207-213
Abstract
Hemorrhoidal disease (HD) is one of the most common anorectal pathologies, affecting 5–10 % of the population, predominantly in the 45–65 age group. Surgical treatment is indicated for stages III–IV of the disease; however, the choice of the optimal method remains a subject of debate.
Results. Hemorrhoidopexy (Longo procedure) is characterized by low postoperative pain and rapid rehabilitation; however, at a mean follow-up of 15 years, recurrence of at least one hemorrhoidal symptom was recorded in 47,4 % of patients, and surgical re-intervention was required in 15,2 % of cases. Transanal Doppler-guided dearterialization (THD) is effective primarily in stages II–III, with a recurrence rate of 12–27 % and a low rate of postoperative complications. Conventional hemorrhoidectomy remains the gold standard for complicated forms and stage IV disease, with a recurrence rate of 2–8 %; however, it is associated with significant postoperative pain and prolonged rehabilitation. The use of modern modifications employing radiofrequency and ultrasonic energy (LigaSure, Harmonic Scalpel) reduces intraoperative blood loss and the intensity of postoperative pain.
Conclusion. The choice of surgical strategy for HD stages III–IV should be determined by the degree and stage of the disease, the presence of complications, and the level of proficiency with the technique. Further studies are needed to develop a personalized approach, assess long-term outcomes and recurrence rates for various treatment methods, and clarify the indications for each of them.
About the Authors
B. G. Khodzhaev
RUDN University named after Patrice Lumumba
Russian Federation
Russian Federation
Begench G. Khodzhaev – Postgraduate Student, Department of Hospital Surgery with the course of Pediatric Surgery, Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University).
6 Miklukho-Maklaya St., Moscow, 117198
A. G. Faibushevich
RUDN University named after Patrice Lumumba
Russian Federation
Russian Federation
Aleksandr G. Faibushevich – Candidate of Medical Sciences, Head of the Department of Hospital Surgery with the course of Pediatric Surgery of the Medical Institute of the Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University).
117198, Miklukho-Maklaj str., 6, Moscow
M. K.M. Al-Ariki
RUDN University named after Patrice Lumumba
Russian Federation
Russian Federation
Malik K.M. Al-Ariki– Candidate of Medical Sciences, assistant professor of the Department of Hospital Surgery with the course of Pediatric Surgery of the Medical Institute of the Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University).
117198, Miklukho-Maklaj str., 6, Moscow
8 977 685 10 28
E. A. Gitelzon
RUDN University named after Patrice Lumumba
Russian Federation
Russian Federation
Ekaterina A. Gitelzon – Candidate of Medical Sciences, associate professor of the Department of the Hospital Surgery with the course of the Pediatric Surgery, of the Medical Institute of the Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University).
117198, Miklukho-Maklaj str., 6, Moscow
References
1. Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol, 2012, no 18(17), pp. 2009–2017.
2. Yeo D., Tan K.Y. Hemorrhoidectomy – making sense of the surgical options. World J Gastroenterol., 2014, no 20(45), pp. 16976–16983.
3. Higuero T., Abramowitz L., Castinel A., Fathallah N., Hemery P., Laclotte Duhoux C., Pigot F., Pillant-le Moult H., Senéjoux A., Siproudhis L., Staumont G., Suduca J.M., Vinson-Bonnet B. Guidelines for the treatment of hemorrhoids (short report). J Visc Surg., 2016, no 153(3), pp. 213–218.
4. Holzheimer R.G. Surgical treatment of haemorrhoids. Surg Treat Evid-Based Probl-Oriented, 2001. Published online.
5. Altomare D.F., Giuratrabocchetta S. Conservative and surgical treatment of haemorrhoids. Nat Rev Gastroenterol Hepatol, 2013, no 10(9), pp. 513–521.
6. Longo A. Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device: a new procedure. In: Monduzzi, ed. 6th World Congress of Endoscopic Surgery, Rome, 3–6 June 1998. Bologne, 1998, pp. 777–784.
7. Burch J., Epstein D., Sari A.B. Stapled haemorrhoidopexy for the treatment of haemorrhoids: a systematic review. Colorectal Dis, 2009, no 11(3), pp. 233–244.
8. Chen H.L., Woo X.B., Cui J., Chen C.Q., Peng J.S. Ligasure versus stapled hemorrhoidectomy in the treatment of hemorrhoids: a meta-analysis of randomized control trials. Surg Laparosc Endosc Percutan Tech, 2014, no 24, pp. 285–289.
9. Yang J., Cui P.J., Han H.Z., Tong D.N. Meta-analysis of stapled hemorrhoidopexy vs LigaSure hemorrhoidectomy. World J Gastroenterol, 2013, no 19, pp. 4799–4807.
10. Schneider R., Jäger P., Ommer A. Long-term results after stapled hemorrhoidopexy: a 15-year follow-up. World J Surg, 2019, no 43, pp. 2536–2543.
11. Sultan S., Rabahi N., Etienney I., Atienza P. Stapled haemorrhoidopexy: 6 years’ experience of a referral Centre. Colorectal Dis, 2010, no 12, pp. 921–926.
12. Cheetham M.J., Mortensen N.L.M., Nystrom P.O., Kamm M.A., Philips R.K.S. Persistent pain and faecal urgency after stapled haemorrhoidectomy, Lancet. 2000, no 356, pp. 730–733.
13. Zhuravlev A.V., Katorkin S.E., Chernov A.A., Shamin A.V., Sotnikov V.M. Results of Longo operation and transanal dearterialization of hemorrhoidal nodes (HAL-RAR) in chronic internal hemorrhoids. Koloproktologiya, 2018, no 2, pp. 18. (In Russ.)
14. Zhuravlev A.V., Katorkin S.E., Chernov A.A., Krasnova V.N., Shamin A.V., Razin A.N. Surgical treatment of patients with rectocele and hemorrhoids using the Longo method. Koloproktologiya, 2017, no 3, pp. 22. (In Russ.)
15. Shalaby R., Desoky A. Randomized clinical trial of stapled versus Milligan-Morgan hemorrhoidectomy. Br J Surg, 2001, no 88, pp. 1049–1053.
16. Faucheron J.L., Voirin D., Abba J. Rectal perforation with life-threatening peritonitis following stapled hemorrhoidopexy. Br J Surg, 2012, no 99, pp. 746–753.
17. Giordano P., Overton J., Madeddu F., Zaman S., Gravante G. Transanal hemorrhoidal dearterialization: a systematic review. Dis Colon Rectum, 2009, no 52, pp. 1665–1671.
18. Gravie J.F., Lehur P.A., Huten N. Stapled hemorrhoidopexy versus Milligan-Morgan hemorrhoidectomy: a prospective, randomized, multicenter trial with 2-year postoperative follow up. Ann Surg, 2005, no 242(1), pp. 29–35.
19. Similis C., Thoukididou S.N., Slesser A.A., Rasheed S., Tan E., Tekkis P.P. Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatment for haemorrhoids. Br J Surg, 2015, no 102, pp. 1603–1618.
20. Denoya P.I., Fakhoury M., Chang K., Fakhoury J., Bergamaschi R. Dearterialization with mucopexy versus haemorrhoidectomy for grade III or IV haemorrhoids: short-term results of a double-blind randomized controlled trial. Colorectal Dis, 2013, no 15, pp. 1281–1288.
21. Giordano P., Nastro P., Davies A., Gravante G. Prospective evaluation of stapled haemorrhoidopexy versus transanal haemorrhoidal dearterialization for stage II and III haemorrhoids: three-year outcomes. Tech Coloproctol, 2011, no 15, pp. 67–73.
22. Iyer V.S., Shrier I., Gordon P.P.H. Long-term outcome of rubber band ligation for symptomatic primary and recurrent internal haemorrhoids. Dis Colon Rectum. 2004, no 47, pp. 1364–1370.
23. Ho Y.H., Buettner P.G. Open compared with closed haemorrhoidectomy: meta-analysis of randomized controlled trials. Tech Coloproctol, 2007, no 11, pp. 135–143.
24. Bhatti M.I., Sajid M.S., Baig M.K. Milligan-Morgan (open) versus Ferguson haemorrhoidectomy (closed): a systematic review and meta-analysis of published randomized, controlled trials. World J Surg, 2016, no 40, pp. 1509–1519.
25. Mushaya C.D., Caleo P.J., Bartlett L., Buettner P.G., Ho Y.H. Harmonic scalpel compared with conventional excisional haemorrhoidectomy: a meta-analysis of randomized controlled trials. Tech Coloproctol, 2014, no 18, pp. 1009–1016.
26. Milito G., Cadeddu F., Muzi M.G., Nigro C., Farinon A.M. Haemorrhoidectomy with Ligasure vs conventional excisional techniques: meta-analysis of randomized controlled trials. Colorectal Dis, 2010, no 12, pp. 85–93.
27. Jayne D.G., Botterill I., Ambrose N.S., Brennan T.G., Guillou P.J., O’Riordain D.S. Randomized clinical trial of Ligasure versus conventional diathermy for day-case haemorrhoidectomy. Br J Surg., 2002, no 89(4), pp. 428–432.
28. Tan J.J., Seow-Choen F. Prospective, randomized trial comparing diathermy and Harmonic Scalpel hemorrhoidectomy. Dis Colon Rectum, 2001, no 44(5): pp. 677–679.
Review
For citations:
Khodzhaev B.G., Faibushevich A.G., Al-Ariki M.K., Gitelzon E.A. Comparative analysis of surgical methods for the treatment of hemorrhoidal disease stages III–IV: a literature review. Moscow Surgical Journal. 2026;(2):207-213. (In Russ.) https://doi.org/10.17238/2072-3180-2026-2-207-213
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