Hemorrhoids are normal vascular structures in the anal canal. The initial approach to treating most patients with hemorrhoids is conservative. For patients who fail medical management or cannot tolerate an office-based procedure, surgical excision remains a very effective approach for treatment of symptomatic hemorrhoids. For some indications, failed prior treatment is not required prior to proceeding with surgical treatment.
Hemorrhoid surgery can be performed using general anesthesia, regional anesthesia, or straight local anesthesia. The choice is often one of surgeon preference, but patient-related factors also play a role. For all hemorrhoid surgeries (external or internal hemorrhoidectomy, internal hemorrhoidopexy), we infiltrate local anesthetic in the perianal region at the time of hemorrhoidectomy, except in patients undergoing spinal anesthesia. Perianal infiltration of local anesthetic provides significant pain relief, whether given alone or as a supplement to other forms of anesthesia.
External hemorrhoids generally do not generally require surgical management. When surgery is indicated for thrombosed external hemorrhoids, we suggest hemorrhoid excision rather than simple incision evacuation of the clot. Simple incision and evacuation of the clot is associated with a high rate of recurrence.
