Changing concepts of surgical treatment for haemorrhoids: From excision to reduction fixation

A diversity of surgical procedures has been described for treating haemorrhoidal disease. The current article attempts to give an account of these procedures, based on different concepts about pathogenesis and aetiology of haemorrhoids. Surgical excision, that is, haemorrhoidectomy, has stood the challenge of time and currently remains to be the most definitive way for treating the disorder. More recently, stapled haemorrhoidopexy has emerged as a potential less painful alternative. Different from conventional excision, this is basically a mucosal reduction procedure rather similar to the Délorme's operation. The concept is exciting and initial results from different studies look promising. However, the published trials so far are limited in the following aspects – insufficient data on fourth‐degree and thrombosed haemorrhoids, complete lack of data on external haemorrhoids, unknown long‐term recurrence rate, as well as insufficient information on feasibility as a day‐case procedure. Further studies with longer follow‐up should be conducted in order to determine whether stapled haemorrhoidopexy will become the ultimate procedure in treating haemorrhoidal disease in the nearest future.