Editing Hemorrhoid (section)

===Surgery===
A number of surgical techniques may be used if conservative management and simple procedures fail.<ref name=NG2011 /> All surgical treatments are associated with some degree of complications, including bleeding, infection, [[anal stricture]]s, and [[urinary retention]], due to the close proximity of the rectum to the nerves that supply the bladder.<ref name=Review09 /> Also, a small risk of [[fecal incontinence]] occurs, particularly of liquid,<ref name=Beck2011 /><ref name="Pescatori 2008">{{cite journal |last = Pescatori |first = M |author2 = Gagliardi, G |title = Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures |journal = Techniques in Coloproctology |date = March 2008 |volume = 12 |issue = 1 |pages = 7–19 |pmid = 18512007 |doi = 10.1007/s10151-008-0391-0 |pmc = 2778725 }}</ref> with rates reported between 0% and 28%.<ref>{{cite journal |last = Ommer |first = A |author2 = Wenger, FA |author3 = Rolfs, T |author4 = Walz, MK |title = Continence disorders after anal surgery—a relevant problem? |journal = International Journal of Colorectal Disease |date = November 2008 |volume = 23 |issue = 11 |pages = 1023–31 |pmid = 18629515 |doi = 10.1007/s00384-008-0524-y |s2cid = 7247471 }}</ref> Mucosal [[ectropion]] is another condition which may occur after hemorrhoidectomy (often together with anal stenosis).<ref name=Garcia2002>{{cite journal |last = Lagares-Garcia |first = JA |author2 = Nogueras, JJ |title = Anal stenosis and mucosal ectropion |journal = The Surgical Clinics of North America |date = December 2002 |volume = 82 |issue = 6 |pages = 1225–31, vii |pmid = 12516850 |doi = 10.1016/s0039-6109(02)00081-6 }}</ref> This is where the anal mucosa becomes everted from the anus, similar to a very mild form of [[rectal prolapse]].<ref name=Garcia2002 />
# '''Excisional hemorrhoidectomy''' is a surgical excision of the hemorrhoid used primarily only in severe cases.<ref name="Review09" /> It is associated with significant postoperative pain and usually requires two to four weeks for recovery.<ref name="Review09" /> However, the long-term benefit is greater in those with '''grade III hemorrhoids''' as compared to rubber band ligation.<ref>{{cite journal |last = Shanmugam |first = V |author2 = Thaha, MA |author3 = Rabindranath, KS |author4 = Campbell, KL |author5 = Steele, RJ |author6 = Loudon, MA |title = Rubber band ligation versus excisional haemorrhoidectomy for haemorrhoids |journal = Cochrane Database of Systematic Reviews |date = Jul 20, 2005 |volume = 2011 |issue = 3 |pages = CD005034 |pmid = 16034963 |doi = 10.1002/14651858.CD005034.pub2 |pmc = 8860341 }}</ref> It is the recommended treatment in those with a [[perianal hematoma|thrombosed external hemorrhoid]] if carried out within 24–72 hours.<ref name="NG2011" /><ref name="Day2006">{{cite book |last = Dayton |first = Peter F. Lawrence, Richard Bell, Merril T. |title = Essentials of general surgery |year = 2006 |publisher = Williams & Wilkins |location = Philadelphia; Baltimore |isbn = 978-0-7817-5003-5 |page = 329 |url = https://books.google.com/books?id=QOeHP5Ky610C&pg=PA329 |edition = 4th |url-status = live |archive-url = https://web.archive.org/web/20170908184817/https://books.google.com/books?id=QOeHP5Ky610C&pg=PA329 |archive-date = 2017-09-08 }}</ref> Evidence to support this is weak, however.<ref name="Dav2018" /> [[Glyceryl trinitrate (pharmacology)|Glyceryl trinitrate]] ointment after the procedure helps both with pain and with healing.<ref>{{cite journal |last = Ratnasingham |first = K |author2 = Uzzaman, M |author3 = Andreani, SM |author4 = Light, D |author5 = Patel, B |title = Meta-analysis of the use of glyceryl trinitrate ointment after haemorrhoidectomy as an analgesic and in promoting wound healing |journal = International Journal of Surgery |year = 2010 |volume = 8 |issue = 8 |pages = 606–11 |pmid = 20691294 |doi = 10.1016/j.ijsu.2010.04.012 |doi-access = free }}</ref>
# '''Doppler-guided [[transanal hemorrhoidal dearterialization]]''' is a minimally invasive treatment using an ultrasound Doppler to accurately locate the arterial blood inflow. These arteries are then "tied off" and the prolapsed tissue is sutured back to its normal position. It has a slightly higher recurrence rate but fewer complications compared to a hemorrhoidectomy.<ref name="Review09" />
# '''Stapled hemorrhoidectomy''', also known as '''[[stapled hemorrhoidopexy]]''', involves the removal of much of the abnormally enlarged hemorrhoidal tissue, followed by a repositioning of the remaining hemorrhoidal tissue back to its normal anatomical position. It is generally less painful and is associated with faster healing compared to complete removal of hemorrhoids.<ref name="Review09" /> However, the chance of symptomatic hemorrhoids returning is greater than for conventional hemorrhoidectomy,<ref name="Jaya2006">{{cite journal |last = Jayaraman |first = S |author2 = Colquhoun, PH |author3 = Malthaner, RA |title = Stapled versus conventional surgery for hemorrhoids |journal = Cochrane Database of Systematic Reviews |date = Oct 18, 2006 |volume = 2010 |issue = 4 |pages = CD005393 |pmid = 17054255 |doi = 10.1002/14651858.CD005393.pub2 |pmc = 8887551 }}</ref> so it is typically recommended only for '''grade II or III disease'''.<ref name="NG2011" />