UPDATED MANAGEMENT OF HEMORRHOIDS

Abstract

Hemorrhoids are a very common anorectal condition defined as the symptomatic enlargement and distal displacement of the normal anal cushions. They affect millions of people around the world, and represent a major medical and socioeconomic problem. Hemorrhoids are a series of 3 cushions in the anal canal, located in the left lateral, right anterior, and right posterior positions. The theory of sliding anal canal proposes that hemorrhoids develop when the supporting tissues of the anal cushions disintegrate or deteriorate. Therapeutic treatment of hemorrhoids ranges from dietary and lifestyle modification to radical surgery, depending on degree and severity of symptoms Medical treatment include Oral flavonoids, Oral calcium dobesilateand Topical treatment. A number of effective nonsurgical approaches are available for patients with hemorrhoids as Sclerotherapy, Rubber band ligation, Infrared coagulation, Radiofrequency ablation and Cryotherapy. Excisional hemorrhoidectomy is the most effective treatment for hemorrhoids with the lowest rate of recurrence compared to other modalities Plication involves oversewing of hemorrhoidal mass and tying a knot at the uppermost vascular pedicle. Doppler-guided hemorrhoidal artery ligation a new technique based on doppler-guided ligation of the terminal branches of the superior hemorrhoidal artery was introduced in 1995 as an alternative to hemorrhoidectomy Stapled hemorrhoidopexy (SH) has been introduced since 1998.