Multidisciplinary Journal of Science and Technology

SURGICAL MANAGEMENT OF HEMORRHOIDS: CURRENT APPROACHES AND ADVANCEMENTS

Teshayev Oktyabr Ruxullayevich

Professor of the Department of Surgical Diseases in Family Medicine, Tashkent State Medical University (TSMU), Tashkent, Uzbekistan

Murodov Alijon Salimovich

Doctor of Medical Sciences of the Department of Surgical Diseases in Family Medicine, Tashkent State Medical University (TSMU), Tashkent, Uzbekistan

Shermamatova Azima Ulug‘bekovna

2nd Year Student of the Department of Surgical Diseases in Family Medicine, Tashkent State Medical University (TSMU), Tashkent, Uzbekistan

Keywords: hemorrhoidal pathology, Anorectal vascular anomalies, Excisional hemorrhoidectomy, Minimally invasive proctological interventions, Stapled hemorrhoidopexy (SH/PPH)

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Abstract

Hemorrhoidal disease, a common vascular pathology of the anorectal region, presents variably from asymptomatic cushions to severe prolapse and bleeding, affecting 4.4-36.4% of adults worldwide, with higher rates in Western populations due to low-fiber diets, inactivity, and rising obesity. When conservative measures—such as ≥30 g/day fiber intake, phlebotonics (e.g., diosmin), and office procedures like rubber band ligation (RBL) or infrared coagulation (IRC)—fail, especially for Goligher grades III-IV with persistent prolapse, surgery is indicated to relieve symptoms, restore anatomy, and improve health-related quality of life (HRQoL).

This systematic review, based on peer-reviewed studies from 2023 to mid-2025, highlights the shift from traditional excisional hemorrhoidectomy to minimally invasive options, aiming to reduce postoperative pain, recovery time, and complications like stenosis or incontinence. Key techniques include Milligan-Morgan/Ferguson excisions, stapled hemorrhoidopexy (SH/PPH), transanal hemorrhoidal dearterialization (THD) with Doppler-guided ligation and mucopexy, laser hemorrhoidoplasty (LHP) using 980-1470 nm lasers, radiofrequency ablation (RFA), and ALTA sclerotherapy hybrids with selective excision.

Meta-analyses and RCTs from PubMed Central and Cochrane confirm excisional methods offer superior longevity with 1-5% recurrence at 36-60 months (95% CI: 0.8-4.2%), but at costs of high VAS pain (6.5-8.5) and 21-35 day recovery. Minimally invasive approaches like THD and LHP lower VAS to 1.5-4.0, enable 3-12 day reintegration, and keep complications <5% (e.g., urinary retention OR 0.45, 95% CI 0.32-0.64), though recurrence rises to 8-18%. Adjuncts such as LigaSure, harmonic scalpels, robotics, and AI planning cut bleeding by 40-60% and procedure time by 15-25%.

Challenges include inconsistent reporting, limited long-term data (>24 months) for hybrids, and costs (e.g., $1,500-3,500 for THD) hindering access in low-resource areas. The review recommends patient-specific algorithms incorporating comorbidities, grading, and expertise to maximize benefits and minimize risks. Future directions involve bioengineered agents, microbiome-based prevention, and large RCTs to strengthen guidelines, potentially easing the >$1.2 billion annual U.S. economic burden.

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