Evolution in the surgical management of hemorrhoidal disease

Hemorrhoidal disease is a very common condition requiring surgical management in approximately 10% of cases. Despite its long history and high prevalence, we are still trying to identify the best treatment. Earlier surgical approaches were soon abandoned and now only detain an historic significance. For long, proctologists have given their preference to hemorrhoidectomy that was gradually perfected through the years. The true innovation came in 1937, with the famous Milligan-Morgan hemorrhoidectomy, still one of the leading interventions for treatment of hemorrhoids. Less fortune encountered alternative techniques, such as the Whitehead hemorrhoidectomy, and closed and semi-closed techniques. Later on, the advent of a new concept of the pathogenesis of hemorrhoidal disease has brought to the development of stapled prolassectomy techniques. This approach has encountered both supporters and detractors between the experts in this field and has received a strong impulse by the emerging trend towards "day-surgery". Today the search for the best surgical technique for hemorrhoidal disease is far from being over and witnesses the introduction of new techniques for hemorrhoidal dissection. The choice of the best strategy remains in the hands of the clinician in the modern conception of tailored surgery.