الفهرس 
Anatomy and PhysiologyOnly 14 pages are availabe for public view
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Abstract
Hemorrhoidal disease is one of the most common anorectal conditions. Preventive medicine plays an important role when addressing this issue. Non operative measures can be offered to patients with mild symptoms or minimally symptomatic hemorrhoids. When dietary modifications and nonsurgical treatments fail to improve symptoms, surgical therapy should be considered. Surgical treatment should be individually tailored to each patient according to the degree of symptoms, coexisting anorectal diseases, and the degree of external anorectal component of the disease. The physician should remember that the most common presenting symptom of hemorrhoidal disease (rectal bleeding) should not be automatically attributed to the hemorrhoids, and a thorough evaluation of the gastrointestinal tract is mandatory when there is suspicion of malignancy or other gastrointestinal disease. Currently, there is a variety of surgical treatments that are available to treat this disease, and most have similar success rates. (Kaidar Person et al, 2007)
Although haemorrhoidectomy is currently the ‘gold standard’ surgical treatment for haemorrhoids, because of its’ proven effectiveness, there is a rapid expansion in the use of modern, new techniques. Post operative pain following haemorrhoidectomy appears to be the most important motivating factor in the drive to acquire better treatment options. (Evans et al, 2008)
The procedure for prolapsing hemorrhoids is a relatively new surgical technique that offers the patients surgical treatment with less postoperative pain, shorter hospital stay and recovery time, and a complication rate similar to that with conventional hemorrhoidectomy. Albeit rare, devastating complications have been described with this procedure, so only experienced surgeons should perform PPH at this time. (Kaidar Person et al, 2007)
Manual hemorrhoidopexy procedure will prove successful in the future, since it is easy to perform and inexpensive and resolves the hemorrhoidal disease in most cases and can be associated with the traditional excisional technique in cases of grade IV hemorrhoid therefore provides a certain degree of versatility. (Carlo Tagariello, 2011).
Overall HAL has so far proven to be a painless, safe and efficacious method to treat haemorrhoids particularly if bleeding is the main complaint. The techniques effectiveness in treating prolapse symptoms is not clear. Combining HAL with a recto anal repair (HAL-RAR) potentially resolves this issue and still enables the procedure to be relatively pain free although at present there is no supporting published data. To provide the most effective surgical treatment it is necessary to choose the appropriate technique tailored to the individual patients clinical symptoms. (Evans et al, 2008)