Comparative analysis of surgical methods for the treatment of hemorrhoidal disease stages III–IV: a literature review

Hemorrhoidal disease (HD) is one of the most common anorectal pathologies, affecting 5–10 % of the population, predominantly in the 45–65 age group. Surgical treatment is indicated for stages III–IV of the disease; however, the choice of the optimal method remains a subject of debate. Results. Hemorrhoidopexy (Longo procedure) is characterized by low postoperative pain and rapid rehabilitation; however, at a mean follow-up of 15 years, recurrence of at least one hemorrhoidal symptom was recorded in 47,4 % of patients, and surgical re-intervention was required in 15,2 % of cases. Transanal Doppler-guided dearterialization (THD) is effective primarily in stages II–III, with a recurrence rate of 12–27 % and a low rate of postoperative complications. Conventional hemorrhoidectomy remains the gold standard for complicated forms and stage IV disease, with a recurrence rate of 2–8 %; however, it is associated with significant postoperative pain and prolonged rehabilitation. The use of modern modifications employing radiofrequency and ultrasonic energy (LigaSure, Harmonic Scalpel) reduces intraoperative blood loss and the intensity of postoperative pain. Conclusion. The choice of surgical strategy for HD stages III–IV should be determined by the degree and stage of the disease, the presence of complications, and the level of proficiency with the technique. Further studies are needed to develop a personalized approach, assess long-term outcomes and recurrence rates for various treatment methods, and clarify the indications for each of them.