Piles or hemorrhoids are a great nuisance when they reach a higher stage. In the 3rd and 4th stage they protrude from the anus and cause a lot of discomfort. This is where surgery comes in. While the first two stages are treated by ointments and creams, injection sclerotherapy and infrared coagulation as well as rubber band ligation, stages 3 and 4 need to be operated.


Like in many popular diseases there are also many surgical approaches and techniques to deal with piles. I prefer a circular mucosectomy technique, the “Longo” operation, where the prolapsing mucosa above the actual hemorrhoid is resected with a stapling device. If performed correctly this technique is associated with less pain and shorter disability and hospital stay as well as lower recurrence rates than any other procedure. see figure 1 see figure 2 see figure 3 see figure 4


An alternative technique I use, especially in very big 4th degree piles, is the Ferguson hemorrhoidectomy.