REVIEW ARTICLE Clinical Outcome Following Hemorrhoid Surgery: a Narrative Review Marcello Picchio & Ettore Greco & Annalisa Di Filippo & Giuseppe Marino & Francesco Stipa & Erasmo Spaziani Received: 6 March 2014 /Accepted: 23 April 2014 /Published online: 10 May 2014 # Association of Surgeons of India 2014 Abstract Surgical therapy guaranties satisfactory results, which are significantly better than those obtained with con- servative therapies, especially for Grade III and IV hemor- rhoids. In this review, we present and discuss the results of the most diffuse surgical techniques for hemorrhoids. Traditional surgery for hemorrhoids aims to remove the hemorrhoids, with closure (Fergusson’ s technique) or without closure (Milligan–Morgan procedure) of the ensuing defect. This traditional approach is effective, but causes a significant post- operative pain because of wide external wounds in the inner- vated perianal skin. Stapled hemorrhoidopexy, proposed by Longo, has gained a vast acceptance because of less postop- erative pain and faster return to normal activities. In the recent literature, a significant incidence of recurrence after stapled hemorrhoidopexy was reported, when compared with conven- tional hemorrhoidectomy. Double stapler hemorrhoidopexy may be an alternative to simple stapled hemorrhoidopexy to reduce the recurrence in advanced hemorrhoidal prolapse. Transanal hemorrhoidal deartertialization was showed to be as effective as stapled hemorrhoidopexy in terms of treatment success, complications, and incidence recurrence. However, further high-quality trials are recommended to assess the efficacy and safety of this technique. Keywords Hemorrhoids . Surgery . Indication . Resection . Stapler Indication to Surgery Anal cushions are normal structural components of the anal canal, serving as a conformable plug to ensure its complete closure. Hemorrhoids should be considered pathologic when symptomatic prolapse occurs. The need for treatment is influ- enced by the severity of symptoms. Surgery is the most effective treatment for hemorrhoids and is particularly recommended in prolapsing piles during defe- cation that may be reduced manually (Grade III) and irreduc- ible hemorrhoids (Grade IV) [1]. Other indications to surgery are failure of nonoperative management, patient preference, and concomitant conditions (such as fissure or fistula) that require surgery. Contraindications are generally relative. Sur- gical option should be carefully proposed if anesthesiologic risk is high, serious hemostatic, and/or coagulative disorders are present, and the presence of anal sphincter and/or conti- nence impairment may lead to postoperative occurrence and/ or worsening of incontinence. Caution is also required if Crohn’ s disease is present [2]. Techniques Numerous methods have been proposed for the surgical ther- apy of hemorrhoids. At present anal dilatation and lateral internal sphincterotomy, based on the hypothesis that anal sphincter hypertone was an etiologic factors contributing to M. Picchio : E. Greco : G. Marino Department of Surgery, Civil Hospital “P. Colombo”, Via Orti Ginnetti 7, 00049, Velletri Rome, Italy F. Stipa Department of Surgery, Hospital “S. Giovanni-Addolorata”, Via dell’Amba Aradam 9, 00184 Rome, Italy A. Di Filippo : E. Spaziani Department of Surgery, Sapienza University of Rome, Polo Pontino Via Firenze, s.n.c., 04019, Terracina Latina, Italy M. Picchio (*) Via Giulio Cesare, n. 58, 04100 Latina, Italy e-mail: marcellopicchio@libero.it Indian J Surg (December 2015) 77(Suppl 3):S1301–S1307 DOI 10.1007/s12262-014-1087-5