Minimally Invasive Treatments of Hemorrhoidal Disease

Context: minimally invasive procedures are used for treatment of nonresponsive hemorrhoids to conservative therapy. these opd (out-patient department) procedures are effective to eradicate the hemorrhoid symptoms with minimal postoperative pain and complications.evidence acquisition: in this review, data base of pubmed, and medline were searched with time limitation(2002- 2012). recent articles in english journals were reviewed to evaluate and compare these minimally invasive procedures including rubber band ligation (rbl), infrared coagulation (irc), direct current electrotherapy (dce), and sclerotherapy.results: upon the articles, 881 were treated with rbl, 454 with irc, 1203 with dce, and 2372 with sclerotherapy. postoperative pain, which is a common complication of hemorrhoidectomy, was 3-25% in rbl, 2.13-4.3% in dce, and 1.8-7% in sclerotherapy. pain was mild to moderate and rarely needed analgesic. postoperative rectal bleeding was seen in 1.26-32.4% of patients treated with rbl. recurrence of preoperative symptoms was 1.9-39% for rbl, 6.9-21% for sclerotherapy, and 2.9-3% for dce. postoperative complications were minor in all procedures and for sclerotherapy it was seen in 6.9-21% of patients. success rate was 69.4-96.4% in rbl, 80% in irc, 89.3-99.7% in sclerotherapy, and 98.2% in dce. patient’s satisfaction was 98% for dce versus 99% for rbl and irc. operation time for each tag of hemorrhoid was 4.5-10 minutes for dce, regarding different amplitudes of currency and degrees of hemorrhoid, and 13 minutes for sclerotherapy and not reported for other methods.conclusions: minimally invasive procedures are used depending on surgeon’s experience and preference. these modalities are comparable from different aspects. the cost of treatment and availability of equipment may affect the