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Hépato-Gastro & Oncologie Digestive

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Minimally invasive hemorrhoid surgery: the end of hemorrhoidectomy reign? Volume 24, issue 10, Décembre 2017

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Authors
Groupe hospitalier Paris Saint-Joseph, service de proctologie médico-chirurgicale, 185 rue Raymond Losserand, 75014 Paris
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Minimally invasive haemorrhoid surgery techniques are a recent alternative to Milligan-Morgan haemorrhoidectomy, and help to mitigate the painful and burdensome aftermath of the latter. However, this advantage comes at a cost of more restrictive indications and a risk of more frequent failure and recurrence. For this reason, a tailored approach is needed in order to find the best compromise for the patient between the immediate postoperative constraints and the therapeutic result. Several techniques are currently available. At the top of the list are stapled hemorrhoidopexy and doppler-guided haemorrhoidal artery ligation with or without mucopexy, which give broadly similar results in terms of efficacy. However, exceptional but serious complications reported with stapled hemorrhoidopexy have caused it to lose ground to doppler-guided ligation. Other even newer techniques, such as laser haemorrhoidoplasty, HeLP® and the Rafaelo® procedure, have attractive principles, but their initial promising results deserve to be confirmed by more robust studies.