ABSTRACT
Hemorrhoids are classified as internal, external, or mixed. Internal Hemorrhoids (IHs) are vascular cushions found above the dentate line, and External Hemorrhoids (EHs) are found below the dentate line. This chapter focuses on recent evidence-based data on the treatment of hemorrhoids after the failure of conservative management. In 2014, Vidal et al. published a novel treatment modality for symptomatic hemorrhoids using endovascular embolization coined “emborrhoid”. This approach allows the interventionalist to identify the arterial branches of the hemorrhoidal cushions for embolization while reducing trauma seen in excisional approaches. Surgical intervention is usually reserved for patients who fail nonoperative management. Excisional hemorrhoidectomy has long been considered the mainstay operation; however, the approach to excision has dramatically evolved to include the use of stapling and energy devices. The exact etiology of thrombosis remains undefined but has been linked with increased intravenous pressure within the hemorrhoidal plexus that leads to rupture of the endothelial lining and subsequent thrombosis.
