Minimally Invasive Procedures for Hemorrhoids

Maher A. Abbas, MD
Compassion, Excellence, Integrity

Diplomate, American Board of Surgery

Diplomate, American Board of Colon and Rectal Surgery

Fellow, American College of Surgeons

Fellow, American Society of Colon and Rectal Surgeons

Honorary Fellow, Philippine Society of Colon and Rectal Surgeons

Honorary Member, Surgical Section Serbian Medical Association

“The best interest of the patient is the only interest to be considered…”W.J. Mayo, MD (Founder of the Mayo Clinic)


Dr. Maher Abbas is an American Board Certified Colon and Rectal Surgeon who performs the latest and most advanced procedures to treat conditions affecting the small intestine, colon, rectum, and anus.  He is a leader in minimally invasive and endoscopic surgery. With over 18,000 operations and procedures experience, he provides state of the art treatment to his patients.


What is the best treatment for hemorrhoids?

Hemorrhoids are very common.  The good news is that the majority of patients can be treated medically without the need for a procedure or surgery.  Dr. Maher Abbas believes in customizing the care according to the needs of the patient.  He recommends to each patient what is best based on a personalized approach.    Dr. Maher Abbas advises a procedure or an operation when the symptoms are very severe, recurrent, or for patients who do not improve with medications.   When an intervention is needed, a minimally invasive procedure is considered for patients who can benefit from it.


What are the benefits of minimally invasive procedures for hemorrhoids?

Minimally invasive procedures yield many benefits including less or no pain, faster recovery, and earlier return to work.   Some interventions are done in the office without the need for hospitalization and patients can return to work the day following the office-based procedure.  For procedures performed in the operating room, most patients are able to go home within 24 hours of the procedure and can often resume work within 1 week.


What are minimally invasive procedures for hemorrhoids?

There are 2 types of minimally invasive procedures for hemorrhoids:

1. Office-based interventions. Over the years, many office based procedures have been introduced for the treatment of internal hemorrhoids.  The most effective procedures are rubber band ligation [Figure 1] and infrared coagulation [Figure 2].  Both painless procedures are performed in the clinic with the patient awake.  Rubber band ligation entails placing a rubber band along the upper aspect of the internal hemorrhoid in order to shrink it.  Infrared coagulation delivers a few bursts of heat energy using a small probe to the areas above and surrounding the internal hemorrhoids.  The infrared light energy quickly coagulates the vessels causing the hemorrhoids to shrink within a few weeks.   While many commercial clinics refer to infrared coagulation as “laser” for marketing purposes, it is not a laser intervention!   Since most patients have multiple internal hemorrhoids, often more than 1 session is needed to obtain relief from symptoms.  During each session, 1 to 2 hemorrhoids are treated.  The treatment can be repeated a few weeks later if needed.  The risks of bleeding or infection are minimal.  Patients can resume their daily activities the following day.  Post-procedural care includes Sitz Bath for 1 to 2 days, acetaminophen pills (Tylenol, Adol, Panadol) if any discomfort, and keeping the stool soft with High Fiber Food and Fiber Supplements.

Figure 1 – Rubber band ligation of internal hemorrhoids

Figure 2 – Infrared coagulation for internal hemorrhoids

2. Operating room procedures. Minimally invasive laser treatment (LHP®) and transanal ligation are 2 effective procedures offered by Dr. Maher Abbas.  Laser hemorrhoids treatment entails delivering laser energy [Figure 3] into the center of each hemorrhoid using a fine needle like probe [Figure 4].  If there are very large protruding hemorrhoids, a lifting procedure for the hemorrhoids (hemorrhoidopexy, mucopexy) can be done at the same time if needed.  Transanal ligation involves internal suturing of the hemorrhoids to limit their blood supply.  Ligation lead to shrinking and lifting of the hemorrhoids.   This second procedure has many different variations known by various names such as THD (transanal hemorrhoidal dearterialization), transanal hemorrhoidopexy, and conventional transanal ligation.  These procedures are typically done in the operating room under a general or spinal anesthetic.  Patients are usually discharged home the same day or within 24 hours.

Figure 3 – Laser energy machine

Figure 4 – Laser probe

Is every patient a candidate for minimally invasive procedures for hemorrhoids?

A minimally invasive procedure for hemorrhoids is a good option for patients with internal hemorrhoids that protrude and/or cause bleeding.  Patients with extensive bulky internal hemorrhoids and/or patients with large external hemorrhoids are best served by other techniques.

Why seek expert care with a board certified proctologist and colorectal surgeon?

The anal area is a delicate part of the body.  It is important to seek care to heal, relieve symptoms, and to exclude other more serious causes of anal symptoms.  The expertise of the doctor is critical in order to ensure the best result and minimize the risk of recurrence, non-healing, infection, and developing any weakness in the anal muscle.  Proctology is a highly specialized field.

Dr. Maher Abbas is an expert in the treatment of diseases of the colon, rectum, and anus.  With over a 30-year career in the USA, he has completed advanced training in Proctology and is American Board Certified in Colon and Rectal Surgery.  Dr. Maher Abbas is a Fellow of the American Society of Colon and Rectal Surgeons.

If you would like to schedule a consultation with Dr. Maher Abbas to discuss your case, click here.



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