Written and medically reviewed by: Assoc. Prof. Cengiz Dibekoğlu, MD, General SurgeryLast updated:
Hemorrhoids — Hemorrhoid Surgery Methods
Excisional hemorrhoidectomy first; office procedures and selected stapled use
Care is stepwise: conservative measures and office procedures first. Excisional hemorrhoidectomy — open or closed — is the standard durable operation when advanced symptomatic disease fails conservative care. LigaSure and similar devices are energy tools used within excisional hemorrhoidectomy, not a separate treatment paradigm. Stapled hemorrhoidopexy is not a routine first-line surgical option for every patient and is discussed only in selected internal-prolapse patterns.
Educational schematic. Some structures may be simplified or emphasized for clarity; not an exact anatomical depiction.
© Cengiz Dibekoğlu — illustrative; not for unauthorized use
Figure summary
- This educational figure shows: Hemorrhoid surgery.
- Related figures on this page: LigaSure option, Longo (stapler).
Related educational figures
Tap a figure to enlarge.
LigaSure option Educational schematic. Some structures may be simplified or emphasized for clarity; not an exact anatomical depiction.
© Cengiz Dibekoğlu — illustrative; not for unauthorized use
Figure summary
LigaSure option
Longo (stapler) Educational schematic. Some structures may be simplified or emphasized for clarity; not an exact anatomical depiction.
© Cengiz Dibekoğlu — illustrative; not for unauthorized use
Figure summary
Longo (stapler)
Step-by-step overview
- 1
Assessment
Grade, symptoms, and endoscopy when indicated decide the method.
- 2
Anesthesia
Spinal, general, or selected local anesthesia with sedation.
- 3
Operation
Standard excision, LigaSure, or stapler (Longo) as planned.
- 4
Early aftercare
Pain control, soft stools, sitz baths, and hygiene are planned before discharge.
Key points
Open hemorrhoidectomy
Classic excision leaves wounds open to heal. Still a gold standard for advanced and mixed internal–external disease. Recurrence is low; early pain can be more noticeable.
Closed hemorrhoidectomy
After excision the mucosa is sutured closed. Selected cases may gain comfort or wound-care advantages. The goal remains symptom relief with sphincter protection — not oncology.
LigaSure-assisted excision
Energy sealing divides vessels within excisional hemorrhoidectomy and may shorten operative time. It is a tool inside standard excision — not a separate disease pathway.
- Key note inside
Stapled hemorrhoidopexy — selected use only
Not recommended as a routine first-line surgical option for every patient. May be discussed in selected internal-prolapse patterns after counseling on recurrence and complication profiles versus excisional hemorrhoidectomy.
How the choice is made
Grade, mixed external disease, prior office treatments, and your priorities are weighed together. Excisional hemorrhoidectomy has the strongest durable profile for advanced disease; stapled lift is not an equal default.
- Grades I–II → conservative and office care first
- Advanced / mixed disease → excisional hemorrhoidectomy
- Selected internal prolapse → stapled use may be discussed, not assumed
Frequently asked questions
Is LigaSure “not real surgery”?
It is still excisional surgery with real wounds and recovery — energy sealing changes hemostasis, not the need for soft-stool aftercare.
Which method has the lowest recurrence?
Excisional hemorrhoidectomy typically has lower recurrence than stapled lift techniques; early pain trade-offs are discussed case by case.
More chapters in this hub
Hemorrhoid Symptoms
What patients notice — and which warning signs need urgent care
Hemorrhoid Diagnosis
Exam, anoscopy, and when colonoscopy is required
Hemorrhoid Treatment
How treatment options are matched to risk, stage, and goals
LigaSure Hemorrhoidectomy
Energy-device-assisted excisional hemorrhoidectomy
After Hemorrhoid Surgery
Pain control, soft stools, and when to call
Hemorrhoid Recurrence
Honest rates by method and how to protect results
Appointment / info
This page is for education. It is not medical advice and does not replace a visit with your physician.
Medical editor: Assoc. Prof. Cengiz Dibekoğlu, MD · Last medically reviewed: August 2026 · English patient-education chapter.