Mini-Invasive Surgery Eases Hemorrhoid Pain Fast

Medscape

11-07-2025

At a recent session of the National Academy of Surgery, experts highlighted that minimally invasive techniques are playing an increasingly central role in proctologic surgery. Béatrice Vinson-Bonnet, MD, visceral and digestive surgeon at Poissy-Saint-Germain-en-Laye Community Hospital, noted that treatment for hemorrhoidal disease has advanced significantly, moving away from traditional hemorrhoidectomy toward less invasive, technology-driven procedures.
'Thanks to advances in technology, all surgical approaches now aim to be as minimally invasive as possible,' said Vinson-Bonnet. 'However, before considering surgery, we prioritize medical treatment for hemorrhoidal disease — addressing intestinal transit disorders, particularly constipation, and educating patients on proper bowel habits.' Surgery is considered only when these measures fail to provide relief.
Until the 2000s, hemorrhoidectomy was the primary surgical treatment for hemorrhoidal disease. Since then, less painful alternatives have emerged, including nerve blocks and stapling all designed to avoid external incisions and reduce postoperative pain and recovery times.
One such option is the pudendal nerve block, which involves anesthetizing the pudendal nerve using a long-acting agent. This provides 12-24 hours of postoperative pain relief following hemorrhoid surgery. However, stool passage over the surgical site can still cause significant discomfort between days 3 and 10, and complete healing may take 6 weeks, Vinson-Bonnet noted.
In 1998, Antonio Longo, MD, colorectal surgeon from Italy, and director of the European Centre for Coloproctology and Pelvic Diseases in Vienna, Austria, introduced stapled hemorrhoidopexy. This surgical technique uses a circular stapler to remove a circumferential ring of rectal mucosa above the hemorrhoids, repositioning prolapsing internal hemorrhoids to their normal anatomical position.
'Although innovative, stapled hemorrhoidopexy has been linked to serious complications and is now often replaced by a simpler technique that uses an anoscope to locate and ligate small rectal arteries,' said Vinson-Bonnet.
According to Vinson-Bonnet, these techniques are limited to internal hemorrhoids and are not appropriate for large external hemorrhoids and do not allow the removal of large external hemorrhoids, often caused by thrombosis, particularly after childbirth in women. Another drawback is recurrence, with symptoms returning to up to 20% of patients within 2 years.
'Thermofusion, which uses microwave energy to completely dry out internal bleeding, is an emerging technique. While still under evaluation, it is already being used in clinical practice,' she added. 'Other recent methods, such as radiofrequency — and, more rarely, laser — are also employed,' said Vinson-Bonnet.
Professor Émilie Duchalais, MD, PhD, digestive surgeon at Nantes University Hospital in Nantes, France, presented recent developments in minimally invasive treatment for fecal incontinence. She leads clinical and translational studies on this condition at the Institute of Digestive System Diseases.
'Sacral neuromodulation and Botox are two techniques mainly reserved for patients with fecal incontinence,' Duchalais explained. These are considered second- or third-line treatment options and are used only when medical treatment or rehabilitation has failed.
Sacral neuromodulation involves stimulating nerve roots near the sacrum, which engage in sphincter control and rectal sensitivity. 'Five to 10 years after implantation, long-term improvement is seen in 50%-70% of patients,' said Duchalais.
A major advantage of this method is that it allows a trial phase. Electrodes are temporarily implanted at the targeted site, enabling patients to evaluate the effectiveness of the treatment over 2-3 weeks. 'If the patient experiences at least a 50% reduction in incontinence episodes during this period, the device is permanently implanted. The system, similar to a pacemaker but placed in the buttocks, typically remains in place for at least 5 years, depending on the battery life,' she said.
'Urologists commonly use Botox to treat overactive bladder. Botox works by blocking acetylcholine, preventing muscle contractions, and reducing urinary leakage. In the rectum, Botox has a similar effect — blocking muscle activity and nerve signals to improve control in patients with fecal incontinence,' Duchalais noted.
Although effective, Botox provides only temporary relief. 'Its effects typically last 6-9 months. However, a recent study showed that after 5 years, patients required injections only once every 3 years on average,' she added.
Another approach currently under investigation is fat injection. 'Researchers are studying autologous fat injection into the anal sphincter as a potential treatment for urge incontinence. The technique aims to restore sphincter tone by harnessing the regenerative potential of stem cells found in fat tissue.' A clinical trial led by Rennes University Hospital, Rennes, France, is evaluating this method, and the early findings are promising. However, this approach remains experimental,' said Duchalais.