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Surgery For Hemorrhoids 


Hem Surg

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Two Common Surgical Techniques

Milligan-Morgan Technique

This medical procedure was orinated in the United Kingdom by both Dr. Milligan and Dr. Morgan back in 1937. It is the most common procedure done even now for hemorhoids. This procedure excises the three major hemorrhoidal blood vessels. Avoiding stenosis (a narrowing of the blood vessel), there are three pear-shaped incisions which are left open and separated by mucosae (thin layer of smooth muscle) and bridges of skin. This is the surgery that is used as a standard of which others are compared.

Ferguson Technique

A physician by the name of Dr. Ferguson modified the Milligan-Morgan Hemorrhoid surgery technique in 1952. This procedure either totally or partially closes incisions with absorbable sutures. A device called a retractor is used to expose the hemorrhoidal tissue, which then removed. The tissue that remains is sealed through coagulation. It has been found that this technique does not bring real advantages over the Milligan-Morgan technique because of the commality of breakage of the sutures. Furthermore, there is no difference in healing time or reduction in pain.


 Stapled Hemorrhoidopexy or PPH Procedure

PPH stands for Procedure for Prolapse and Hemorrhoids. It is also referred to as Stapled Hemorrhoidectomy and Circumferential Musosectomy. This surgical technique came a ways from the Morgan-Milligan and the Ferguson techniques. It was developed in the early 1990's and focuses on reducing the prolapse of hemorrhoidal tissue. It excises a band of prolapsed and mucosa membrane with a circular stapling device. The prolapsed tissue is drawn into a surgical instrument which enables excess tissue to be removed as the remaining hemorrhoidal tissue gets stapled back into its correct anatomical position.

The device used is called a "Circular Anal Dialator" and is used to reduce the prolapse anal skin and areas of the anal mucous membrane. After the obstruction area is removed, the prolapsed membrane moves into the Dilator Lumen (artery closure system). After this takes place, another surgical instrument called the Purse-String Suture Anoscope is inserted through the dilator. This device pushes the prolapsed mucous back and up against the rectal wall. The mucous membrane that comes through the anascope can be held in a suture that only holds mucous membrane. By rotating this device, it makes it possible to suture the whole anal circumference in a "Purse-String" suture.

The Hemorrhoidal Circular Stapler is opened completely and inserted through the dilator. It is then adjacent to the Purse-String Suture. Each end of the suture is then exteranally tied closed.

Next, placing slight pressure on the suture, the prolapsed membrane is pulled into the circular stapling device. As the device is tightened, the prolapse gets stapled. The device is held in place for half of one minute and then fires off a staple. It does not release immediately enabling homeostasis since the area is still held in place.

The stapler shoots off double staggered rows of titanium staples into the tissue. A circular knife is then used to cut away any extra tissue. It is a column of mucosa that is removed from the upper anal canal. In the last stage, an anascope is used to review the surgical procedure and to see if there is any bleeding still taking place. If there is continual bleeding, further absorbable sutures are anatomically inserted.


Circular Anal Dilator with Purse-String Suture Anascope


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 Rubber Band Ligation

Elastic bands are wrapped around the base of a hemorrhoid to cut off its blood supply. Within several days, the hemorrhoid dies and falls off. Some patients experience pain and bleeding after the treatment. It does not cure the cause of hemorrhoids so they usually reappear.

Infrared Coagulation 

An Infrared beam is used to burn off some tissues to cut off the blood supply to the hemorrhoid. Five to six treatments (one per week) are necessary. Although it's advertised as pain-free, many patients complain of intense pain during treatment. It does not cure the cause so the hemorrhoids usually reappear.


Hemorrhoidectomy is an outpatient sugery that is done to remove hemorrhoids. It is done using anesthesia or "spinal anesthesia" for the pain associated with the surgery. Statistics have shown that this treatment may cause incontinence later in life so it is recommended only for severe cases. Many patients complain of intense pain during recovery, so it should be the last resort. The surgery is often done with scalpel, laser or cautery pencil and there are two kinds of procedures used.

The first procedure uses a circular stapeling device. It does not make any incisions in the patient. The hemorrhoid is raised up and the device simply staples underneath it.

Hem Surgery StapleHemorrhoid Surgical Stapler


The second procedure is where there are incisions made around the hemorrhoid and the hemorrhoid is then removed. At the same time, the swollen vein is tied together to stop any bleeding. The affected area is then stitched back together.

Nurse & Needle

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When Should You Have Surgery For Hemorrhoids?

Doctors have come up with a grading system in describing the depth or severity of the hemorrhoid case. The severity is often in Stage three and absolutly in Stage Four. It is labeled as follows:

First Degree Hemorrhoids: Hemorrhoids that are bleeding but are not prolapsing.


Second Degree Hemorhoids: Hemorrhoids that have prolapsed but actually retract by themselves with bleeding or without bleeding.

Third Degree Hemorrhoids: Hemorrhoids that have the ability to be pushed back in by a finger.

Fourth Degree Hemorrhoids: Hemorrhoids that can not be pushed back in at all and are often "thrombosed." This means that it contains blood clots and is a very serious condition. It can also be a case of the rectal lining being pulled through the anus.

It would be a decision between you and the doctor of if you need to have the surgery done and which kind is best for you.

Know your options and question your doctor with knowledge so you have a thorough understanding of the procedures and what to do.


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