Colorectal LLM Wiki

Browse
Home / Sources / ASCRS Ch11 - Hemorrhoids
Source created 2026-08-24 · updated 2026-08-24
colorectalhemorrhoidsanorectaltextbookreferenceASCRS

ASCRS Ch11 — Hemorrhoids

Citation: Davids JS, Ridolfi TJ. "Hemorrhoids." In: Steele SR, et al. (eds.), The ASCRS Textbook of Colon and Rectal Surgery, 4th ed. Springer Nature Switzerland AG; 2022. pp. 209–228 (PDF pp. 219–238 of the combined textbook file). Source file: raw/ASCRS Textbook 4th Ed.pdf (full 1,198-page textbook; cite by page range within the single PDF). First chapter of Part II ("Anorectal Disease") — Part I ("Perioperative/Endoscopy") ended with Chapter 10.

Type: Specialty textbook chapter (reference/background, not primary literature).

Scope

Eleventh chapter of the sequential full-textbook ingest (see ASCRS Ch01 - Anatomy and Embryology for the ingest's scope/plan). Covers hemorrhoid epidemiology, anatomy/grading (internal grades I–IV, external, strangulated, thrombosed), innervation and continence role, pathogenesis, clinical presentation and workup (incl. malignancy exclusion), medical management, office-based procedures (RBL, IPC, bipolar diathermy, sclerotherapy, thrombosed hemorrhoid excision), operative management (excisional hemorrhoidectomy — Ferguson/Milligan-Morgan/Whitehead, stapled hemorrhoidopexy, Doppler-guided HAL/THD), perioperative pain management, hemorrhoidectomy complications, and special populations (pregnancy, portal hypertension, Crohn's disease, immunocompromise).

Key content

Filed as the first dedicated wiki page on hemorrhoids — Colorectal Anatomy & Embryology (ASCRS Ch1) had explicitly flagged full hemorrhoid coverage as deferred to this chapter, so this ingest closes that open item rather than extending an existing page. Created Hemorrhoids (conditions) as a comprehensive new condition page. Minor cross-links added to existing pages: Colorectal Anatomy & Embryology (open-item closure), Anorectal Physiology (continence-contribution figure corroboration), Rectal Prolapse (Procidentia) (differential exam finding), and Fecal Incontinence (hemorrhoidectomy as sphincter-injury etiology, thrombosed hemorrhoid in the anorectal-pain differential).

Limitations

  • Textbook chapter, not primary literature; cited trial/meta-analysis figures (recurrence rates, complication rates, RCT outcomes) are the chapter authors' synthesis, not independently verified against primary sources.
  • Doppler-guided hemorrhoidectomy (HAL/THD) long-term comparative outcome data are explicitly described by the chapter itself as "somewhat lacking."
  • Genetic/tissue-level pathogenesis content (GWAS findings, MMP/VEGF/nitric oxide synthase associations) is early-stage and not further characterized in this chapter chunk.

Relevance

Eleventh entry in the ASCRS ingest, and the first chapter of Part II ("Anorectal Disease"). Closes a gap explicitly flagged as pending since Ch1's anatomy chapter. Chapter 12 continues Part II with "Anal Fissure and Anal Stenosis."