Surgical management of anorectal conditions: 


Rubber band ligation as an outpatient is effective and will relieve symptoms in 80% of first-, second- and third-degree haemorrhoids [3].

Haemorrhoidectomy is reserved for fourth-degree haemorrhoids or failure of conservative therapy – open versus closed technique. Traditional excision haemorrhoidectomy is still more effective in terms of recurrence rates than newer stapled techniques [3,10].

Anal fissure

Sphincterotomy is effective in 90% of cases, although 10% of patients will develop long-term incontinence. Anal stretch results in higher rates of incontinence [5,11].

Anorectal abscesses

Anorectal abscesses always require surgical drainage and this should normally be carried out under general anaesthesia in the operating room. In some centres, mainly in the US, superficial abscesses are drained in the ED [1].

Pilonidal abscesses

Pilonidal abscesses should be incised ‘off midline’ [1].

Rectal prolapse

Excision is normally combined with pelvic floor repair [4].