Hemorrhoids are a common condition with a variety of presenting symptoms. Rectal bleeding should not be attrib-
FIGURE 92-2. Fourth degree (irreducible) hemorrhoids before (A) and immediately after (B) procedure for prolaspe and hemorrhoids (PPH) has been performed. Circumferential specimen of mucosa and submu-cosa excised with the PPH stapler (C).
uted to hemorrhoids alone without proper investigations, especially if symptoms persist following therapy. Most early lesions may be treated in the office setting. Advances in stapling devices offer less painful means of surgical management for advanced hemorrhoidal disease.
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