Surgical options for fourth-degree hemorrhoids are still matter of debate. The high incidence of the disease encouraged research and brought to technical improvements able to achieve a painless, reliable, harmless and well tolerated surgical treatment. The Authors report a retrospective study of 193 patients who underwent surgery for fourth-degree hemorrhoids. In these cases the Authors advise anatomic techniques using local anaesthesia with i.v. administration of sedatives, thus allowing a 24-hour hospitalization.
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