[Stage-adjusted therapy of hemorrhoids--ambulatory or inpatient treatment?].

The aim of the therapy of piles is to cure the complaints of the patient by reducing the enlarged haemorrhoidal plexus according to the stage (1 degree to 3 degrees) to a nearly physiological size and in case of a prolapse to replace the sensitive anoderma. The basic therapy consists of regulating the bowel function and avoiding straining. A high fibre diet or bulk laxatives may be necessary. If this fails 1 degree haemorrhoids should be treated in the office by sklerotherapy, 2nd or 2nd to 3rd degree haemorrhoids by rubber band ligation from the very beginning. The Haemorrhoidal Artery Ligation (HAL) and the circular mucosectomy with a stapling device can be done as an office procedure too. An anal prolapse of 1 or 2 segments should be treated as outpatient surgery in an "open" technique (Milligan-Morgan), more than 2 segments in a "closed" (Ferguson) or better in a "semi-closed submucosal" technique (Parks) in the hospital. A cicular anoplasty preserves the anoderma and enables its reposition as well as the excision of perianal skin tags and fibromata. This is not an office procedure.