Hemorrhoids are a common medical condition, with an estimated prevalence of 4.4% to 36.4% worldwide [1]. Three hemorrhoidal pads are present in relation to the arteries of the upper rectal end at 3, 7, and 11 o’clock in the lithotomy position. The main part of the hemorrhoidal pad lies just above the dentate line and is covered by a tender mucosa. In the cross section between the pads and the internal sphincter lies the submucosal layer, which consists of veins, arteries and muscle and connective fiber tissues, including the hemorrhoidal bundles, supported by fibroelastic collagenous tissue (Treitz’s muscular structure) and the mucous suspensory ligament (Park’s ligament), which penetrates the internal sphincter to attach the pads to the longitudinal joint muscle [1].

Hemorrhoidectomy was described by Milligan and Morgan in 1937, one of the gold standard procedures; however, it is known to be a painful procedure [2]. Regarding morbidity or symptomatic recurrence for closed hemorrhoidectomy, we found an index of 4% 1 to 2 years after surgery [3].

The stapled hemorrhoidopexy procedure was first described by Dr. Antonio Longo. It avoids wounds in sensitive perianal and anal areas. As a result, it has the advantage of significantly reducing postoperative pain and hospital stay. The Longo procedure describes the shortening of the prolapsed hemorrhoidal tissue and the fixation of the pads to their original position by automatic suturing above the dentate line [4]. However, we cannot fail to mention the complications that have been reported associated with this procedure and why it has been gradually put aside by surgeons: a higher rate of recurrent prolapsed, less effective at reducing postoperative hemorrhage, greater difficulty in maintaining normal continence to liquid stools in the early PO days, higher cost of single use devices.

In respect to other parameters, the differences are not significant, fecal impaction needing enema, pain scores at 24 h, short-term bleeding, short-term anal sepsis, minor bleeding at 8 weeks, long-term anal stricture, and long-term anal sepsis. In respect about serious complications were also reported: rectal perforation, pelvic sepsis, rectovaginal fistula, intraabdominal bleeding, severe retroperitoneal sepsis, and Fournier´s gangrene [4].

More recently, in 2016, a surgical technique for hemorrhoids has been described with the same purpose, performing Supradentate Transmucosal Hemorrhoidopexy [5].

Dr. Shantikumar Chivate modified this technique and named it transanal suture mucorectopexy [6]. Transanal suture mucopexy consists of two circumferential suture lines. These sutures repair rectal prolapse by suturing the mucosa to the internal sphincter muscles, creating fibrosis between these structures, thus preventing prolapse, dilation, and symptoms associated with hemorrhoidal disease [7].

New and sophisticated techniques have been proposed for minimally invasive surgical treatment of hemorrhoidal pathology, such as Doppler-guided hemorrhoidal artery ligation associated or not with mucopexy; however, it is known that the established indication is for grade II-III hemorrhoids of the Goligher classification, al least in European Guideliness, as well as its recurrence rate at 5 years of follow-up is 12% to 27% [8].

Minimally invasive surgical treatment for hemorrhoidal pathology using laser (NeoV® Laser System) has become popular. However, it has the disadvantage of being an expensive system, not reproducible in all media and with a recurrence rate of up to 20% [9].

The PROM-HISS scale is a scale reported and validated by the European Society of Coloproctology (ESCP) in 2022. This follow-up survey consists of three major domains: (1) symptoms, including bleeding, prolapse, itching, soiling or discharge, pain, (2) return to activities of daily living, and (3) satisfaction with the procedure performed. The five symptom items of the first domain are rated using a 5-point Likert scale, ranging from (1) “not at all”, (2) “a little”, (3) “reasonable”, (4) “a lot”, and (5) “All the time”. The remaining two domains are rated on a numerical scale from 0 to 10. Regarding the impact of symptoms, 0 correlates with “no impact at all” and 10 with “great impact on daily activities”. Regarding patient satisfaction with treatment, this range goes from 0 “not at all satisfied” to 10 “very satisfied” [10].

There are many other types of scales and follow-up surveys for both pre- and post-surgery symptoms after hemorrhoidal surgery, such as the 2014 Sodergen score, the 2010 Nystrom scale, HSS, among others [11].