Which surgical specialty typically performs the removal of external hemorrhoids?

Which Surgical Specialty Removes External Hemorrhoids

Colorectal surgeons (also known as colon and rectal surgeons or proctologists) are the surgical specialists who perform removal of external hemorrhoids. 1, 2

Specialty Training and Scope

• Colorectal surgeons complete general surgery residency followed by fellowship training specifically in diseases of the colon, rectum, and anus, making them the most qualified specialists for hemorrhoidal surgery 2
• These specialists are also referred to as coloproctologists in some regions and are the primary surgeons performing hemorrhoidectomy procedures 3
• General surgeons with appropriate training may also perform hemorrhoidectomy, though colorectal surgeons have the most specialized expertise in anorectal conditions 1, 2

When Surgical Referral Is Indicated

Surgical excision of external hemorrhoids is specifically indicated when:

• External hemorrhoids become acutely thrombosed and the patient presents within 72 hours of symptom onset—excision under local anesthesia provides faster pain relief and reduced recurrence risk 1, 4
• Conservative management fails for symptomatic external hemorrhoids causing significant discomfort or hygiene issues 4, 3
• Mixed internal and external hemorrhoids require comprehensive surgical treatment (hemorrhoidectomy) 1, 5

Office-Based vs Operating Room Procedures

• For thrombosed external hemorrhoids presenting within 72 hours, colorectal surgeons can perform excision as an outpatient procedure under local anesthesia in the office or clinic setting 1, 5
• More extensive hemorrhoidectomy for mixed disease or complicated cases is typically performed in an operating room or ambulatory surgery center 2, 5
• Simple office-based procedures like rubber band ligation are traditionally reserved for internal hemorrhoids, though recent evidence suggests potential application to external hemorrhoids with local anesthesia 6

Critical Distinction: When Surgery Is NOT Needed

• Most external hemorrhoids are asymptomatic and require no surgical intervention—they only need treatment when thrombosed or causing significant symptoms 4, 3
• For thrombosed external hemorrhoids presenting more than 72 hours after onset, conservative management with stool softeners and topical analgesics is preferred over surgery, as natural resolution has typically begun 1, 5
• Simple incision and drainage should never be performed by any specialty, as it leads to persistent bleeding and higher recurrence rates compared to complete excision 1, 4

Common Pitfall to Avoid

• Do not refer patients to vascular surgeons for hemorrhoid treatment—despite hemorrhoids being vascular structures, they are managed by colorectal surgeons who specialize in anorectal pathology, not peripheral vascular disease 1, 3