LAUSR

Selected patients with symptomatic hemorrhoids were treated in the outpatient department under local anesthesia. The exclusion criteria were American Society of Anesthesiologists (ASA) class > II, Lee Index (RCRI) for cardiac risk > 1, body mass index (BMI) > 40 kg/m2, age < 18 years, pregnancy, history of panic attacks. The hemorrhoidal disease was classified according to the Single Pile Hemorrhoid Classification (SPHC) [1] and to Goligher’s classification. SPHC considers the number of pathological piles (N), the presentation of internal and external pile, possible presence of fibrous pile (F), the presence of subversion of dentate line or congestion of external pile (E), and the presence of skin tags (S) [1]. Surgical strategy was defined by the symptomatic pile tailored procedure (SPTT) [2]. Although every operation represents a tailored mix of different techniques, depending on the characteristics of each single pathological pile and anatomical presentation, the surgical procedures, we performed were: hemorrhoidopexy, tailored mucosectomy and hemorrhoidopexy (TM&H) [3], excision of external component, and complete semi-closed pile excision. Technique