Patients who have failed conservative therapy or who have grade 4 hemorrhoids are candidates for surgery to remove the swollen hemorrhoids and the larger external hemorrhoid skin tags. Options include hemorrhoid removal with laser surgery or hemorrhoidectomy (ectomy=removal) using a scalpel. Another alternative is stapled hemorrhoidectomy, where a special staple gun is positioned to remove the hemorrhoid and surround the tissue with a ring of staples to close the area as well as controlling the bleeding.
A thrombosed external hemorrhoid indicates that a clot has formed in the hemorrhoid causing significant pain. Treatment involves cutting into the hemorrhoid to remove the clot and reduce the swelling.