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Circumferential hemorrhoids represent one of the most advanced and severe forms of hemorrhoidal disease, causing significant pain and discomfort for affected patients. Therefore, timely medical examination and appropriate treatment are essential for individuals diagnosed with this condition.

What are hemorrhoids (piles)?

Hemorrhoids are a medical condition that occurs due to the excessive dilation of hemorrhoidal venous plexuses or the swelling of veins in the tissues surrounding the anus, leading to inflammation, swelling, or congestion. Hemorrhoidal disease is classified into three types: internal hemorrhoids, external hemorrhoids, and mixed hemorrhoids.

• Internal hemorrhoids: These are hemorrhoidal cushions located above the dentate line. Internal hemorrhoids are divided into four grades, depending on the size and degree of prolapse of the hemorrhoidal tissue.
• External hemorrhoids: These are hemorrhoidal cushions located below the dentate line and are usually covered by mucosa or the perianal skin.
• Mixed hemorrhoids: This type results from the development and fusion of both internal and external hemorrhoids.

When mixed hemorrhoidal cushions enlarge and merge to occupy most of the anal circumference, the condition is called circumferential hemorrhoids. This represents an advanced stage of hemorrhoidal disease. In this condition, multiple hemorrhoidal masses of varying sizes form a ring that completely encircles the anal canal. Therefore, surgical hemorrhoidectomy is considered the most effective treatment for circumferential hemorrhoids.

Causes of circumferential hemorrhoids

There are many factors that contribute to the development of circumferential hemorrhoids. The most common causes include:

• Anal infections 
• Genetic predisposition
• Chronic constipation
• Unbalanced diet: A diet low in protein and fiber but high in fat can lead to constipation and impaired bowel function.
• Excessive anal pressure: Caused by heavy physical labor, prolonged sitting, lack of physical activity, or frequent straining during defecation.
• Habitual stool retention
• Pregnancy

Symptoms of circumferential hemorrhoids

Similar to other forms of hemorrhoidal disease, circumferential hemorrhoids present with several characteristic signs and symptoms, including:

• Bright red bleeding during bowel movements;
• Prolapsed hemorrhoidal tissue and mucous discharge from the anus;
• Itching, burning, or pain in the anal area.

However, because circumferential hemorrhoids represent a severe stage of the disease, the appearance of the hemorrhoidal mass is more distinct:

• The circumferential hemorrhoid is formed by multiple hemorrhoidal cushions of varying sizes that merge together.
• Smaller hemorrhoidal lumps are typically located around the anal margin, while larger ones are found in the central area, creating a complete ring surrounding the anus.

Why is surgery necessary for circumferential hemorrhoids?

Circumferential hemorrhoids are a complex and advanced form of hemorrhoidal disease, formed by the fusion of multiple large internal and external hemorrhoidal masses. Because of this structural complexity and severity, medical or topical treatments are generally ineffective.

This condition is considered highly serious, as it can lead to dangerous complications that significantly affect the patient’s health and quality of life, including:

• Anal infection and necrosis: Occur when prolapsed hemorrhoids remain outside the anus and cannot retract. The swollen tissue obstructs the anal canal, leading to inflammation, infection, and even tissue necrosis.
• Severe blood loss: Studies show that up to 94% of patients with hemorrhoids experience chronic bleeding, which can cause anemia and physical weakness.
• Thrombosis and anal fissures: When the hemorrhoidal masses become engorged and inflamed, patients experience severe pain, discomfort, and the passage of blood clots during defecation. In severe cases, pain persists even at rest, causing patients to sit on one side to relieve discomfort.
• Reduced sexual desire and psychological distress: Persistent pain, bleeding, and discomfort negatively affect sexual activity and mental well-being.

Therefore, the most appropriate and effective treatment for circumferential hemorrhoids is surgical hemorrhoidectomy. Since the hemorrhoidal masses occupy nearly the entire circumference of the anal canal, circumferential hemorrhoid surgery requires a high level of surgical precision and expertise to ensure complete removal of the hemorrhoidal tissue while preserving normal anal structure and function.

Effective treatment of circumferential hemorrhoids with the Longo procedure

Longo surgical technique for circumferential hemorrhoidectomy

There are several surgical techniques for treating circumferential hemorrhoids. Traditional procedures, such as mucocutaneous excision or separate excision of each hemorrhoidal mass, have notable disadvantages, including severe postoperative pain, anal stricture, fecal incontinence, and prolonged hospitalization.

Based on the principle of preserving the anal cushions and reducing blood flow to the hemorrhoidal venous plexus to decrease hemorrhoidal volume, a number of modern surgical techniques have been developed. Among them, the Longo procedure remains the most optimal option for managing circumferential hemorrhoids.

The Longo hemorrhoidectomy was first introduced in 1993 by Dr. Antonio Longo, an Italian colorectal surgeon. This technique uses a circular stapling device to excise a ring of rectal mucosa approximately 2–3 cm above the dentate line, followed by stapled closure using an automatic circular stapler.

Circumferential hemorrhoidectomy using the Longo method is performed based on the principle of lifting the prolapsed hemorrhoidal tissue back to its normal anatomical position, then resecting and stapling the blood vessels that supply the hemorrhoidal masses. As a result, the hemorrhoids gradually shrink and decrease in size due to the interruption of their blood supply and nutrition.

The Longo procedure is typically indicated for patients with grade III or IV circumferential hemorrhoids. However, this method is not recommended in the following cases:

• Patients with active infection or inflammation of the anal canal.
• Patients with coagulation disorders, cardiovascular diseases, or other severe systemic conditions that have not been stabilized prior to surgery.

Advantages and disadvantages of the Longo hemorrhoidectomy

The Longo method offers several outstanding advantages compared with traditional hemorrhoidectomy techniques:

• Minimal pain: The procedure removes only the hemorrhoidal tissue and a ring of rectal mucosa without cutting the skin of the anal canal. Since this area contains very few sensory nerves, patients experience significantly less postoperative pain.
• Minimal bleeding: Because the surgery does not leave open wounds in the anal area, postoperative bleeding is reduced, wound care is easier, and the risk of infection is minimized.
• Short operative time and quick recovery: The average surgical time is only 20–30 minutes. Most patients can be discharged within 1–2 days and recover their health rapidly.
• Low recurrence rate: The procedure interrupts the blood supply to the hemorrhoidal tissue and restores the normal anatomical structure of the anal canal, resulting in a low risk of recurrence.
• Aesthetic outcome: As the Longo procedure is performed above the anal folds, no external scars are left. Additionally, it prevents anal stenosis or fibrosis caused by scarring.

However, as a modern surgical technique, the Longo procedure involves relatively high treatment costs. In addition, the method may carry certain postoperative risks, such as secondary bleeding, rectal stricture, or rectal perforation. To minimize these complications and reduce the risk of recurrence, the surgery should be performed by experienced colorectal surgeons, supported by a well-coordinated surgical team and followed by careful postoperative monitoring to ensure patient safety and optimal recovery.

Reader may also be interested in: 

• Hemorrhoids: Causes, symptoms, prevention, and treatment
• Is grade 1 hemorrhoids dangerous? Can it resolve on its own?

Postoperative care after circumferential hemorrhoidectomy

To promote fast wound healing, quick recovery, and prevent postoperative complications, patients should follow these essential care guidelines after circumferential hemorrhoid surgery:

1. Wound care

• Limit movement or strenuous activity during the early recovery period to prevent bleeding, wound dehiscence, or infection.
• Clean the anal area and surrounding skin carefully as instructed by the physician.
• Wash the anus with warm water and gently pat dry with a clean towel. Antiseptic solutions may be used under medical guidance to disinfect the surgical site.

2. Lifestyle and dietary adjustments

• Stay well-hydrated and maintain a fiber-rich diet. In the first few days after surgery, choose soft, easily digestible foods to facilitate bowel movements, soften stool, and prevent constipation.
• Avoid fatty, spicy, or highly seasoned foods, as well as stimulant beverages such as alcohol, coffee, and carbonated drinks. These can cause inflammation and delay healing.
• Avoid prolonged sitting or standing to reduce pressure on the anal area.
• Establish a regular bowel habit—go to the toilet at fixed times each day and avoid using phones, reading, or sitting for too long during defecation.
• Maintain a positive and relaxed mindset, manage stress, and get adequate rest to support the healing process.

>>> When to see a doctor

If you notice any abnormal symptoms after hemorrhoid surgery, such as bleeding, pus discharge, or prolonged pain, you should immediately inform your doctor for timely evaluation and management.

It is also important to schedule regular follow-up visits to monitor your recovery and detect any signs of recurrence early.

The Longo procedure for circumferential hemorrhoidectomy is a necessary intervention to completely remove hemorrhoidal tissue, relieve pain, and prevent complications. However, this technique requires high surgical expertise and modern medical equipment. Therefore, patients should choose a reputable and well-equipped hospital to ensure safe and effective treatment outcomes.

Where to seek reliable and effective examination and treatment for circumferential hemorrhoids

Circumferential hemorrhoids represent an advanced and severe stage of hemorrhoidal disease, requiring highly skilled and experienced colorectal surgeons to ensure complete removal of the hemorrhoids, prevent recurrence, minimize pain, shorten recovery time, and optimize treatment costs for patients.

As one of the leading private hospitals in Northern Vietnam, Hong Ngoc General Hospital has become a trusted destination for thousands of patients with hemorrhoidal disease, including complex cases such as thrombosed and circumferential hemorrhoids, thanks to its outstanding advantages:

• People’s Physician, Assoc. Prof. Dr. Nguyen Xuan Hung – Former Director of the Center for Colorectal and Pelvic Floor Surgery, Viet Duc University Hospital; Vice President of the Vietnam Association of Colorectal Surgery; Member of the French Society of Coloproctology; MSc. Dr. Cu Trung Kien – Specialized training in gastrointestinal surgery in Hong Kong; formerly worked at Bach Mai Hospital; currently Deputy Head of the Department of Gastrointestinal Surgery, Hong Ngoc - Yen Ninh General Hospital; Specialist Level I Doctor Bach Phuc Huy – Over 15 years of experience, Head of the Gastrointestinal Surgery Unit, Hong Ngoc - Phuc Truong Minh General Hospital.
• Advanced surgical techniques: The hospital applies state-of-the-art technologies in hemorrhoid treatment, including German LHP Laser hemorrhoidectomy and Longo stapled hemorrhoidectomy, ensuring effective and minimally invasive outcomes.
• Pain-free hemorrhoid surgery: A comprehensive pain management protocol—before, during, and after surgery—has been developed by MSc. Dr. Nguyen Thi Thu Ba, who received advanced anesthesiology and pain control training in France. A team of highly skilled anesthesiologists closely monitors patients throughout the entire surgical process.
• Preemptive pain prevention strategy: Patients undergo thorough pre-anesthesia evaluation, are continuously monitored during surgery, and receive pain control measures even before pain onset, ensuring maximum comfort.
• Modern surgical techniques with minimal trauma: The procedures are performed in non-sensitive areas to limit tissue damage and postoperative discomfort.
• Comprehensive 24/7 patient care: A dedicated medical team provides continuous support and attentive care throughout hospitalization.
• Comfortable inpatient facilities: Spacious, well-ventilated recovery rooms designed with hotel-like amenities, offering patients a comfortable and relaxing environment during their stay.

For detailed consultation, please contact: Hotline for appointment with specialists: 0911 908 856 Hotline for hemorrhoid surgery consultation: 0949 646 556

 Register for information and consultation at:

Note: The information provided in this article by Hong Ngoc General Hospital is for reference purposes only and should not replace professional medical diagnosis or treatment. Patients are advised not to self-medicate. To determine the exact condition and receive an appropriate treatment plan, please visit a reputable medical facility for direct examination and consultation with a qualified physician.

Follow the official fanpage of Hong Ngoc General Hospital for more useful health information and updates on special offers and hospital programs.

Circumferential hemorrhoids represent one of the most advanced and severe forms of hemorrhoidal disease, causing significant pain and discomfort for affected patients. Therefore, timely medical examination and appropriate treatment are essential for individuals diagnosed with this condition.

What are hemorrhoids (piles)?

Hemorrhoids are a medical condition that occurs due to the excessive dilation of hemorrhoidal venous plexuses or the swelling of veins in the tissues surrounding the anus, leading to inflammation, swelling, or congestion. Hemorrhoidal disease is classified into three types: internal hemorrhoids, external hemorrhoids, and mixed hemorrhoids.

• Internal hemorrhoids: These are hemorrhoidal cushions located above the dentate line. Internal hemorrhoids are divided into four grades, depending on the size and degree of prolapse of the hemorrhoidal tissue.
• External hemorrhoids: These are hemorrhoidal cushions located below the dentate line and are usually covered by mucosa or the perianal skin.
• Mixed hemorrhoids: This type results from the development and fusion of both internal and external hemorrhoids.

When mixed hemorrhoidal cushions enlarge and merge to occupy most of the anal circumference, the condition is called circumferential hemorrhoids. This represents an advanced stage of hemorrhoidal disease. In this condition, multiple hemorrhoidal masses of varying sizes form a ring that completely encircles the anal canal. Therefore, surgical hemorrhoidectomy is considered the most effective treatment for circumferential hemorrhoids.

Causes of circumferential hemorrhoids

There are many factors that contribute to the development of circumferential hemorrhoids. The most common causes include:

• Anal infections 
• Genetic predisposition
• Chronic constipation
• Unbalanced diet: A diet low in protein and fiber but high in fat can lead to constipation and impaired bowel function.
• Excessive anal pressure: Caused by heavy physical labor, prolonged sitting, lack of physical activity, or frequent straining during defecation.
• Habitual stool retention
• Pregnancy

Symptoms of circumferential hemorrhoids

Similar to other forms of hemorrhoidal disease, circumferential hemorrhoids present with several characteristic signs and symptoms, including:

• Bright red bleeding during bowel movements;
• Prolapsed hemorrhoidal tissue and mucous discharge from the anus;
• Itching, burning, or pain in the anal area.

However, because circumferential hemorrhoids represent a severe stage of the disease, the appearance of the hemorrhoidal mass is more distinct:

• The circumferential hemorrhoid is formed by multiple hemorrhoidal cushions of varying sizes that merge together.
• Smaller hemorrhoidal lumps are typically located around the anal margin, while larger ones are found in the central area, creating a complete ring surrounding the anus.

Why is surgery necessary for circumferential hemorrhoids?

Circumferential hemorrhoids are a complex and advanced form of hemorrhoidal disease, formed by the fusion of multiple large internal and external hemorrhoidal masses. Because of this structural complexity and severity, medical or topical treatments are generally ineffective.

This condition is considered highly serious, as it can lead to dangerous complications that significantly affect the patient’s health and quality of life, including:

• Anal infection and necrosis: Occur when prolapsed hemorrhoids remain outside the anus and cannot retract. The swollen tissue obstructs the anal canal, leading to inflammation, infection, and even tissue necrosis.
• Severe blood loss: Studies show that up to 94% of patients with hemorrhoids experience chronic bleeding, which can cause anemia and physical weakness.
• Thrombosis and anal fissures: When the hemorrhoidal masses become engorged and inflamed, patients experience severe pain, discomfort, and the passage of blood clots during defecation. In severe cases, pain persists even at rest, causing patients to sit on one side to relieve discomfort.
• Reduced sexual desire and psychological distress: Persistent pain, bleeding, and discomfort negatively affect sexual activity and mental well-being.

Therefore, the most appropriate and effective treatment for circumferential hemorrhoids is surgical hemorrhoidectomy. Since the hemorrhoidal masses occupy nearly the entire circumference of the anal canal, circumferential hemorrhoid surgery requires a high level of surgical precision and expertise to ensure complete removal of the hemorrhoidal tissue while preserving normal anal structure and function.

Effective treatment of circumferential hemorrhoids with the Longo procedure

Longo surgical technique for circumferential hemorrhoidectomy

There are several surgical techniques for treating circumferential hemorrhoids. Traditional procedures, such as mucocutaneous excision or separate excision of each hemorrhoidal mass, have notable disadvantages, including severe postoperative pain, anal stricture, fecal incontinence, and prolonged hospitalization.

Based on the principle of preserving the anal cushions and reducing blood flow to the hemorrhoidal venous plexus to decrease hemorrhoidal volume, a number of modern surgical techniques have been developed. Among them, the Longo procedure remains the most optimal option for managing circumferential hemorrhoids.

The Longo hemorrhoidectomy was first introduced in 1993 by Dr. Antonio Longo, an Italian colorectal surgeon. This technique uses a circular stapling device to excise a ring of rectal mucosa approximately 2–3 cm above the dentate line, followed by stapled closure using an automatic circular stapler.

Circumferential hemorrhoidectomy using the Longo method is performed based on the principle of lifting the prolapsed hemorrhoidal tissue back to its normal anatomical position, then resecting and stapling the blood vessels that supply the hemorrhoidal masses. As a result, the hemorrhoids gradually shrink and decrease in size due to the interruption of their blood supply and nutrition.

The Longo procedure is typically indicated for patients with grade III or IV circumferential hemorrhoids. However, this method is not recommended in the following cases:

• Patients with active infection or inflammation of the anal canal.
• Patients with coagulation disorders, cardiovascular diseases, or other severe systemic conditions that have not been stabilized prior to surgery.

Advantages and disadvantages of the Longo hemorrhoidectomy

The Longo method offers several outstanding advantages compared with traditional hemorrhoidectomy techniques:

• Minimal pain: The procedure removes only the hemorrhoidal tissue and a ring of rectal mucosa without cutting the skin of the anal canal. Since this area contains very few sensory nerves, patients experience significantly less postoperative pain.
• Minimal bleeding: Because the surgery does not leave open wounds in the anal area, postoperative bleeding is reduced, wound care is easier, and the risk of infection is minimized.
• Short operative time and quick recovery: The average surgical time is only 20–30 minutes. Most patients can be discharged within 1–2 days and recover their health rapidly.
• Low recurrence rate: The procedure interrupts the blood supply to the hemorrhoidal tissue and restores the normal anatomical structure of the anal canal, resulting in a low risk of recurrence.
• Aesthetic outcome: As the Longo procedure is performed above the anal folds, no external scars are left. Additionally, it prevents anal stenosis or fibrosis caused by scarring.

However, as a modern surgical technique, the Longo procedure involves relatively high treatment costs. In addition, the method may carry certain postoperative risks, such as secondary bleeding, rectal stricture, or rectal perforation. To minimize these complications and reduce the risk of recurrence, the surgery should be performed by experienced colorectal surgeons, supported by a well-coordinated surgical team and followed by careful postoperative monitoring to ensure patient safety and optimal recovery.

Reader may also be interested in: 

• Hemorrhoids: Causes, symptoms, prevention, and treatment
• Is grade 1 hemorrhoids dangerous? Can it resolve on its own?

Postoperative care after circumferential hemorrhoidectomy

To promote fast wound healing, quick recovery, and prevent postoperative complications, patients should follow these essential care guidelines after circumferential hemorrhoid surgery:

1. Wound care

• Limit movement or strenuous activity during the early recovery period to prevent bleeding, wound dehiscence, or infection.
• Clean the anal area and surrounding skin carefully as instructed by the physician.
• Wash the anus with warm water and gently pat dry with a clean towel. Antiseptic solutions may be used under medical guidance to disinfect the surgical site.

2. Lifestyle and dietary adjustments

• Stay well-hydrated and maintain a fiber-rich diet. In the first few days after surgery, choose soft, easily digestible foods to facilitate bowel movements, soften stool, and prevent constipation.
• Avoid fatty, spicy, or highly seasoned foods, as well as stimulant beverages such as alcohol, coffee, and carbonated drinks. These can cause inflammation and delay healing.
• Avoid prolonged sitting or standing to reduce pressure on the anal area.
• Establish a regular bowel habit—go to the toilet at fixed times each day and avoid using phones, reading, or sitting for too long during defecation.
• Maintain a positive and relaxed mindset, manage stress, and get adequate rest to support the healing process.

>>> When to see a doctor

If you notice any abnormal symptoms after hemorrhoid surgery, such as bleeding, pus discharge, or prolonged pain, you should immediately inform your doctor for timely evaluation and management.

It is also important to schedule regular follow-up visits to monitor your recovery and detect any signs of recurrence early.

The Longo procedure for circumferential hemorrhoidectomy is a necessary intervention to completely remove hemorrhoidal tissue, relieve pain, and prevent complications. However, this technique requires high surgical expertise and modern medical equipment. Therefore, patients should choose a reputable and well-equipped hospital to ensure safe and effective treatment outcomes.

Where to seek reliable and effective examination and treatment for circumferential hemorrhoids

Circumferential hemorrhoids represent an advanced and severe stage of hemorrhoidal disease, requiring highly skilled and experienced colorectal surgeons to ensure complete removal of the hemorrhoids, prevent recurrence, minimize pain, shorten recovery time, and optimize treatment costs for patients.

As one of the leading private hospitals in Northern Vietnam, Hong Ngoc General Hospital has become a trusted destination for thousands of patients with hemorrhoidal disease, including complex cases such as thrombosed and circumferential hemorrhoids, thanks to its outstanding advantages:

• People’s Physician, Assoc. Prof. Dr. Nguyen Xuan Hung – Former Director of the Center for Colorectal and Pelvic Floor Surgery, Viet Duc University Hospital; Vice President of the Vietnam Association of Colorectal Surgery; Member of the French Society of Coloproctology; MSc. Dr. Cu Trung Kien – Specialized training in gastrointestinal surgery in Hong Kong; formerly worked at Bach Mai Hospital; currently Deputy Head of the Department of Gastrointestinal Surgery, Hong Ngoc - Yen Ninh General Hospital; Specialist Level I Doctor Bach Phuc Huy – Over 15 years of experience, Head of the Gastrointestinal Surgery Unit, Hong Ngoc - Phuc Truong Minh General Hospital.
• Advanced surgical techniques: The hospital applies state-of-the-art technologies in hemorrhoid treatment, including German LHP Laser hemorrhoidectomy and Longo stapled hemorrhoidectomy, ensuring effective and minimally invasive outcomes.
• Pain-free hemorrhoid surgery: A comprehensive pain management protocol—before, during, and after surgery—has been developed by MSc. Dr. Nguyen Thi Thu Ba, who received advanced anesthesiology and pain control training in France. A team of highly skilled anesthesiologists closely monitors patients throughout the entire surgical process.
• Preemptive pain prevention strategy: Patients undergo thorough pre-anesthesia evaluation, are continuously monitored during surgery, and receive pain control measures even before pain onset, ensuring maximum comfort.
• Modern surgical techniques with minimal trauma: The procedures are performed in non-sensitive areas to limit tissue damage and postoperative discomfort.
• Comprehensive 24/7 patient care: A dedicated medical team provides continuous support and attentive care throughout hospitalization.
• Comfortable inpatient facilities: Spacious, well-ventilated recovery rooms designed with hotel-like amenities, offering patients a comfortable and relaxing environment during their stay.

For detailed consultation, please contact: Hotline for appointment with specialists: 0911 908 856 Hotline for hemorrhoid surgery consultation: 0949 646 556

 Register for information and consultation at:

Note: The information provided in this article by Hong Ngoc General Hospital is for reference purposes only and should not replace professional medical diagnosis or treatment. Patients are advised not to self-medicate. To determine the exact condition and receive an appropriate treatment plan, please visit a reputable medical facility for direct examination and consultation with a qualified physician.

Follow the official fanpage of Hong Ngoc General Hospital for more useful health information and updates on special offers and hospital programs.