The standards task force of the American Society of Colon and Rectal Surgeons states that surgery should be reserved for those who "fail more conservative measures" or who have "third and fourth degree piles" ... with severe symptoms.
Several operative techniques have been described. The surgeon's choice of technique is primarily based on personal experience and technical training, and only a competently performed technique produces satisfying results. If technical guidelines are rigorously followed, the feared complications associated with surgical procedures, such as anal narrowing and muscle injuries, are largely reduced. Furthermore, certain medicines suppress postoperative pain, increase patients' satisfaction, and allows them to return to work earlier.