hello thank you for trusting HCM dear usually third grade piles with thrombosed or continue bleeding may need surgery. pros and cons depends on what type of surgery your undergoing. 1.NEWSLETTER Hemorrhoid Surgery Medically reviewed by Nancy Choi, MD on August 24, 2017 — Written by Debra Stang Complications of hemorrhoids Symptoms Surgeries without anesthetic Surgeries with anesthetic Aftercare Hemorrhoids are swollen veins that can be internal, which means they’re inside the rectum. Or they can be external, which means they’re outside the rectum. Most hemorrhoidal flare-ups stop hurting within two weeks without treatment. Eating a high-fiber diet and drinking 8 to 10 glasses of water per day can usually help you manage the symptoms by promoting softer and more regular bowel movements. You may also need to use stool softeners to reduce straining during bowel movements, as straining makes the hemorrhoids worse. Your doctor may recommend over-the-counter topical ointments to ease occasional itching, pain, or swelling. COMPLICATIONS OF HEMORRHOIDS Complications of hemorrhoids Sometimes, hemorrhoids can lead to other complications. External hemorrhoids may develop painful blood clots. If this happens, they’re called thrombosed hemorrhoids. Internal hemorrhoids may prolapse, which means they drop through the rectum and bulge from the anus. External or prolapsed hemorrhoids can become irritated or infected and may require surgery. The American Society of Colon and Rectal Surgeons estimates that less than 10 percent of hemorrhoid cases require surgery. SYMPTOMS Symptoms of hemorrhoids Internal hemorrhoids often cause no discomfort. They may bleed painlessly after a bowel movement. They become a problem if they bleed too heavily or prolapse. It’s typical to see blood after a bowel movement when you have a hemorrhoid. External hemorrhoids may also bleed after bowel movements. Because they’re exposed, they often become irritated and may itch or become painful. Another common complication of external hemorrhoids is the formation of blood clots inside the vessel, or a thrombosed hemorrhoid. While these clots aren’t usually life-threatening, they can cause sharp, severe pain. Proper treatment for such thrombosed hemorrhoids consists of an “incision and drainage” procedure. A surgeon or a doctor in an emergency room can perform this procedure. SURGERIES WITHOUT ANESTHETIC Surgeries without anesthetic Some types of hemorrhoid surgery can be done in your doctor’s office without anesthetic. 1.Banding Banding is an office procedure used to treat internal hemorrhoids. Also called rubber band ligation, this procedure involves using a tight band around the base of the hemorrhoid to cut off its blood supply. Banding usually requires two or more procedures that take place about two months apart. It’s not painful, but you may feel pressure or mild discomfort. Banding isn’t recommended for those taking blood thinners because of the high risk of bleeding complications. 2.Sclerotherapy This procedure involves injecting a chemical into the hemorrhoid. The chemical causes the hemorrhoid to shrink and stops it from bleeding. Most people experience little or no pain with the shot. Sclerotherapy is done at the doctor’s office. There are few known risks. This may be a better option if you’re taking blood thinners because your skin isn’t cut open. Sclerotherapy tends to have the best success rates for small, internal hemorrhoids. 3.other cryoablation,hemorrhoidopexy etc.. for fissure you may need sphincterotomy. please consult your doctor he will examine and treat you in correct way. I think I answered to your question if you have more questions feel free to ask. take care