Hemorrhoidectomy

Hemorrhoidectomy: Colorectal Surgery to Remove Hemorrhoids

A hemorrhoidectomy is surgery to remove internal or external hemorrhoids that are extensive or severe. Surgical hemorrhoidectomy is the most effective treatment for hemorrhoids, though it is associated with the greatest rate of complications.

  1. Hemorrhoidectomy: Colorectal Surgery to Remove Hemorrhoids
  2. Closed Hemorrhoidectomy
  3. Open Hemorrhoidectomy
  4. Stapled Hemorrhoidectomy for Prolapsing Hemorrhoids
  5. Risks of Hemorrhoidectomy
  6. Before a Hemorrhoidectomy
  7. After a Hemorrhoidectomy

In this kind of operation, the enlarged hemorrhoids are removed (“ectomy” means “removal”) using instruments like scissors, a scalpel or a laser. In some approaches the wound is left open afterwards, in others it is partially or completely closed with stitches. These types of surgical techniques are referred to as “open,” “partially open,” or “closed.” Leaving the wound partially or completely open has the advantages of fewer stitch-related complications and fewer hematoma (bruising) problems. One disadvantage is that it takes longer for open wounds to heal.

Hemorrhoidectomy may be done with a standard scalpel or with an ultrasonic scalpel to cut away hemorrhoids (a method that does not require sutures). Another sutureless method involves staples. Tissue from further in the anus is used to close the wound with surgical staples after the hemorrhoids are removed.

Regardless of which operation they have, most patients experience pain in their anal region afterwards. Bowel movements and sitting may hurt as a result. These problems can usually be treated with painkillers. Other problems that may arise include bleeding after the operation, wound infections, abscesses, narrowing of the anus (anal stenosis), and – rarely – fecal incontinence. Fecal incontinence is the inability to control bowel movements.

Hemorrhoidectomy: Colorectal Surgery to Remove Hemorrhoids

A hemorrhoidectomy is performed in the following settings:

  • Symptomatic grade III, grade IV, or mixed internal and external hemorrhoids
  • Where there are additional anorectal conditions that require surgery
  • Strangulated internal hemorrhoids
  • Some thrombosed external hemorrhoids
  • Where patients who cannot tolerate or fail minimally invasive procedures

Types of hemorrhoidectomies and related procedures performed during surgery:

  • Closed Hemorrhoidectomy
  • Open Hemorrhoidectomy
  • Stapled Hemorrhoidectomy (Procedure for Prolapse and Hemorrhoids – PPH)
  • Rubber band Ligation
  • Lateral Internal Sphincterotomy

Closed Hemorrhoidectomy

Closed hemorrhoidectomy is the surgical procedure most commonly used to treat internal hemorrhoids.

It consists of the excision of hemorrhoidal bundles using a sharp instrument, such as a scalpel, scissors, electrocautery, or even laser followed by complete wound closure with absorbable suture. Typically all three hemorrhoidal columns are treated at one time. Postoperative care includes frequent sitz baths, mild analgesics, and avoidance of constipation. Closed hemorrhoidectomy is successful 95% of the time.

Potential complications include pain, delayed bleeding, urinary retention/urinary tract infection, fecal impaction, and very rarely, infection, wound breakdown, fecal incontinence, and anal stricture. Although this technique has the most postoperative discomfort and pain, it does have the best long term results with the lowest recurrence rates. New methods are being devised to decrease the pain associated with the surgery and should allow for a better patient experience.

Open Hemorrhoidectomy

In an open hemorrhoidectomy, hemorrhoidal tissue is excised in the same manner as in a closed procedure, but here the incision is left open. Surgeons may opt for open hemorrhoidectomy when the location or amount of disease makes wound closure difficult or the likelihood of postoperative infection high. Often, a combination of open and closed technique is utilized. Complications following open hemorrhoidectomy are similar to those that occur after closed hemorrhoidectomy.

Stapled Hemorrhoidectomy for Prolapsing Hemorrhoids

Stapled hemorrhoidectomy is the newest addition to the armamentarium of surgical internal hemorrhoid procedures. It has several aliases, including Longo’s procedure, the procedure for prolapse and hemorrhoids (PPH, Ethicon Endo-surgery, Inc., Cincinnati, OH), stapled circumferential mucosectomy, and circular stapler hemorrhoidopexy.

Stapled hemorrhoidectomy is mostly used in patients with grade III and IV hemorrhoids and those who fail prior minimally invasive treatments. During stapled hemorrhoidectomy, a circular stapling device is used to excise a circumferential ring of excess hemorrhoid tissue, thereby lifting hemorrhoids back to their normal position within the anal canal.

Stapling also disrupts hemorrhoid blood supply. Studies have suggested that stapled hemorrhoidectomy results in less postoperative pain and shorter recovery compared with conventional surgery, but a higher rate of recurrence. Frequency of complications is similar to that following standard hemorrhoidectomy.

Risks of Hemorrhoidectomy

Potential risks of a hemorrhoidectomy include:

  • Infection
  • Bleeding
  • Stool leakage
  • Problems passing urine due to pain

Before a Hemorrhoidectomy

Tell your doctor about all medicines you take before having hemorrhoid surgery.

You may need to stop taking drugs such as aspirin, Advil (ibuprofen), Aleve (naproxen), oral anticoagulants such as Coumadin (warfarin), Eliquis (apixaban), and Xarelto (rivaroxaban), or Plavix (clopidogrel bisulfate) several days before your procedure.

Also, let your doctor know if you smoke before having a hemorrhoidectomy. Smoking can make it harder for your body to heal.

You may be told not to eat or drink anything for 6 to 12 hours before the procedure. Follow your doctor’s instructions.

After a Hemorrhoidectomy

You’ll probably be able to go home the same day as your procedure. Be sure to have someone else drive you.

You may experience pain after hemorrhoid surgery. Take the medicines your doctor prescribes to relieve discomfort.

Your doctor may also recommend that you take a sitz bath, which involves sitting in a shallow bath of warm water for 15 to 20 minutes.

This helps keep the area clean and increases blood flow to the region. Ask your doctor how often you should do this.

Complete recovery usually takes about two weeks.

After the Hemorrhoidectomy procedure, you should try to make diet and lifestyle changes so that your hemorrhoids don’t return. These may include:

  • Consuming a high-fiber diet
  • Drinking more water
  • Avoiding straining during a bowel movement
  • Exercising often
  • Avoiding long periods of sitting
Reviewed by the QSota Medical Advisory Board

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