Hemorrhoidectomy

A hemorrhoidectomy is the surgical removal of a hemorrhoid, which is an enlarged, swollen and inflamed cluster of vascular tissue combined with smooth muscle and connective tissue located in the lower part of the rectum or around the anus. A hemorrhoid is not a varicose vein in the strict sense. Hemorrhoids are also known as piles.

Hemorrhoids can occur inside the rectum, or at its opening (A). To remove them, the surgeon feeds a gauze swab into the anus and removes it slowly. A hemorrhoid will adhere to the gauze, allowing its exposure (B). The outer layers of skin and tissue are removed (C), and then the hemorrhoid  itself (D). The tissues and skin are then repaired (E). ( Illustration by GGS Inc.)

The primary purpose of a hemorrhoidectomy is to relieve the symptoms associated with hemorrhoids that have not responded to more conservative treatments. These symptoms commonly include bleeding and pain. In some cases, the hemorrhoid may protrude from the patient’s anus. Less commonly, the patient may notice a discharge of mucus or have the feeling that they have not completely emptied the bowel after defecating. Hemorrhoids are usually treated with dietary and medical measures before surgery is recommended because they are not dangerous and are only rarely a medical emergency. Many people have hemorrhoids that do not produce any symptoms at all.

What treatments are available for the relief of hemorrhoids?
There are several types of surgical procedures that can reduce hemorrhoids. Most surgical procedures in current use can be performed on an outpatient level or office visit under local anesthesia.

Rubber band ligation is a technique that works well with internal hemorrhoids that protrude outward with bowel movements. A small rubber band is tied over the hemorrhoid, which cuts off the blood supply. The hemorrhoid and the rubber band will fall off within a few days and the wound will usually heal in a period of one to two weeks. The procedure causes mild discomfort and bleeding. Another procedure, sclerotherapy, utilizes a chemical solution that is injected around the blood vessel to shrink the hemorrhoid. A third effective method is infrared coagulation, which uses a special device to shrink hemorrhoidal tissue by heating. Both injection and coagulation techniques can be effectively used to treat bleeding hemorrhoids that do not protrude. Some surgeons use a combination of rubber band ligation, sclerotherapy, and infrared coagulation; this combination has been reported to have a success rate of 90.5%.

Surgical resection (removal) of hemorrhoids is reserved for patients who do not respond to more conservative therapies and who have severe problems with external hemorrhoids or skin tags. Hemorrhoidectomies done with a laser do not appear to yield better results than those done with a scalpel. Both types of surgical resection can be performed with the patient under local anesthesia.

What risks are associated with a hemorrhoidectomy?
As with other surgeries involving the use of a local anesthetic, risks associated with a hemorrhoidectomy include infection, bleeding, and an allergic reaction to the anesthetic. Risks that are specific to a hemorrhoidectomy include stenosis (narrowing) of the anus, recurrence of the hemorrhoid, fistula formation, and non-healing wounds.

What are the treatment alternatives to a hemorrhoidectomy?
Doctors recommend conservative therapies as the first line of treatment for either internal or external hemorrhoids. A non-surgical treatment protocol generally includes drinking plenty of liquids, eating foods that are rich in fiber, sitting in a plain warm water bath for five to 10 minutes, applying anesthetic creams or witch hazel compresses, and using psyllium or other stool bulking agents. In patients with mild symptoms, these measures will usually decrease swelling and pain in about two to seven days. The amount of fiber in the diet can be increased by eating five servings of fruit and vegetables each day, replacing white bread with whole-grain bread and cereals, and eating raw rather than cooked vegetables.

Who performs the procedure and where is it performed?
A board certified, general surgeon who has completed one additional year of advanced training in colon and rectal surgery performs the procedure. Specialists typically pass a board certification examination in the diagnosis and surgical treatment of diseases in the colon and rectum and are certified by the American Board of Colon and Rectal Surgeons. Most hemorrhoidectomies can be performed in the surgeon’s office, an outpatient clinic, or an ambulatory surgery center.

What should I expect after my hemorrhoidectomy?
Patients may experience pain after surgery as the anus tightens and relaxes. The doctor may prescribe narcotics to relieve the pain. The patient should take stool softeners and attempt to avoid straining during both defecation and urination. Soaking in a warm bath can be comforting and may provide symptomatic relief.

Hemorrhoidectomies have a high rate of success. Most patients have an uncomplicated recovery with no recurrence of the hemorrhoids. Complete recovery is typically expected within a maximum period of two weeks.