Hemorrhoidectomy is surgical procedure to remove hemorrhoids. You will receive general anesthesia or spinal anesthesia in order not to feel pain.
Incisions are made within the tissue around the hemorrhoid. The swollen vein inside the hemorrhoid is tied off to stop bleeding, then the hemorrhoid is removed. The surgical area could also be stitched closed or left open. Medicated gauze is used to protect the wound.
The surgery is often done with a knife (scalpel), a tool that uses electricity (cautery pencil), or a laser.
The operation is typically done in a surgery center. You will presumably go home that same day (outpatient).
There is a procedure that uses circular stapling device to remove hemorrhoidal tissue and close the wound without any incision. During the procedure, hemorrhoid is "stapled" back into place within the anal canal. This surgery is termed stapled hemorrhoidopexy. Persons that have stapled surgery may have less pain after surgery than persons who have the traditional hemorrhoid surgery. However the stapled surgery is a bit more expensive and people that have stapled surgery are more likely to have hemorrhoids come back and need surgery again Doppler-guided hemorrhoidectomy is a procedure that uses a scope with a particular probe to locate the hemorrhoidal arteries in order to have less tissue removed. Some studies show that it is less painful but more long-term studies are required to compare it with other procedures.
Recovery takes around 2 to 3 weeks.
• Immediately after the surgery, when you are still under anesthesia, you will receive a long-acting local anesthetic. It will last 6 to 12 hours to provide relief from pain after surgery. If you are not staying overnight in the hospital after surgery, you will leave only after the anesthesia wears off and you have passed urine. Inability to urinate (urinary retention) sometimes occurs due to swelling (edema) within the tissues or a spasm of the pelvic muscles.
• Someone should assist drive you home.
• You can expect little pain after surgery. If your doctor gave you a prescription drug for pain, take it as prescribed. Ask your doctor what over-the-counter drugs are safe for you.
• Some bleeding is expected, especially with the early bowel movement after surgery.
• For some days after surgery, drink liquids and eat a plain diet (plain rice, bananas, dry toast or crackers, applesauce). Then you may return to everyday foods and gradually increase the amount of fiber in your diet.
• You can apply numbing medicines before and after bowel movements to alleviate pain.
• Ice packs applied to the anal area may prevent swelling and pain.
• Regular soaks in warm water (sitz baths) assist relieve pain and muscle spasms.
• Some doctors might recommend that you take an antibiotic (such as metronidazole) after surgery to combat infection and reduce pain.
• Doctors suggest that you take stool softeners that contain fiber to aid make your bowel movements smooth. Straining during bowel movements can make hemorrhoids to come back.
• Follow-up exams with the surgeon normally are done 2 to 3 weeks after surgery to check for complications.
Hemorrhoidectomy is proper when you have:
• Very big internal hemorrhoids.
• Internal hemorrhoids that still present symptoms after nonsurgical treatment.
• Large external hemorrhoids that lead to major discomfort and make it hard to keep the anal area clean.
• Both internal and external hemorrhoids.
• Had other treatments for hemorrhoids (such as rubber band ligation) that failed.
Surgery usually treats a hemorrhoid. But the long-term success of hemorrhoid surgery depends mostly on how well you are able to change your daily bowel habits to prevent constipation and straining. Around 5 out of 100 people who have hemorrhoids come back after surgery.
Pain, bleeding, and an inability to urinate (urinary retention) are the main frequent side effects of hemorrhoidectomy.
Other relatively uncommon risks include the following:
• Bleeding from the anal area
• Accumulation of blood in the surgical region (hematoma)
• Inability to direct the bowel or bladder (incontinence)
• Infection of the surgical area
• Stool trapped in the anal canal (fecal impaction)
• Narrowing (stenosis) of the anal canal
• Recurrence of hemorrhoids
• An irregular passage (fistula) that forms between the anal or rectal canal and other area
• Rectal prolapsed, which occurs when the rectal lining slips out of the anal opening
What to Think About
The success of hemorrhoidectomy depends so much on your ability to make changes in your everyday bowel habits to make passing stools easier. Hemorrhoidectomy may provide better long-term results than procedures that stop blood flow to hemorrhoids (fixative procedures). But surgery is more expensive, has a higher risk of complications, and usually is more painful.
Most internal hemorrhoids improve (they get smaller and discomfort reduces) with either home medications or fixative procedures. When compared with surgery, fixative procedures entail less risk, are less painful, and need less time away from work and other activities.
Surgery is not advised for small internal hemorrhoids (unless you also have large internal hemorrhoids or internal and external hemorrhoids).
Lasers are usually advertised as being a less painful, faster-healing process of removing hemorrhoids, however none of these claims have been proved. Lasers are more costly than traditional techniques. The procedure takes longer, and it can cause deep tissue injury.
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