Hemorrhoidectomy is the surgical excision of a haemorrhoid (swollen veins in the rectum), which is performed in severe cases. The surgical area may be sewn closed, in which case it is termed as a Closed Hemorrhoidectomy or is left open, in which case it is known as an Open Hemorrhoidectomy. A Hemorrhoidectomy procedure involves the anal canal and lower rectum.
What are the reasons for hemorrhoidectomy?
A Hemorrhoidectomy procedure is performed in cases of severe symptomatic haemorrhoids that fail conservative management.
How hemorrhoidectomy is performed?
- Haemorrhoids are swollen and inflamed blood vessels located inside the rectum, or around the anus
- Haemorrhoids are classified into 2 types - internal haemorrhoids and external haemorrhoids
- These are differentiated by their position with respect to the dentate line (a line which divides the upper two-thirds and lower one-third of the anal canal)
- Internal haemorrhoids are those that originate above the dentate line and external haemorrhoids are those that originate below the dentate line
- Internal haemorrhoids usually present with painless, bright red, rectal bleeding during or following a bowel movement. The blood is on the toilet paper or drips into the toilet bowl. Usually, the stool itself appears normally-coloured
- Other symptoms may include mucous discharge, a perianal mass, if they prolapse through the anus, itchiness, and faecal incontinence. They are usually only painful, if they become thrombosed or necrotic
- External haemorrhoids are generally painful when thrombosed - blood inside the haemorrhoid clots
- A Hemorrhoidectomy procedure is normally performed in the operating room.
- Spinal or general anaesthesia is given to the patient
- The patient is placed either in prone or supine position
- An elliptical incision is made around the internal or external haemorrhoidal complex
- The haemorrhoidal tissue is then dissected off, of the underlying sphincter muscles with scissors or scalpel
- The correct plane is essential to avoid injury to the sphincter muscle
- The haemorrhoid is then amputated and the wound closed with a running suture
- Sometimes, the mucosal defect is closed, but the skin incision is left open and it heals spontaneously in 4-8 weeks
A Hemorrhoidectomy is usually performed in an out-patient surgery centre facility or a hospital by a trained general surgeon
. It usually takes about an hour to complete the hemorrhoidectomy procedure.
Preparations needed before hemorrhoidectomy procedure
Risks and complications during hemorrhoidectomy surgical procedure
- The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
- Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
- Blood tests may be performed to determine, if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
- Do inform the physician if you are allergic to any local anaesthetics, lidocaine, etc.
- Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
- It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
- Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- For persons suffering from diabetes, it is important that the blood sugar stays within the normal range if not their diabetologist may have to control blood sugar by recommending insulin or a combination of oral medicines
The possible risks or complications that may arise during the surgery are:
Risks and complications after hemorrhoidectomy surgical procedure
- Local abscess
- Faecal incontinence
- Anal stenosis (narrowing of the anus)
- Urinary retention
Post Hemorrhoidectomy procedure, the following complications may arise:
Post-operative care needed after hemorrhoidectomy surgical procedure
- Pain and discomfort
At home, the following post-operative care is recommended, after a hemorrhoidectomy procedure:
- Avoid any possibilities of constipation, take medications, if required to do so (per advise of physician)
- Take stool softeners, as straining during bowel movements can cause the haemorrhoids to recur
- Increase fibre content in the diet
- Take plenty of fluids
- Do expect some pain after surgery take pain killers as prescribed
- Some bleeding is normal, especially with the first bowel movement after surgery
- Ice packs applied to the anal area may reduce swelling and pain
- Frequent soaks in warm water (sitz baths) help relieve pain and muscle spasms