Definition and Overview
Hemorrhoidectomy is the surgical removal of hemorrhoids, which can be performed using either stapled or excisional method. In a stapled hemorrhoidectomy, a part of the hemorrhoid is removed and the rest is stapled to the anal canal. The excisional method, on the other hand, involves cutting the tissues and leaving the excised wound open (open hemorrhoidectomy) or stitched (closed hemorrhoidectomy). In certain circumstances, these procedures are combined.
Who Should Undergo and Expected Results
Hemorrhoidectomy is performed on people diagnosed with hemorrhoids, the inflammation or swelling of the blood vessels or veins in the anus (external) or rectum (internal) area. The condition is triggered by chronic straining especially during bowel movements, pregnancy, obesity, constipation, and prolonged sitting on the toilet or squatting. Patients with this condition typically experience the following symptoms: the presence of blood in the stool and sensitive lump, as well as pain, in the affected area and inflammation.
However, it’s important to note that hemorrhoidectomy is not the primary treatment for hemorrhoids. It is only recommended by surgeons if all non-surgical treatment methods including medications as well as minimally invasive procedures such as rubber band ligation fail to address the condition. Also, the surgical removal of hemorrhoids is considered when the condition is deemed serious or severe or when the hemorrhoids are too big, have already prolapsed, cause significant discomfort, reduce the patient’s mobility, and make ordinary activities extremely difficult for the patient.
Hemorrhoidectomy is one of the most effective surgeries for hemorrhoids with a recurrence rate of no more than 5 percent—significantly higher than minimally invasive procedures, which recurrence rate can be up to 50 percent. Nevertheless, this procedure requires the expertise and extensive skill of the surgeon because of the possibility of many complications.
How Does the Procedure Work?
Hemorrhoid removal is usually an outpatient procedure that takes about an hour to complete. It can be performed using either general or local anesthesia with sedation depending on the surgeon’s recommendation and patient’s preference. With the patient lying prone and the rest of the body covered except for the anus, the surgeon begins by excising the tissues that surround the hemorrhoids.
The hemorrhoids are then removed using a scalpel or through electrocautery (which minimizes bleeding) or laser technology that cuts hemorrhoids more precisely and quickly. The surgeon then has the option to leave the wound open or closed with stitches.
In severe cases where the hemorrhoids can be seen around the anus, the surgeon may perform the stapled method, which is a relatively new technique. In this procedure, the surgeon inserts a circular stapling instrument into the rectum to remove the prolapsed hemorrhoid and then staples the supporting tissues to the rectum.
Possible Risks and Complications
One of the possible complications of hemorrhoid removal is excessive bleeding, which may occur right after the surgery and can persist up to two weeks. To prevent this, the surgeon ties the veins first before removing the hemorrhoids. There will also be discomfort and pain, which can be alleviated with pain relievers. They should also disappear as the patient recovers.
Although rare, the patient may also develop an infection as well as damage to the muscle tissues, particularly the sphincter muscles, the muscular tissue responsible for controlling the passage of urine from the bladder. These may be indicated by the need to pass urine more frequently and incontinence (or loss of bladder control).
Chaudhry V, Abcarian H. Hemorrhoids. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy. 11th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 53.
Hall JF. Hemorrhoids and hemorrhoidectomy. In: Delaney CP, ed. Netter's Surgical Anatomy and Approaches. Philadelphia, PA: Elsevier Saunders; 2014:chap 26.