Hemorrhoidectomy is a surgical procedure that is done to treat and manage hemorrhoids or piles. Hemorrhoids are inflamed and swollen vascular structures in the anal canal often associated with increased intra-abdominal pressure as seen with straining during defecation, irregular bowel habits, etc.
Hemorrhoidectomy is usually done as an elective procedure, and it may sometimes be done as an emergency procedure.
Hemorrhoidectomy may be of the following types:
It is indicated for the management of hemorrhoids in the following circumstances:
Hemorrhoidectomy is contraindicated in the following conditions:
Some investigations that may be done before Hemorrhoidectomy include:
Before Hemorrhoidectomy, the following are done:
Duration: Hemorrhoidectomy may last between 30 to 45 minutes.
Anesthesia: Hemorrhoidectomy is done under bilateral pudendal nerve block with local anesthesia; general anesthesia may be used in rare cases.
The individual is placed in a jackknife position, a bilateral pudendal nerve block is done, and a local anesthetic with epinephrine is injected into the area after the buttocks are retracted to expose the anus. A retractor is placed in the anal canal, the prolapsed hemorrhoid is grasped, sutured first (to minimize blood loss) and then resected either with scissors or electrocautery. The wound is then closed with an absorbable suture, packing is done, and covered with gauze. The difference between a closed and an open hemorrhoid is that in closed hemorrhoid the anal mucosa is sutured while in open hemorrhoid the anal mucosa is left open and not sutured. The use of electrocautery or ultrasound energy devices to remove the hemorrhoids is associated with lesser postoperative complications than conventional excision with other surgical instruments.
The individual is placed in a jackknife or lithotomy position, a bilateral pudendal nerve block is done, and a local anesthetic with epinephrine is injected into the area after the buttocks are retracted to expose the anus (general anesthesia lesion may be used sometimes). A retractor is placed in the anal canal and a pursestring suture is applied in the mucosal layer and a stapler is introduced, the prolapsed hemorrhoid is dissected completely along with a ring of mucosa and submucosa within the canal, after which the distal mucosa is stapled over the proximal mucosa. The wound is closed with an absorbable suture, packing is done, and covered with gauze.
After Hemorrhoidectomy, discharge is usually done on the same day after briefly monitoring for immediate postoperative complications.
Common post-procedure occurrences: Pain is usually present for 1 to 2 weeks.
Medications: Pain relievers and antibiotics are generally prescribed.
Review: This will be usually 4 to 6 weeks after the procedure.
Resumption of normal activities: With some restrictions on the second or third postoperative day.
Some measures that need to be taken after a Hemorrhoidectomy include:
Some complications that can be seen after Hemorrhoidectomy include:
Stapled Hemorrhoidectomy is associated with lesser postoperative pain, shorter recovery time, and lesser complications when compared to conventional surgery to remove hemorrhoids.
The prognosis for Hemorrhoidectomy is generally good although there is a risk of recurrence after the procedure. Recurrence is more commonly seen with conventional surgery to remove hemorrhoids.
Hospitalization is usually not required for Hemorrhoidectomy
Hemorrhoidectomy is done by specialists from the Department of General Surgery.