Hemorrhoidectomy

A hemorrhoidectomy is an operation to remove symptomatic internal or external hemorrhoids, which are swollen blood vessels in the lower anal canal. There are four types of hemorrhoidectomies:

• Closed Hemorrhoidectomy – the hemorrhoid is removed and the resulting incision is sutured closed.
• Open Hemorrhoidectomy – the hemorrhoid is removed and the resulting incision is left open to heal naturally
• Stapled Hemorrhoidectomy – a circular stapler is used to remove excess hemorrhoidal tissue and replace the remaining normal tissue higher in the anal canal.
• Transanal Hemorrhoidal Dearterialization (THD) – During a THD, precisely placed stitches are used to ligate or occlude the arteries leading into the hemorrhoid.  The same stitches is then used to replace the prolapsed or protruding hemorrhoidal tissue back into the anal canal.

The Procedures

A hemorrhoidectomy is usually performed in a surgical center. General or regional anesthesia is used during surgery to ensure you do not feel any pain. The colon and rectal surgeon, also known as a proctologist, makes an incision in the tissue around the hemorrhoid, excising the hemorrhoidal tissue with a scalpel, electrocautery or laser. The wound left by the removal of the hemorrhoid is then left open or sutured closed.

During a stapled hemorrhoidectomy, a circular stapling device is used to lift the excess hemorrhoid tissue back into place in the anal canal, anchor the excess tissue into place, remove the hemorrhoid, and close the wound. This option is less painful, but still requires pain management.

During a THD, the hemorrhoid blood flow is occluded and the hemorrhoidal tissue is replaced back into the anal canal.

You should be released from the surgical center the same day of surgery, but you will need someone to drive you home. You may experience some pain, which can be treated with prescription or over-the-counter medications. A full recovery usually takes two to three weeks. During this time, you can relieve any discomfort with sitz baths and ice packs.

Risks

Pain, bleeding, and urinary retention are the most common side effects of a hemorrhoidectomy, however, they do not occur with great frequency.  There are other, much less common side effects and these can be explained to you by your colon and rectal surgeon.

A hemorrhoidectomy is the most permanent way of treating hemorrhoids, but it also carries a higher risk than other treatment options. Because of this, a hemorrhoidectomy is only recommended in specific cases to be determined by the colorectal surgeon.