Name of the Procedure:

Hemorrhoidectomy, External (2 or more columns/groups)

Summary

A hemorrhoidectomy is a surgical procedure performed to remove external hemorrhoids, particularly when they are large, cause significant discomfort, or do not respond to less invasive treatments. The procedure involves excising two or more groups of hemorrhoidal tissue.

Purpose

The medical condition it addresses is external hemorrhoids, which are swollen veins in the rectal area. The goals are to relieve symptoms such as pain, bleeding, and itching, and to prevent complications like thrombosis (clotting) or prolapse (falling out through the anus).

Indications

• Persistent pain, itching, and discomfort from external hemorrhoids
• Bleeding during bowel movements
• Large hemorrhoids unresponsive to non-surgical treatments
• Complications like thrombosed hemorrhoids
• Patients with a prolapsed hemorrhoid

Preparation

• Fasting may be required several hours before the surgery.
• Discontinuing certain medications, such as blood thinners, as advised by the surgeon.
• Preoperative assessments including blood tests and possibly imaging studies.
• Enemas or laxatives might be recommended to clear the bowel.

Procedure Description

• The patient is positioned appropriately, often on their side or in a lithotomy position.
• Anesthesia: The procedure is usually performed under local anesthesia with sedation, regional anesthesia, or general anesthesia depending on the case.
• The surgeon uses a scalpel, surgical scissors, or specialized devices to excise the hemorrhoidal tissue from at least two different columns/groups.
• Hemostasis (control of bleeding) is achieved using sutures, cauterization, or surgical clips.
• The wound may be left open to heal naturally (open technique) or closed with stitches (closed technique).

Duration

The procedure typically takes 30 to 60 minutes, depending on the number of hemorrhoids removed and the complexity of the case.

Setting

The procedure is commonly performed in a hospital operating room or an outpatient surgical center.

Personnel

• The primary healthcare professional involved is a colorectal surgeon.
• An anesthesiologist or nurse anesthetist provides anesthesia care.
• Surgical nurses assist during the procedure.

Risks and Complications

• Common risks: Pain, bleeding, infection
• Rare risks: Fistula formation, anal stricture, urinary retention
• Complications are managed with medications, additional surgeries, or other interventions as necessary.

Benefits

• Significant relief from pain, bleeding, and discomfort.
• Improvement in quality of life and daily functioning.
• Results are usually realized within a few weeks post-procedure.

Recovery

• Post-procedure care includes pain management, wound care, and a high-fiber diet.
• Sitz baths may be recommended to soothe the area.
• Restrictions: Avoid heavy lifting and strenuous activities for a few weeks.
• Follow-up appointments with the surgeon to monitor healing are essential.

Alternatives

• Non-surgical treatments: Dietary changes, over-the-counter creams, rubber band ligation, sclerotherapy.
• Pros of non-surgical options: Less invasive, less recovery time.
• Cons: May not be as effective for severe or large hemorrhoids.
• Each alternative varies in effectiveness and suitability depending on individual patient conditions.

Patient Experience

• During procedure: Minimal sensation if under anesthesia or sedation.
• After procedure: Expect some pain, swelling, and discomfort managed with prescribed pain relief.
• Daily activities may be limited initially, with gradual improvement over weeks.
• Comfort measures: Ice packs, sitz baths, and pain medications as prescribed.