Name of the Procedure:

Hemorrhoidectomy, Internal and External, Single Column/Group with Fissurectomy

Summary

A hemorrhoidectomy with fissurectomy is a surgical procedure to remove both internal and external hemorrhoids, as well as any associated anal fissures. This involves excising the swollen blood vessels and repairing the surrounding tissue to relieve discomfort and prevent further complications.

Purpose

The procedure addresses the presence of internal and external hemorrhoids, which can cause pain, bleeding, and prolapse. In addition, it treats fissures—tears in the lining of the anus—that can cause severe pain and discomfort. The primary goals are to alleviate symptoms, improve bowel function, and enhance the patient's quality of life.

Indications

• Persistent bleeding from hemorrhoids
• Significant pain and discomfort
• Prolapsed hemorrhoids
• Chronic anal fissures that have not responded to conservative treatments
• Symptoms interfering with daily activities

Preparation

• Patients are typically advised to fast for 6-8 hours before surgery.
• Documentation of any medications, especially blood thinners, is required; some medications may need to be adjusted or paused.
• Pre-operative blood work and potentially a colonoscopy to rule out other conditions.
• Cleansing enema or bowel preparation may be recommended.

Procedure Description

1. Anesthesia: The patient is given either spinal or general anesthesia.
2. Positioning: The patient is placed in a prone or lithotomy position.
3. Incision: An incision is made around the hemorrhoidal tissue.
4. Excision: The swollen hemorrhoidal veins are excised along with the fissure tissue if present.
5. Repair: The surgical area is repaired, and the tissue is sutured.
6. Hemostasis: Bleeding is controlled using various methods such as cauterization.
7. Closure: The incision site may be left open or partially closed to facilitate healing.

Duration

The procedure typically takes about 30 minutes to an hour, depending on the case's complexity.

Setting

Hemorrhoidectomy with fissurectomy is performed in a hospital's operating room, outpatient surgical center, or clinic.

Personnel

• Surgeon (Colorectal or General Surgeon)
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Pain and discomfort
• Bleeding or infection at the surgery site
• Urinary retention
• Anal stricture or narrowing
• Recurrence of hemorrhoids or fissures
• Adverse reactions to anesthesia

Benefits

• Relief from chronic pain and discomfort
• Stopping recurrent bleeding
• Reduction in prolapse and irritation
• Improved bowel function and quality of life
• Immediate reduction in symptoms, with full benefits realized in a few weeks

Recovery

• Initial pain management may include oral analgesics and sitz baths.
• Patients can expect some discomfort for 1-2 weeks post-operation.
• Daily activities can typically be resumed within a week, though heavy lifting should be avoided for several weeks.
• Follow-up appointments may be scheduled to monitor healing.
• Diet modifications and stool softeners to ease bowel movements.

Alternatives

• Non-surgical treatments such as rubber band ligation, sclerotherapy, or infrared coagulation.
• Medical management with high-fiber diets, topical ointments, and medications.
• Lifestyle changes to reduce straining during bowel movements.
• Less invasive surgical procedures such as stapled hemorrhoidopexy.

Patient Experience

• Patients may experience initial discomfort and pain, managed with prescribed medication.
• Some bleeding and swelling are common in the first week.
• Return to work and normal activities is usually possible after a week but might vary.
• It's essential to maintain a high-fiber diet and stay hydrated to prevent recurrence.