Name of the Procedure:

Hemorrhoidectomy, Internal and External, Single Column/Group; with Fistulectomy, including Fissurectomy (when performed)

Summary

A hemorrhoidectomy is a surgical procedure to remove hemorrhoids, which are swollen veins in the lower rectum and anus. This specific type of hemorrhoidectomy includes the removal of both internal and external hemorrhoids, and may also involve the excision of a fistula and a fissure if present.

Purpose

This procedure addresses the presence of severe hemorrhoids that cause significant discomfort, bleeding, or other issues. It also treats associated conditions like fistulas (abnormal connections between organs) and fissures (tears in the anal lining). The goal is to relieve symptoms, prevent complications, and improve the patient's quality of life.

Indications

• Persistent pain or bleeding from hemorrhoids
• Hemorrhoids that prolapse (protrude) frequently
• Thrombosed (clotted) hemorrhoids
• Associated anal fistulas or fissures
• Failure of other treatments (diet, medications, less invasive procedures) to provide relief

Preparation

• Patients may be instructed to fast for several hours before the procedure.
• Adjustments to medications, especially blood thinners, might be necessary.
• Preoperative tests such as blood work and a physical exam are typically required.
• Bowel preparation, such as using an enema, might be needed.

Procedure Description

1. Anesthesia: Administer either general anesthesia or regional anesthesia (spinal/epidural).
2. Patient Positioning: The patient is placed in a prone or lithotomy position.
3. Incision and Hemorrhoid Removal: The surgeon makes small incisions around the hemorrhoid to remove the swollen veins.
4. Fistulectomy (if needed): Incision and removal of any fistulas present.
5. Fissurectomy (if needed): Incision and excision of any anal fissures.
6. Closure: The surgical site may be left open to heal naturally or closed with sutures.

Tools and equipment: Surgical scalpel, scissors, sutures, cautery devices.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

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

Personnel

• Surgeon
• Surgical assistants
• Anesthesiologist
• Nurses and other operating room staff

Risks and Complications

• Pain and discomfort post-surgery
• Infection at the surgical site
• Bleeding
• Urinary retention
• Anal stricture (narrowing of the anal canal)
• Recurrence of hemorrhoids

Benefits

• Relief from symptoms such as pain, bleeding, itching, and prolapse
• Improved quality of life
• Reduction in complications associated with untreated hemorrhoids, fistulas, and fissures
• Benefits are usually evident within a few weeks post-surgery

Recovery

• Post-procedure care includes pain management, stool softeners, and sitz baths.
• Patients are typically advised to rest and avoid strenuous activities for a few weeks.
• Follow-up appointments are essential to monitor healing.
• Full recovery may take several weeks, depending on the extent of the surgery and the patient’s overall health.

Alternatives

• Non-surgical treatments: dietary changes, topical treatments, rubber band ligation, sclerotherapy, infrared coagulation.
• Pros of alternatives: less invasive, shorter recovery time.
• Cons of alternatives: may not be effective for severe hemorrhoids, fistulas, or fissures.

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel pain. Post-procedure, there will be discomfort and pain, which can be managed with prescribed medications. The patient may experience limited mobility and may need assistance with daily activities during the initial recovery period. Comfort measures include pain relief, use of sitz baths, and maintaining a soft diet to ease bowel movements.