Name of the Procedure:

Hemorrhoidectomy, Internal and External, 2 or more columns/groups
Common name(s): Hemorrhoid Surgery
Technical/Medical term: Hemorrhoidectomy

Summary

Hemorrhoidectomy is a surgical procedure used to remove internal and external hemorrhoids. Hemorrhoids are swollen veins in the lower rectum and anus that can cause discomfort, pain, and bleeding. The procedure offers relief by excising these swollen areas.

Purpose

Addresses: Hemorrhoids
Goals/Outcomes: The primary aim is to alleviate symptoms such as pain, bleeding, and swelling caused by hemorrhoids, and to prevent recurrence.

Indications

Symptoms/Conditions:

• Persistent pain or discomfort
• Bleeding from the rectum
• Prolapsed hemorrhoids that do not respond to other treatments
• Thrombosed hemorrhoids, where blood clots form within the hemorrhoidal tissue

Patient Criteria:

• Failure to respond to conservative treatments (e.g., dietary changes, over-the-counter medications)
• Severe symptoms affecting quality of life

Preparation

Pre-procedure Instructions:

• Fasting for a certain period before the surgery (usually 6-8 hours)
• Adjusting or stopping certain medications as directed by the healthcare provider
• Completing any required diagnostic tests such as blood tests or a colonoscopy

Procedure Description

1. Anesthesia: The patient is given either general anesthesia or regional anesthesia combined with sedation.
2. Positioning: The patient is positioned in a way that gives the surgeon easy access to the anus and rectum.
3. Incision: The surgeon makes small incisions around the anus to access the hemorrhoids.
4. Removal: The hemorrhoidal tissue is excised using surgical tools.
5. Closure: The incisions are either left open to heal naturally or sutured closed, depending on the surgeon's technique and the patient's condition.

Tools/Equipment: Scalpels, electrocautery devices, surgical sutures
Anesthesia Details: General anesthesia or regional anesthesia with sedation

Duration

Typically takes about 30 to 60 minutes.

Setting

Usually performed in a hospital or a specialized surgical center.

Personnel

• Surgeon
• Anesthesiologist
• Surgical nurses
• Operating room staff

Risks and Complications

Common Risks:

• Pain
• Bleeding
• Infection
• Difficulty urinating

Rare Risks:

• Anal stricture (narrowing of the anal canal)
• Recurrence of hemorrhoids
• Fecal incontinence

Complication Management: Antibiotics for infection, dietary adjustments, and follow-up procedures if necessary.

Benefits

Expected Benefits: Relief from pain, bleeding, and discomfort associated with hemorrhoids.
Realization: Benefits are often realized within a few weeks after recovery.

Recovery

Post-procedure Care:

• Pain management with prescribed medications
• Sitz baths to ease discomfort
• Keeping the area clean and dry

Expected Recovery Time: Approximately 2-4 weeks.
Restrictions: Avoid heavy lifting and strenuous activities.
Follow-up: Scheduled follow-up appointments to monitor healing.

Alternatives

Other Treatment Options:

• Rubber band ligation
• Sclerotherapy
• Hemorrhoid stapling

Pros and Cons:

• Rubber band ligation: Less invasive but may not be effective for severe cases.
• Sclerotherapy: Minimally invasive but can have varying success rates.
• Hemorrhoid stapling: Less painful but can be associated with a higher recurrence rate.

Patient Experience

During Procedure: The patient will be under anesthesia and should feel no pain.
After Procedure:

• Discomfort and pain are common, often managed with pain medications.
• Swelling and minor bleeding may occur initially.

• Sitz baths and stool softeners can improve comfort and aid recovery.

  Pain Management: Prescription pain relievers, over-the-counter painkillers, and comfort measures such as sitz baths.