Hemorrhoidectomy, internal and external, 2 or more columns/groups; with fissurectomy
CPT4 code
Name of the Procedure:
Hemorrhoidectomy with Fissurectomy (Internal and External, 2 or more columns/groups)
Summary
A hemorrhoidectomy with fissurectomy is a surgical procedure to remove both internal and external hemorrhoids and to repair an anal fissure. Hemorrhoids are swollen veins in the rectum and anus, and anal fissures are small tears in the lining of the anus.
Purpose
This procedure is performed to alleviate pain, bleeding, and discomfort caused by hemorrhoids and anal fissures. The primary goal is to eliminate the hemorrhoids and heal the fissure, thus improving the patient's quality of life.
Indications
- Persistent pain or bleeding from hemorrhoids
- Prolapsed hemorrhoids that cannot be managed with conservative treatments
- Chronic anal fissures that do not heal with non-surgical methods
- Presence of both internal and external hemorrhoids
- Significant impact on daily activities and quality of life
Preparation
- Fasting for at least 8 hours prior to surgery
- Adjusting or stopping certain medications as advised by the healthcare provider
- Completing pre-operative assessments such as a physical examination and blood tests
Procedure Description
- The patient is placed under general or spinal anesthesia.
- The surgeon makes incisions around the hemorrhoid to remove it.
- Both internal and external hemorrhoids are excised.
- The surgeon then identifies and repairs any anal fissures present.
- Sutures are used to close the incisions and control bleeding.
- Post-procedure, the area is dressed appropriately.
Tools/Equipment:
- Scalpel
- Surgical scissors
- Hemostats
- Sutures
- Anesthesia equipment
Duration
The procedure usually takes about 1 to 2 hours, depending on the number and size of hemorrhoids and fissures treated.
Setting
This procedure is typically performed in a hospital operating room or a specialized surgical center.
Personnel
- Surgeon
- Anesthesiologist
- Surgical nurse
- Operating room technician
Risks and Complications
- Common risks include pain, bleeding, and infection.
- Rare risks might include urinary retention, fecal incontinence, and anal stricture.
- Complications can usually be managed with medications and follow-up care.
Benefits
- Relief from pain, bleeding, and discomfort.
- Healing of anal fissures.
- Improved bowel movements.
- Enhanced quality of life, usually noticeable within a few weeks after surgery.
Recovery
- Patients may require a hospital stay of one to two days.
- At-home care includes soaking in warm baths, taking prescribed pain medications, and keeping the area clean.
- Full recovery typically takes 2-4 weeks.
- Follow-up appointments are necessary to monitor healing.
Alternatives
- Non-surgical treatments such as dietary changes, topical medications, and rubber band ligation.
- Each alternative has its own benefits and limitations, often less invasive but potentially less effective for severe cases.
Patient Experience
- Patients may feel discomfort and soreness post-procedure, managed with pain relievers.
- It's common to experience some bleeding during bowel movements initially.
- Measures like sitz baths, stool softeners, and avoiding strenuous activities can aid in comfort and recovery.