Name of the Procedure:

Hemorrhoidectomy, internal and external, 2 or more columns/groups; with fistulectomy, including fissurectomy, when performed

Summary

A hemorrhoidectomy is a surgical procedure to remove internal and external hemorrhoids, which are swollen and inflamed veins in and around the anus and rectum. This procedure can also include the removal of anal fistulas (fistulectomy) and anal fissures (fissurectomy) if present.

Purpose

This procedure is used to treat severe hemorrhoids that do not respond to other treatments, as well as associated conditions such as fistulas and fissures. The goal is to alleviate pain, bleeding, and discomfort, and to prevent further complications.

Indications

• Persistent hemorrhoidal bleeding
• Severe pain and discomfort not managed by conservative treatments
• Prolapsed hemorrhoids
• Associated anal fistulas or fissures causing additional symptoms like infection or severe pain

Preparation

• Fasting for at least 8 hours prior to surgery
• Adjustments or discontinuation of certain medications as advised by the doctor
• Preoperative assessment tests such as blood work, and sometimes imaging studies

Procedure Description

The surgery is typically performed under general or regional anesthesia. The surgeon will:

1. Position the patient properly on the operating table.
2. Make incisions around the hemorrhoidal tissues.
3. Remove the hemorrhoids along with any fistulas or anal fissures.
4. Depending on the case, the surgical site may be left open to heal naturally or sutured closed.
5. Apply post-surgical dressings and care instructions.

Instruments used include scalpels, scissors, and specialized surgical tools for cauterization or laser surgery.

Duration

The procedure typically lasts between 1 to 2 hours.

Setting

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

Personnel

• Surgeon
• Anesthesiologist
• Surgical nurses
• Operating room support staff

Risks and Complications

Common risks:

• Pain
• Bleeding
• Infection

Rare risks:

• Incontinence
• Urinary retention
• Anal stenosis (narrowing of the anal canal)

Benefits

• Relief from hemorrhoid symptoms such as pain and bleeding
• Improved quality of life
• Reduction in the risk of future hemorrhoidal problems

Benefits are generally realized within a few days to weeks post-surgery.

Recovery

• Pain management with prescribed medications
• Sitz baths to clean and soothe the anal area
• Follow-up appointments to monitor healing
• Avoidance of heavy lifting and straining for several weeks
• Most patients can return to normal activities within 1-2 weeks with full recovery in about 4-6 weeks

Alternatives

• Rubber band ligation
• Sclerotherapy
• Infrared coagulation
• Stapled hemorrhoidopexy

These alternatives have varying success rates and are often considered for less severe cases.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel pain. Post-procedure, some pain and discomfort are expected, which can be managed with medications and care instructions provided by the healthcare team. Most patients report significant relief of symptoms after the initial recovery period.