46945 Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid column/group, without imaging guidance

Name of the Procedure:

Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid column/group, without imaging guidance

Summary

A hemorrhoidectomy by ligation is a surgical procedure to remove an internal hemorrhoid through the use of a ligature, which ties off the hemorrhoid to cut off its blood supply. This procedure is performed without the aid of imaging guidance.

Purpose

The procedure is used to treat internal hemorrhoids that cause significant pain, bleeding, itching, or other discomforts. The goal is to remove the problematic hemorrhoid, alleviate symptoms, and prevent recurrence.

Indications

• Persistent rectal bleeding
• Severe pain or discomfort in the anal region
• Significant itching or irritation
• Prolapse (hemorrhoid protrudes from the anus)
• No response to conservative treatments like dietary changes, topical medications, or other non-surgical interventions.

Preparation

• Fasting for several hours prior to the procedure.
• Adjustments to medications as per the doctor's recommendations, especially blood thinners.
• Pre-procedure evaluation including medical history and physical examination.
• Possible enemas or laxatives to clear the rectum.

Procedure Description

1. The patient is positioned appropriately, typically lying on their side.
2. Sedation or local anesthesia is administered to ensure patient comfort.
3. The surgeon identifies the internal hemorrhoid.
4. A ligature is carefully placed around the base of the hemorrhoid to cut off its blood supply.
5. The ligated hemorrhoid eventually shrinks and falls off.
6. No imaging devices are used during this procedure.

Duration

Approximately 30 to 60 minutes.

Setting

Typically performed in an outpatient clinic or a surgical center.

Personnel

• A qualified surgeon or proctologist
• Registered nurses or surgical technologists
• An anesthesiologist or anesthetist, if sedation is required

Risks and Complications

• Bleeding
• Infection
• Pain
• Difficulty urinating
• Hemorrhoid recurrence
• Rare: Severe complications such as thrombosis or sepsis

Benefits

• Relief from pain and other symptoms caused by internal hemorrhoids.
• Improvement in quality of life.
• Reduced risk of recurrence compared to non-surgical treatments.

Recovery

• Expect mild discomfort or pain manageable with medications.
• Instructions on wound care and sitz baths to promote healing.
• Avoid heavy lifting, straining, and sitting for prolonged periods for a few days.
• A follow-up appointment within a few weeks to monitor healing.
• Typical recovery time ranges from a few days to a week.

Alternatives

• Rubber band ligation
• Sclerotherapy (injection of a solution causing the hemorrhoid to shrink)
• Infrared coagulation (burning the hemorrhoid tissue)
• Conservative treatments (dietary changes, over-the-counter creams, and suppositories)

Pros and cons of Alternatives

• Rubber band ligation: Less discomfort but may be less effective for larger hemorrhoids.
• Sclerotherapy: Minimally invasive but suitable for smaller hemorrhoids.
• Infrared coagulation: Quick recovery but may require multiple sessions.
• Conservative treatments: Non-invasive but often only provide temporary relief.

Patient Experience

During the procedure, the patient might feel pressure or mild discomfort but should not feel significant pain due to anesthesia. Post-procedure, some pain or discomfort is common, which can be managed with pain relievers and sitz baths. Follow instructions for diet and activity to promote a smooth recovery, and attend follow-up appointments to ensure proper healing.