Name of the Procedure:

Hemorrhoidectomy, internal, by ligation other than rubber band; 2 or more hemorrhoid columns/groups, without imaging guidance

Summary

A hemorrhoidectomy is a surgical procedure to remove internal hemorrhoids by ligation. This means tying off the blood supply to the hemorrhoid using suture material, resulting in its eventual shrinkage and loss. The focus of this procedure is on treating two or more hemorrhoid columns or groups, without the need for rubber band ligation or imaging guidance.

Purpose

This procedure addresses symptomatic internal hemorrhoids, which are swollen veins in the lower rectum or anus. The procedure aims to alleviate discomfort, bleeding, and other complications associated with hemorrhoids. The expected outcome is relief from symptoms and a decrease in the recurrence of hemorrhoid-related problems.

Indications

• Persistent bleeding from hemorrhoids.
• Hemorrhoids causing significant pain or discomfort.
• Failure of other non-surgical treatments, such as dietary changes or medication.
• Prolapsed hemorrhoids that cannot be managed with less invasive measures.

Preparation

• Patients may be instructed to fast for several hours before the procedure.
• Any blood-thinning medications or NSAIDs may need to be paused after consulting with the doctor.
• Pre-procedure assessments may include a physical examination and possibly blood tests.

Procedure Description

1. Anesthesia: The patient will receive either local anesthesia (to numb the area) or general anesthesia (to be asleep).
2. Preparation: The area is cleaned and prepped.
3. Ligation: The surgeon identifies the hemorrhoid columns and uses sutures to tie off the blood supply.
4. Completion: The blood flow to the hemorrhoids is cut off, leading to shrinkage and natural resolution over time.

The procedure involves basic surgical tools (scissors, suture material), with no imaging guidance required.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

This procedure is usually performed in an outpatient surgical center, hospital, or specialized clinic.

Personnel

• Surgeon
• Anesthesiologist or nurse anesthetist (if general or regional anesthesia is used)
• Surgical nurses or assistants

Risks and Complications

• Common risks: Pain, bleeding, infection, difficulty urinating.
• Rare risks: Anal stricture, damage to the anal sphincter, persistent lymphatic leakage.

Management of complications involves medication, follow-up procedures, or additional supportive care.

Benefits

• Relief from symptoms such as pain, bleeding, and itching.
• Lowered risk of hemorrhoid recurrence.
• Quick recovery compared to more invasive surgical options.

Benefits are typically seen within a few days to weeks post-procedure.

Recovery

• Post-procedure care includes keeping the area clean and taking prescribed pain medication.
• Patients might need to avoid strenuous activity for a few days.
• Follow-up appointments ensure proper healing.

Expected recovery time ranges from a few days to two weeks, depending on individual healing.

Alternatives

• Rubber band ligation
• Sclerotherapy
• Infrared coagulation
• Hemorrhoid stapling
• Conservative treatments like dietary changes or topical medications

Each alternative has its pros and cons; for instance, rubber band ligation is less invasive but may require multiple sessions, whereas stapling can be more effective but has a longer recovery period.

Patient Experience

• Mild to moderate discomfort immediately following the procedure which can be managed with medication.
• Some bleeding and discomfort during bowel movements for a few days.
• Improved symptoms after the initial recovery period, leading to a better quality of life.

Pain management involves prescribed pain relievers, stool softeners to ease bowel movements, and sitz baths for comfort.