Hemorrhoidectomy

What is a hemorrhoidectomy?

A hemorrhoidectomy is the surgical removal of hemorrhoidal tissue. Hemorrhoidal tissues contain blood vessels that act as cushions by swelling slightly to protect the anal canal during bowel movements. Too much pressure due to straining or other factors can make these tissues remain enlarged and cause hemorrhoids and symptoms, such as rectal pain and bleeding. When this happens inside the anal canal, they’re called internal hemorrhoids. If it occurs around the anal opening, they’re external hemorrhoids. A hemorrhoidectomy is a treatment for large symptomatic hemorrhoids.

A hemorrhoidectomy is a major surgery with significant risks and potential complications. You may have less invasive treatment options available depending on your circumstances. You should consider getting a second opinion about all your treatment choices before having a hemorrhoidectomy.

Types of hemorrhoidectomy

The types of hemorrhoidectomy procedures include:

• Excisional hemorrhoidectomy is removing the hemorrhoidal tissue by cutting it. Your surgeon may choose to leave the tissue wound open (open excisional hemorrhoidectomy) or close it with stitches (closed excisional hemorrhoidectomy). Most surgeons prefer the closed technique.
• Stapled hemorrhoidopexy removes only a portion of the hemorrhoidal tissues. The remaining hemorrhoidal tissues are lifted back up into the anal canal and stapled into place with a special stapling device. This procedure tends to cause less post-operative pain and has a shorter recovery period. However, it is not effective for large external hemorrhoids and hemorrhoids tend to recur more often.

Other procedures that may be performed

In addition to a hemorrhoidectomy, your doctor may also perform a lateral internal sphincterotomy. This is the opening or widening of the internal sphincter muscle. Your doctor may perform this procedure if you have high resting internal sphincter pressure, which may make it difficult for you to push out stool. However, it is not a common procedure. The goal of this procedure is to reduce post-operative pain during bowel movements.

Why is a hemorrhoidectomy performed?

A hemorrhoidectomy is a major surgical procedure that your doctor may recommend to treat large hemorrhoids that are causing symptoms, such as rectal pain and bleeding. Your doctor may only consider a hemorrhoidectomyfor you if other treatment options with less risk of complications are ineffective. Talk with your doctor about all of your treatment options and consider getting a second opinion.

Your doctor may recommend a hemorrhoidectomy under the following conditions:

• You have additional anorectal conditions that require surgery.
• You have combined internal and external hemorrhoids.
• You have grade 3 or 4 prolapsed internal hemorrhoids. Prolapse means that the hemorrhoids are falling out of the anus. Grade 3 prolapse occurs with a bowel movement, but you can manually push the hemorrhoid back through your anus. A grade 4 prolapse cannot be put back.
• You’ve had minimally invasive doctor’s office procedures or other treatments that have not corrected the problem.
• You have a strangulated internal hemorrhoid, which occurs when the anal sphincter traps the hemorrhoid and cuts off blood supply to the tissue.
• You have a hemorrhoid with blood clots (thrombosed external hemorrhoid) that recur after less invasive procedures.

How is a hemorrhoidectomy performed?

A general surgeon or a colorectal surgeon will lead the surgical team and perform your hemorrhoidectomy in a hospital or outpatient surgery setting. A colorectal surgeon is a surgeon who specializes in surgical treatment of diseases of the lower digestive tract. This includes the colon (large intestine), rectum and anus.

A hemorrhoidectomy starts with an anorectal exam under anesthesia. Your surgeon inserts a retractor into your anus to visualize the internal and external hemorrhoids. The hemorrhoids are removed by cutting or stapling. Stitches are placed internally or externally. They are usually absorbable and do not need to be removed. Packing and dressings are then placed over the wounds.