Hemorrhoidectomy for hemorrhoids

Surgery Overview

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Hemorrhoidectomy is surgery to remove hemorrhoids. You will be given general anesthesia or spinal anesthesia so that you will not feel pain.

Incisions are made in the tissue around the hemorrhoid. The swollen vein inside the hemorrhoid is tied off to prevent bleeding, and the hemorrhoid is removed. The surgical area may be sewn closed or left open. Medicated gauze covers the wound.

Surgery can be done with a knife (scalpel), a tool that uses electricity (cautery pencil), or a laser.

The operation is usually done in a surgery center. You will most likely go home the same day (outpatient).

There is a procedure that uses a circular stapling device to remove hemorrhoidal tissue and close the wound. No incision is made. In this procedure, the hemorrhoid is lifted and then "stapled" back into place in the anal canal.

What To Expect After Surgery

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Recovery takes about 2 to 3 weeks.

Going home after surgery

• Before the surgery, you will be given a long-acting local anesthetic. It should last 6 to 12 hours to provide pain relief after surgery. If you are not going to stay overnight in the hospital after surgery, you will leave only after the anesthesia wears off and you have urinated. Inability to urinate (urinary retention) sometimes occurs because of swelling (edema) in the tissues or a spasm of the pelvic muscles. This complication occurs in about 20% of people who have a hemorrhoidectomy.
• Someone should drive you home.

Care after surgery

• You can expect some pain after surgery. If your doctor gave you a prescription medicine for pain, take it as prescribed. Ask your doctor what over-the-counter medicines are safe for you.
• Some bleeding is normal, especially with the first bowel movement after surgery.
• You may apply numbing medicines before and after bowel movements to relieve pain.
• Ice packs applied to the anal area may reduce swelling and pain.
• Frequent soaks in warm water (sitz baths) help relieve pain and muscle spasms.
• Some doctors may recommend that you take an antibiotic (such as metronidazole) after surgery to prevent infection and reduce pain.
• Health professionals recommend that you take stool softeners that contain fiber to help make your bowel movements smooth. Straining during bowel movements can cause hemorrhoids to come back.
• Follow-up exams with the surgeon usually are done 1 week and 3 weeks after surgery to check for problems.

Why It Is Done

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Hemorrhoidectomy is appropriate when you have:

• Very large internal hemorrhoids.
• Internal hemorrhoids that still cause symptoms after nonsurgical treatment.
• Large external hemorrhoids that cause significant discomfort and make it difficult to keep the anal area clean.
• Both internal and external hemorrhoids.
• Had other treatments for hemorrhoids (such as rubber band ligation) that have failed.

How Well It Works

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Hemorrhoids come back about 5% of the time after hemorrhoidectomy.¹

Hemorrhoidectomy is done with equal success using traditional surgical tools and lasers.

Risks

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Pain, bleeding, and an inability to urinate (urinary retention) are the most common side effects of hemorrhoidectomy.

Other relatively rare risks include the following:

Early problems

• Bleeding from the anal area
• Collection of blood in the surgical area (hematoma)
• Inability to control the bowel or bladder (incontinence)
• Infection of the surgical area
• Stool trapped in the anal canal (fecal impaction)

Late problems

• Narrowing (stenosis) of the anal canal
• Recurrence of hemorrhoids
• An abnormal passage (fistula) that forms between the anal or rectal canal and another area
• Rectal prolapse, which happens when the rectal lining slips out of the anal opening

What To Think About

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The success of hemorrhoidectomy depends a lot on your ability to make changes in your daily bowel habits to make passing stools easier. Hemorrhoidectomy may provide better long-term results than procedures that cut off blood flow to hemorrhoids (fixative procedures). However, surgery is more costly, has a greater risk of complications, and usually is more painful.

Most internal hemorrhoids improve (they get smaller and discomfort decreases) with either home treatment or fixative procedures. When compared with surgery, fixative procedures involve less risk, are less painful, and require less time away from work and other activities.

Surgery is not recommended for small internal hemorrhoids (unless you also have large internal hemorrhoids or internal and external hemorrhoids).

Lasers are often advertised as being a less painful, faster-healing method of removing hemorrhoids, but none of these claims have been proven. Lasers are more expensive than traditional techniques. The procedure takes longer, and it may cause deep tissue injury.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

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Citations

1. Society for Surgery of the Alimentary Tract (2004). SSAT Patient Care Guidelines: Surgical Management of Hemorrhoids. Available online: http://www.ssat.com/cgi-bin/hemorr.cgi?affiliation=other&referer.

Credits

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Author	Monica Rhodes
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman
Primary Medical Reviewer	Adam Husney, MD - Family Medicine
Specialist Medical Reviewer	Brent Shoji, MD - General Surgery
Last Updated	October 10, 2006