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About Hemorrhoidectomy

It is quite clear from its name that this procedure is done to remove hemorrhoids both internal as well as external. These hemorrhoids can be extensive or severe. According to medical experts, this procedure is the most sought after way to treat hemorrhoids, though it is related to various complications.

Generally known as piles, hemorrhoid refers to an inflamed, swollen accretion of inflamed veins along with even muscle and connective tissue in the rectum and anus that can lead to discomfort and blood loss. Sometimes, the hemorrhoid may obtrude outside the anus (external hemorrhoids) or remain within the rectum (internal hemorrhoids). In India, more than 40 million people suffer from hemorrhoids. Almost 1 million new cases are registered annually, 47 per 1000, with the incidence increasing with age. The typically affected age group is 45-65 years.

In most of the cases, people come to know about hemorrhoids when they notice bleeding during a bowel movement. The doctor carries out a digital test of the rectum in order to rule out other possible causes. After the digital analysis, the rectum and lower part of the large intestine are detected with an anoscope, proctoscope or sigmoidoscope to determine the presence of internal hemorrhoids. The doctor may suggest a barium enema only if he founds traces of colorectal cancer. Else, imaging is not generally done for hemorrhoids. In certain cases, a stool guaiac test or guaiac fecal occult blood test (gFOBT) may be ordered to detect blood in the stool that is not visible to the naked eye.

Before performing the surgery, your doctor may give stop you from medical certain medications such as:

  • Ibuprofen
  • Aspirin
  • Naproxen
  • Warfarin
  • Apixaban
  • Rivaroxaban
  • Clopidogrel

Besides this, you’ll be advised to stop smoking for at least two weeks before the surgery as it coul dealy the recovery. Routine blood and urine tests are carried out to determine the health status of the patient and rule out any underlying disease.

A chest x-ray and electrocardiogram (ECG) will be performed to rule out any heart or lung disease. The patient is evaluated before surgery by the cardiologist and anesthetist and proclaimed fit for surgery. The patient is instructed to get admitted to the hospital on the evening prior to the operation for undergoing certain procedures and for medications.

The surgical hemorrhoidectomy is carried out in an operation theater. Any of the three types of anesthesia may be used to sedate the patient. Local anesthesia may be given around the anorectal area, making a local effect. A spinal block involves administration of anesthesia in the vertebral column at the back, which anesthetizes the entire lower portion of the body. If general anesthesia (GA) is used, the patient will be unconscious and will not be aware of the operation at all.

During the surgical procedure, incisions are made around the hemorrhoid with a scalpel, cautery pencil (heat-generating electrical instrument) or laser. The swollen veins in the hemorrhoid are knotted to prevent bleeding. The surgical wound can be left open or sutured. Medicated gauze is used on the wound.

There could be different types of hemorrhoidectomies that can be done including:

  • Rubber Band Ligation
  • Injection Sclerotherapy
  • Coagulation
  • Stapled Hemorrhoidopexy (Procedure for Prolapse and Hemorrhoids – PPH)
  • Conventional Surgical Hemorrhoidectomy
  • Hemorrhoidal Artery Ligation Operation (HALO)
  • New Techniques

Recovery period can be pretty less if local anesthesia is administered, while considerably longer if GA is used. Spinal anesthesia generally takes a few hours to wear off. The patient lies on the back horizontally for at least an hour following surgery to prevent anesthesia induced headache, which can be intense and take a long time to subside.

Hemorrhoidectomies are found to have a high success rate. Most patients have a reliable recovery following surgery, without any major risks or recurrence. However, even following a successful surgery, there is a 5% chance of recurrence. Complications are generally rare with hemorrhoidectomy, but nevertheless, can occur. One of the most painful complexities of internal or external hemorrhoids is thrombosis. Other complications may include the following:

  • Anal fistula or fissure
  • Severe constipation
  • Excessive bleeding
  • Excessive fluid discharge from the rectum
  • Fever of 38°C or higher
  • Inability to urinate or have bowel movements
  • Intense pain if bowel movements occur
  • Redness and swelling in the rectal area
  • Stenosis (narrowing) of the anus
  • Recurrence of the hemorrhoid


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