Hemorrhoids are swollen veins in the anal canal, similar to varicose veins. These vascular structures function as cushions that aid in stool control. When inflamed or swollen, they can cause uncomfortable symptoms like pain, itching, or bleeding. While many cases resolve with home remedies, surgery is an option for severe or persistent instances.
Deciding on Surgical Intervention
Surgery for hemorrhoids is considered when less invasive treatments have not provided adequate relief, or when the condition is advanced. Lifestyle changes, such as increased fiber and fluid intake, are often the first approach. However, for significantly prolapsed hemorrhoids that extend outside the anus and do not retract, or those with a blood clot (thrombosed), surgery might be recommended. Persistent symptoms, including significant bleeding, chronic pain, or discomfort interfering with daily activities, can also lead to a surgical recommendation. Hemorrhoids are categorized by severity, with Grade 3 (prolapsed but manually reducible) and Grade 4 (permanently prolapsed) often warranting surgical evaluation.
Overview of Surgical Techniques
Several surgical techniques are available, each designed to address hemorrhoids differently. The specific method depends on the type and severity of hemorrhoids, as well as surgeon and patient preferences. These procedures are typically performed under anesthesia, ensuring comfort during the operation.
Hemorrhoidectomy
Hemorrhoidectomy involves the direct removal of affected hemorrhoidal tissue. In a closed hemorrhoidectomy, the surgeon excises the hemorrhoid using instruments like a scalpel or electrocautery, then closes the wound with dissolvable stitches. This approach is frequently used for internal hemorrhoids. An open hemorrhoidectomy involves similar tissue excision, but the incision is left open to heal naturally, often preferred if closing the wound is challenging or infection risk is high. Both closed and open hemorrhoidectomies are effective for severe hemorrhoids, including Grade 3 and 4 cases.
Hemorrhoidopexy (Stapled Hemorrhoidectomy)
Stapled hemorrhoidopexy utilizes a circular stapling device. A stapler is inserted into the anal canal to remove excess tissue above the hemorrhoids, lifting them back into position. This also disrupts the blood supply to the hemorrhoids, causing them to shrink over time. This technique is often used for prolapsed internal hemorrhoids (Grade 3 or 4) and generally results in less pain after surgery compared to traditional hemorrhoidectomy. The staples typically fall out gradually as the tissue heals.
Doppler-Guided Hemorrhoidal Artery Ligation (DG-HAL) / Transanal Hemorrhoidal Dearterialization (THD)
Doppler-guided hemorrhoidal artery ligation (DG-HAL), also known as transanal hemorrhoidal dearterialization (THD), reduces blood flow to the hemorrhoids. An anoscope with a Doppler ultrasound probe helps locate the arteries supplying blood. Once identified, these arteries are tied off with sutures, cutting off the blood supply. This causes the hemorrhoids to shrink. This method is considered less invasive than traditional removal and is often used for Grade 2 or 3 hemorrhoids.
Laser Hemorrhoidoplasty (LHP)
Laser Hemorrhoidoplasty (LHP) is a newer technique that uses laser energy to treat hemorrhoids. A laser fiber is inserted into the hemorrhoidal tissue. The laser energy causes the hemorrhoid to shrink and coagulate. This method aims to reduce the size of the hemorrhoid and alleviate symptoms with minimal tissue damage.
Before the Operation
Preparation for hemorrhoid surgery ensures patient safety and optimizes surgical outcomes. Patients undergo pre-operative consultations, discussing medical history, current medications, and the surgical plan. Tests, such as blood work, may be ordered to assess overall health and identify potential risks. Patients receive instructions regarding diet and medication, including fasting and temporarily stopping blood-thinning medications to reduce bleeding risks. Bowel preparation, such as using enemas, is commonly required to ensure the surgical area is clean.
After the Operation: Recovery
Recovery after hemorrhoid surgery typically ranges from two to eight weeks, depending on the procedure and individual healing. Pain management is key; providers prescribe oral or topical medications, and ice packs or warm sitz baths offer relief. Wound care involves keeping the anal area clean by gently patting dry after bowel movements. Dietary adjustments, including a high-fiber diet, fluids, and sometimes stool softeners, prevent constipation and straining. Activity restrictions include avoiding heavy lifting and strenuous activities for several weeks; however, excessive bleeding, fever, or severe uncontrolled pain require immediate medical attention.