A hemorrhoidectomy is a surgical procedure to remove internal or external hemorrhoids that are severely symptomatic, large, or unresponsive to less invasive treatments. It involves the physical excision of swollen vascular tissue from the anal canal. Whether it is considered major surgery depends on both the technical classification used by medical professionals and the patient’s personal recovery experience.
How Hemorrhoidectomy Is Classified
In the medical community, a hemorrhoidectomy is generally not classified as “major” surgery, a term reserved for procedures involving large body cavities or life-threatening risks. It is more accurately considered an intermediate or complex minor procedure. This classification often relates to the type of anesthesia used, the need for hospital admission, and the overall complexity.
The procedure is commonly performed under general or spinal anesthetic, meaning the patient is either fully asleep or numb from the waist down. Despite this, a hemorrhoidectomy is frequently an outpatient procedure, allowing the patient to return home the same day. The operation is relatively short, usually lasting less than an hour. The perception of the procedure being major stems from the significant discomfort and lengthy recovery period associated with the delicate anatomical location.
Overview of Surgical Techniques
The traditional approach, excisional hemorrhoidectomy, involves physically cutting away the hemorrhoidal tissue. Two main techniques are used: the Milligan-Morgan open technique, where surgical wounds are left open to heal naturally, or the Ferguson closed technique, where the wounds are stitched shut. The closed technique is sometimes associated with lower post-operative pain and better wound healing.
Newer methods offer alternatives to direct excision to reduce recovery time and pain. Stapled hemorrhoidopexy (PPH) uses a circular stapling device to remove a ring of tissue above the hemorrhoids. This lifts the remaining tissue and disrupts its blood supply. Because the procedure is performed higher in the anal canal, it results in significantly less pain.
Another technique is Doppler-guided hemorrhoidal artery ligation (HAL-RAR). This uses an ultrasound probe to locate the arteries supplying the hemorrhoids, which are then tied off, causing the hemorrhoids to shrink. While these less-invasive methods lead to quicker recovery, they may carry a slightly higher risk of recurrence compared to the traditional excisional procedure.
Navigating the Post-Operative Recovery
The recovery period often involves intense discomfort for the first few weeks, making the surgery feel substantial to the patient. The anal area is highly sensitive, and bowel movements irritate the surgical site, causing pain that usually peaks between days two and four. Patients are typically advised to take one to two weeks off work, with complete recovery taking up to four weeks.
Pain management is a primary focus of post-operative care, often requiring prescription pain medication and over-the-counter anti-inflammatories. Warm sitz baths are frequently recommended for self-care, soaking the area several times a day to soothe the surgical site and promote cleanliness.
Managing bowel movements is equally important, as straining must be strictly avoided to protect the surgical wounds. A high-fiber diet, stool softeners, and plenty of water are prescribed to ensure stools are soft and easy to pass, preventing constipation. Light bleeding or clear discharge can be expected for up to a month as the tissue heals. Strenuous activities should be avoided for four to six weeks.
Considering Non-Surgical Treatment Options
Non-surgical, office-based treatments are typically explored before resorting to a hemorrhoidectomy. These alternatives are reserved for less severe, earlier-stage hemorrhoids (Grade I and Grade II). They are minimally invasive, require little to no anesthesia, and have minimal recovery time, making them attractive when symptoms permit their use.
Rubber Band Ligation
This common option involves placing a tiny elastic band around the base of the internal hemorrhoid. This cuts off its blood flow, causing the hemorrhoid to wither and fall off within about a week.
Sclerotherapy
Sclerotherapy involves injecting a chemical solution into the hemorrhoidal tissue, causing it to scar and shrink over time. This method is usually painless because the injection occurs in an area with fewer nerve endings.
Infrared Coagulation
Infrared coagulation uses focused heat to create scar tissue, effectively cutting off the blood supply to the internal hemorrhoid. These procedures are performed in an outpatient setting, making them attractive alternatives when symptoms permit their use.