Hemorrhoidectomy

About Hemorrhoidectomy

Hemorrhoidectomy is the surgical removal of hemorrhoids, the cushions of blood vessels in the anal canal, when they cause persistent symptoms that have not responded to conservative measures or office treatments such as rubber band ligation. Hemorrhoid symptoms are very common, but only a small proportion of people need an operation, typically those with large prolapsing internal hemorrhoids or combined internal and external disease. The two classic excisional techniques are the Milligan Morgan open hemorrhoidectomy, described in London in 1937, which leaves the wounds open to heal, and the Ferguson closed hemorrhoidectomy, in which the wounds are sutured. Stapled hemorrhoidopexy uses a circular stapler to remove a ring of tissue above the hemorrhoids, lifting them back into place and reducing their blood supply; it is generally less painful than excision but has a higher recurrence rate. Doppler guided hemorrhoidal artery ligation uses ultrasound to locate and tie the feeding arteries, sometimes combined with stitching of prolapsing tissue. Pain after excisional surgery is well known to be significant, and postoperative care focuses on pain control and keeping stools soft. Complications include bleeding, difficulty passing urine, particularly after spinal anesthesia, narrowing of the anus if too much tissue is removed, and, rarely, problems with continence. A painful thrombosed external hemorrhoid is sometimes excised under local anesthesia when it is seen early.