Hemorrhoidectomy is a surgical procedure used to treat severe hemorrhoids, primarily for patients who do not respond to conservative treatments or have severe symptoms. This therapy involves excising diseased tissue to address issues such as bleeding, prolapse, pain, and itching caused by internal hemorrhoids, external hemorrhoids, or thrombosed hemorrhoids. The surgical approach varies depending on the patient's symptoms and is commonly performed on patients with third- or fourth-degree hemorrhoids, effectively improving quality of life and preventing complications.
The goal of the surgery is to remove abnormal vascular clusters and overly dilated veins, and to repair the surrounding anal tissue structures. This procedure is usually performed in outpatient or inpatient settings, requiring local anesthesia, spinal anesthesia, or general anesthesia, selected based on the patient's condition and physician assessment.
Hemorrhoidectomy includes various techniques, mainly divided into open and closed excision methods. Open hemorrhoidectomy involves directly removing hemorrhoidal tissue and suturing the wound, suitable for extensive lesions; closed hemorrhoidectomy uses specialized instruments to ligate the hemorrhoidal base before excision, reducing tissue damage. Additionally, the "Stapled Hemorrhoidopexy (PPH)" involves inserting a device through the anus to excise and lift hemorrhoidal tissue, preserving part of the anal wall structure.
The mechanism involves removing diseased tissue and reconstructing the normal anatomy around the anus. The surgery cuts off abnormal vascular plexuses to prevent blood pooling and restores the connection between the sphincter muscles and mucosa, fundamentally addressing recurrent bleeding and prolapse issues associated with hemorrhoids.
This procedure is suitable for symptoms unresponsive to conservative treatments such as medication and sitz baths, including:
For complex cases such as fibrotic tissue, large hemorrhoids, or concurrent anal stenosis, the physician may recommend this treatment. Other anorectal diseases (such as anal fissures or rectal tumors) must be ruled out before proceeding.
The surgery is typically performed in a hospital operating room, with steps including:
The procedure lasts approximately 30 minutes to 2 hours. Hospital stay depends on the surgical method; some patients can be discharged on the same day after outpatient surgery. Postoperative care includes sitz baths, dietary modifications, and pain medication, with wound healing taking about 4-6 weeks.
Main advantages include:
Compared to non-surgical treatments, this method directly removes diseased tissue, reducing recurrence rates. It is suitable for patients with severe lesions or recurrent bleeding, effectively restoring anal function and anatomy.
Potential risks include:
Serious risks include anesthesia-related complications, deep vein thrombosis, or rarely, damage to the anal sphincter leading to incontinence. Elderly patients or those with diabetes require special attention to infection risks.
Preoperative considerations include:
Contraindications include:
Drug interactions include:
If the patient is receiving biologic agents or immunosuppressants, discuss with the physician about adjusting medication timing. When combined with radiation therapy or chemotherapy, evaluate wound healing capacity.
Clinical studies show:
Most patients resume normal activities within 6 weeks postoperatively. Long-term follow-up indicates significant improvement in anal function scores (FAC). However, individual outcomes are closely related to the severity of the lesion, surgical technique, and postoperative care.
Non-surgical options include:
Medications such as topical steroids or non-steroidal anti-inflammatory drugs can temporarily relieve symptoms but cannot cure the diseased tissue. When choosing alternatives, consider symptom severity and patient preferences.
Pain after surgery can be alleviated with prescribed analgesics such as NSAIDs or mild opioids. Non-pharmacological methods include ice packs on the anal area, maintaining soft stools to reduce strain during defecation, and avoiding prolonged sitting. Strict adherence to pain management instructions and reporting pain levels during follow-up are essential for adjustment.
How soon can I resume daily activities after surgery? Are there stage-specific restrictions?Light activities such as walking can typically start 1-2 days post-surgery, but lifting heavy objects or vigorous exercise should be avoided for at least 2-4 weeks. The time to return to full-time work depends on the nature of the job; office work may resume after about 1 week, while manual laborers may need over 4 weeks. Initially, standing or walking for 5 minutes every 2 hours is recommended to promote blood flow and prevent complications.
How should I handle minor bleeding after surgery? When is immediate medical attention necessary?Minor bleeding is usually normal; clean the anal area with warm water and apply antibiotic ointment. If bleeding is profuse, persistent over 20 minutes, or accompanied by blood clots and severe pain, it may indicate vessel ligature failure or infection, requiring urgent hospital evaluation. Monitoring bleeding daily during the first week is important for self-assessment.
What is the long-term success rate of hemorrhoidectomy? What are the key factors for recurrence?According to medical studies, the success rate of traditional open hemorrhoidectomy is approximately 85-90% over five years, with stapled procedures having a slightly lower recurrence due to less trauma. Key preventive measures include maintaining a daily intake of 15-20 grams of dietary fiber, avoiding constipation or diarrhea, controlling weight, and regularly practicing anal sphincter relaxation exercises. Those who sit for long periods or lift heavy objects should pay special attention to posture and exercise habits.
What special bowel preparations are required before and after surgery?Start bowel cleansing with laxatives 3 days before surgery, and fast for 8 hours on the day of the procedure. The first 24 hours post-surgery may require fasting due to anesthesia effects. After resuming eating, gradually transition from liquids to soft foods. Physicians often prescribe laxatives to prevent constipation, and patients should monitor stool consistency daily, ensuring bowel movements are within 2 minutes to avoid wound damage.
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