Hemorrhoidectomy

What is hemorrhoidectomy?

Hemorrhoidectomy is a surgical procedure where the doctor extracts anal hemorrhoids that have become extreme or severe. Usually, hemorrhoids are treatable with home remedies and over-the-counter medication and creams, but in cases when all of this does not work, the doctor will recommend hemorrhoidectomy. But before we know more about hemorrhoidectomy, here is an overview of different types of hemorrhoids:

Internal: They can happen when swollen veins develop inside the anus and the rectum. Although they are not visible or sensitive to touch, they can bleed when stool is passed.
This happens when pressure is put on the anus during defecation. Despite the lack of pain, seeing blood in one's poop can be unsettling.

External: Also known as 'external piles,' they form around the skin of the anus. They can be itchy and painful and can also bleed. The patient may develop a clot in external hemorrhoids or thrombosis (formation of blood clots). They are not dangerous but can cause a lot of discomforts.

Prolapsed: When internal or external hemorrhoids protrude out of the rectum, they are called 'prolapsed.' The patient may experience lumps on the anus, itching, irritation, bleeding, inability to defecate properly (bowels do not feel empty), faecal leakage, and/or mucus discharge that emits an unpleasant odour.

Who needs a hemorrhoidectomy?
 
In the case of external hemorrhoids, if they form on the dentate line (a line marking the end of the rectum and beginning of the anal canal) and are symptomatic (inflamed, tender, itchy, or thrombosed), then hemorrhoidectomy is on the cards. 
 
Internal hemorrhoids are usually situated above this dentate line and are painless. Surgical excision is recommended on the level of their prolapse, as follows:

Grade 1: They protrude but do not bleed
Grade 2: They prolapse outside the anal canal (like during defecation) but then reduce in size spontaneously.
Grade 3: They are visible at the anal canal and require manual reduction
Grade 4: They cannot be reduced over time or with other methods. They are constantly prolapsed. Thrombosed internal hemorrhoids also fall into this category.

The UCF Center for Colorectal Surgery states that people experiencing Grade 3, Grade 4, and a mix of internal and external hemorrhoids require a hemorrhoidectomy. Those with strangulated internal hemorrhoids (blood clot forms here), thrombosed external hemorrhoids, and unable to tolerate general pain of the hemorrhoids or minimally invasive interventions need hemorrhoidectomy. 

Types of hemorrhoidectomy

There are different types of hemorrhoidectomy like:

• Closed Hemorrhoidectomy: Closed Hemorrhoidectomy is the most common surgery to treat internal hemorrhoids. The surgeon uses a scalpel, scissors, electrocautery, or laser to cut out the mass and then uses stitches to close the wound. These sutures absorb into the skin over time. 
• Open Hemorrhoidectomy: The surgery takes place similarly to the closed hemorrhoidectomy, but the wound is left open.
• Stapled Hemorrhoidectomy: This procedure is exclusively used to treat prolapsed internal hemorrhoids. Here the surgeon will use a staple to put the hemorrhoidal tissue back in its original position in the anal canal. This step is usually taken for patients who have grade III and IV hemorrhoids or for whom minimally invasive techniques have not yielded the expected results.

 
How long does it take to recover from a hemorrhoidectomy?
 
The patient is usually given general anesthesia, so they are unconscious during the procedure, and the muscles are relaxed so they cannot feel the pain. However, the pain is experienced after the patient wakes up. Usually, patients can go back home on the same day with their caregiver unless the doctor does not see them as fit to leave. Patients are also asked to take stool softeners for a brief while so they can poop easily. Besides this, they are also advised to eat fiber-rich food and take fiber supplements to avoid constipation. Sitting in a sitz bath, using a cold compress, and taking painkillers are also part of the post-surgery plan. Patients may or may not experience some after-effects of the anesthesia. The recovery period differs from person to person, but the usual time is about a week or two. Stitches of the surgery will dissolve into the skin on their own. The doctor will also schedule a follow-up to check on the progress post-surgery.

MIRUS^TMHEMORRHOIDS STAPLER: MIRUS^TM HEMORRHOIDS STAPLER by Meril Life is used for the hemorrhoidectomy of internal and external hemorrhoids and thrombosed hemorrhoids. It is also used for Minimally Invasive Procedures for Hemorrhoids (MIPH) and Stapled Transanal Resection of Rectum (STARR). This device ensures security and clean hemostasis and is easy to use. It gives optimised staple formation with adjustable height staples. 
 
Just like any surgery, a hemorrhoidectomy is also a major procedure. Going under the knife and being administered anesthesia can be daunting for the patient, but if they are well-versed with all aspects of the surgery and its after-effects, they can go with a calm state of mind. This surgical procedure has few risks and has been proven safe and effective in combating hemorrhoids. 
 
Following your doctor's instructions after the surgery is essential, and maintaining a balanced diet with plenty of fruits and vegetables will only be beneficial in the long run. Also, ensure that you avoid sitting in one spot for an extended period, especially if you have a desk job. This will reduce any chances of hemorrhoids or their recurrence.

References

https://colorectalsurgery.ucsf.edu/conditions--procedures/hemorrhoidectomy.aspx#:~:text=A%20hemorrhoidectomy%20is%20surgery%20to,Hemorrhoid%20Anatomy
https://www.health.harvard.edu/diseases-and-conditions/hemorrhoids_and_what_to_do_about_them
https://www.merillife.com/medical-devices/endosurgery/endo-mechancial-staplers/open-surgery/mirus-hemorrhoids-stapler