Hemorrhoidectomy

Alternative names
Hemorrhoid surgery

Definition
Hemorrhoid surgery is the removal of enlarged veins around the anus (hemorrhoids).

Description

Hemorrhoids are swollen (enlarged, dilated) veins (varicose veins) inside (internal) or outside (external) the anus that are usually caused by increased pressure, such as straining when constipated or during pregnancy. Hemorrhoids can cause pain, bleeding, clots, and itching.

Hemorrhoids can be removed surgically while the patient is sleepy (sedated) and pain-free (local anesthesia or spinal anesthesia) or deep asleep and pain-free (general anesthesia). The enlarged vein (hemorrhoid) is removed and a gauze packing is inserted to reduce bleeding.

Smaller hemorrhoids can be “banded,” a procedure in which a small rubber band is placed around the base of the hemorrhoid, which causes the hemorrhoid tissue to die and fall off as a result of lack of blood flow. Alternatively, such hemorrhoids can be injected with a sclerosing agent, which has the same effect. These procedures can often be done as an outpatient or office procedure with minimal or no anesthesia.

Indications
Hemorrhoid removal may be recommended when nonsurgical treatment (fiber-rich diet, laxatives, stool softener, suppositories, medications, warm baths) has not provided adequate relief from:

     
  • Persistent itching  
  • Anal bldding  
  • Pain  
  • Blood clots (thrombosis of the hemorrhoids)  
  • Infection

RISKS
Risks for any anesthesia are:

     
  • Reactions to medications  
  • Problems breathing

Risks for any surgery are:

     
  • Bleeding  
  • Infection

Additional risks include possible narrowing (stricture) of the anus.

Expectations after surgery
The outcome is usually very good in the majority of cases. Preventive measures such as adherence to a high fiber diet, and avoiding constipation must be taken to prevent recurrence.

Convalescence
The patient may experience considerable pain after surgery as the anus tightens and relaxes. Medications to relieve pain may be used. To avoid straining, stool softeners will be used. Avoid any straining during bowel movement or urination. Soaking in a warm bath can bring additional comfort. Expect complete recovery in about 2 weeks.

Johns Hopkins patient information

Last revised: December 3, 2012
by Gevorg A. Poghosian, Ph.D.

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