Hemorrhoidectomy is a surgical procedure used to treat severe hemorrhoids, primarily indicated for patients who do not respond to conservative treatments or have severe symptoms. This method involves excising diseased tissue to address issues caused by internal hemorrhoids, external hemorrhoids, or thrombosed hemorrhoids, such as bleeding, prolapse, pain, and itching. The surgical approach is tailored according to the patient's symptoms and is commonly performed in 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 overexpanded veins, and to repair the surrounding anal tissue structures. This procedure is usually performed in outpatient or hospital settings, requiring local anesthesia, spinal anesthesia, or general anesthesia, selected based on the patient's condition and physician assessment.
Hemorrhoidectomy encompasses various techniques, mainly divided into open and closed procedures. Open hemorrhoidectomy involves directly removing the hemorrhoidal tissue and suturing the wound, suitable for extensive lesions; closed hemorrhoidectomy uses special 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 works by excising abnormal vascular plexuses to block blood congestion, while repairing the connection between the sphincter muscles and mucosal layers, fundamentally addressing recurrent bleeding and prolapse associated with hemorrhoids.
Suitable for symptoms unresponsive to conservative treatments (such as medication and sitz baths), including:
For complex cases involving fibrotic tissue, large hemorrhoids, or concomitant anal stenosis, physicians may recommend this treatment. Other anorectal diseases (such as anal fissures or rectal tumors) should be ruled out before proceeding.
The procedure is typically performed in a hospital operating room, with steps including:
The operation lasts approximately 30 minutes to 2 hours. Hospital stay depends on the procedure; some patients may be discharged on the same day after outpatient surgery. Postoperative care includes sitz baths, dietary adjustments, and pain medication, with wound healing typically taking 4-6 weeks.
Main benefits 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 on biological agents or immunosuppressants, discuss with the physician to adjust medication timing. When combined with radiotherapy 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 diseased tissue. When choosing alternatives, consider the severity of symptoms and patient needs.
Postoperative pain 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 straining, and avoiding prolonged sitting. Strict adherence to medical advice on pain management and reporting pain levels during follow-up are essential for adjustment.
When can I resume daily activities after surgery? What stage restrictions should I observe?Light activities like walking can typically begin 1-2 days after 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, stand up every 2 hours for 5 minutes to promote circulation and avoid prolonged bed rest or sitting.
How should I handle minor bleeding after surgery? When is it necessary to seek immediate medical attention?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 clots and severe pain, it may indicate vessel ligation 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 key factors for recurrence?Traditional open hemorrhoidectomy has a 5-year success rate of approximately 85-90%, while stapled procedures have slightly lower recurrence due to less trauma. Key preventive measures include maintaining a daily fiber intake of 15-20 grams, avoiding constipation or diarrhea, controlling weight, and performing regular anal sphincter relaxation exercises. Patients with prolonged sitting or heavy lifting 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. Postoperative fasting may be necessary for the first 24 hours due to anesthesia effects, gradually transitioning from clear liquids to soft foods. Physicians often prescribe laxatives to prevent constipation. Patients should monitor stool consistency daily, ensuring bowel movements are within 2 minutes to avoid wound damage.
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