Hemorrhoids are a collection of blood in the venous system (engorged veins) that occurs in the anal region either internally or externally.Hemorrhoidectomy is normally reserved for the failed outpatient treatment but factors such as the patient’s preference, the extent of the clinical signs and symptoms and the anatomy of the hemorrhoid are also considered when considering surgery.
Haemorrhoidectomy can be done using the open or the closed techniques in which both involve ligation and excision of hemorrhoid but in the open technique, the anal mucosa and the skin are left open to heal through secondary intention while in the closed technique, the
wound is sutured.
The indications for a haemorrhoidectomy include:
The procedure is usually performed under general or regional anesthesia with the patient in the lithotomy or the jack-knife position. This position helps in the easy accessibility of the piles during surgery. The perianal skin is shaved and a formal examination is performed to assess the progression of the piles as per the moment. Haemorrhoidectomy can be performed using the open (Milligan-Morgan technique) or the closed technique.
Haemorrhoidectomy is normally a well-done procedure but sometimes it can be associated with complications which are as follows:
The use of rectal enema preoperatively is advised so as to clear the rectum before the surgery. Stool softeners are also taken days before the surgery. You are required to show up to the health care facility about a day prior to the surgery. This will give the care givers enough time to run the lab blood tests required and other tests that might be required prior to the surgery. This will give a clear picture of the current status of the patient. The caregivers will still assess if you are fit for the surgery particularly to prevent the adverse effects of the anesthesia. As of any surgical procedure that you’ll be required to be under general anesthesia, the patient is required to fast for about 8-12 hours to avoid complications of the anesthesia. An intravenous line is required to feed the required drugs into the body system of the patient. A water drip may or may not be employed.
The recovery is normally good in most patients. The wound heals faster in the closed technique compared to the open one with a high 95% success rate. The open technique is often prone to infections. Stool softeners and bulking agents are used to enhance defecation to avoid straining postsurgery. Appropriate pain medication and antibiotics postoperatively are also given. The patient needs to be reassessed after 4-6 weeks after discharge to assess if the piles are healing well or are well healed. The patient is also required to take two warm baths each day.
Chance of recurrence is very low after hemorrhoidectomy. A patient is normally discharged the same day of surgery with a median of about 6 weeks of recovery