Haemorrhoidectomy

What Is a Haemorrhoidectomy?

A haemorrhoidectomy is a surgical procedure to remove haemorrhoids, which are enlarged, congested blood vessels in or around the anus that can cause discomfort, pain, and bleeding. This surgery is typically reserved for severe cases where less invasive treatments have failed.

Who Is a Good Candidate for a Haemorrhoidectomy?

A hemorrhoidectomy is typically recommended if your haemorrhoids are present with specific complications, including:

• Prolapse

  : This occurs when internal haemorrhoids protrude from the anus, often causing irritation and bleeding. Prolapse is a progressive condition that tends to worsen over time, making surgical intervention a more permanent solution for long-term relief.

• Strangulation (Incarcerated Haemorrhoids)

  : This is an emergency where a prolapsed haemorrhoid becomes trapped, and its blood supply is cut off. This condition is extremely painful and can lead to tissue death, necessitating immediate surgical intervention.

• Thrombosis

  : A thrombosed haemorrhoid develops when a blood clot forms within it, leading to severe pain and swelling, often presenting with a distinct purple-blue discolouration. In some cases, these can rupture, causing significant bleeding. Surgical removal can provide rapid pain relief and prevent further complications.

• Recurrence

  : When piles persist or frequently return despite other treatments, a haemorrhoidectomy offers a highly effective and lasting solution. The procedure boasts a 95% success rate in addressing these persistent issues.

Who Is Not a Good Candidate for a Haemorrhoidectomy?

A haemorrhoidectomy may not be recommended if you have certain medical conditions that could increase your risk of serious complications. These include:

• A weakened immune system, which can make you more susceptible to infections and hinder healing after surgery.
• Bleeding disorders, which can increase the risk of excessive bleeding during and after the procedure.
• Conditions like Crohn's disease or ulcerative colitis, which can affect the healing process and potentially worsen symptoms in the anal area.
• Portal hypertension, which can lead to increased pressure in the veins around the anus, raising the risk of bleeding.

How Do I Prepare for a Haemorrhoidectomy?

Proper preparation for a haemorrhoidectomy is crucial for a smooth procedure and recovery. Your surgeon will provide specific instructions, but general guidelines include:

• Avoidance

  : Refrain from smoking and alcohol for at least a week before surgery, and stay well-hydrated to reduce the risk of complications and support recovery after the procedure.

• Fasting

  : You must stop eating for 6-8 hours and cease fluid intake 2-3 hours before surgery. This ensures an empty stomach, reducing the risk of complications like nausea, vomiting, or aspiration during anaesthesia. If you need to take essential medications, do so with a tiny sip of water.

• Medication Adjustments

  : Inform your doctor about all medications, supplements, and herbal remedies you are taking. They will advise you on which ones to stop, especially those that can increase bleeding risk (e.g., blood thinners) or interact negatively with anaesthesia.

• Bowel Preparation

  : Typically, you must empty your colon using a laxative or enema the day before surgery. This step is vital to ensure the surgical site is clean and to minimise the risk of infection.

• Home Preparation

  : Before surgery, prepare your home for recovery. Stock up on necessary supplies like ice packs, any prescribed medications, and over-the-counter pain relievers. Set up a comfortable resting area where you can relax and heal.

What to Expect During a Haemorrhoidectomy Surgery

A hemorrhoidectomy is typically performed under general anaesthesia, meaning you will be unconscious and pain-free throughout the operation. The surgery usually takes less than an hour, depending on the complexity of your condition. While some patients can go home the same day, others may require an overnight stay in the hospital for observation.

The procedure may differ based on the type of haemorrhoidectomy:

• Conventional Haemorrhoidectomy (Open or Closed)

  This is the traditional surgical approach where the haemorrhoids are excised.
  
  In a closed haemorrhoidectomy, the surgical wound is stitched closed. Conversely, in an open haemorrhoidectomy, the wound is left open to heal naturally. This approach is often chosen when there is a higher risk of infection or difficulty with closure.

• Stapled Haemorrhoidectomy

  Performed under general anaesthesia, this technique uses a circular stapling device to remove a ring of excess tissue above the haemorrhoids, lifting them back into their normal position within the anal canal and reducing their blood supply. The internal wound is closed with staples.
  
  Compared to conventional methods, a stapled haemorrhoidectomy often results in less immediate postoperative pain and a shorter recovery period.

• Laser Haemorrhoidectomy

  This is a contemporary approach to treating piles that utilises concentrated laser energy to precisely remove or shrink the affected tissue. This method's accuracy minimises damage to surrounding healthy tissues, leading to reduced pain and faster healing for patients.
  
  Laser surgery is a versatile option, effective for both internal and external haemorrhoids. It is frequently chosen for its minimally invasive nature and shorter recovery period compared to traditional surgical techniques.

What Is the Recovery Like for a Haemorrhoidectomy Surgery?

Following surgery, it is normal to experience some pain and discomfort, which can be effectively managed with prescribed medications. You can also expect mild bleeding, itching, and potentially temporary faecal incontinence for 1 to 2 months. Most patients can resume normal daily activities within 1 to 2 weeks, though full recovery can take longer.

Effective self-care is vital for a smoother and faster recovery. Your doctor will provide specific instructions, but here are commonly recommended measures:

• Sitz Baths: Soaking the anal area in comfortably warm water for 15-20 minutes, 2-3 times daily (especially after bowel movements), helps soothe pain, reduce muscle spasms, and keep the wound clean.
• Ice: Applying an ice pack wrapped in a thin cloth to the surgical area for 10-15 minutes, several times daily (especially in the first 24-48 hours) can reduce swelling, inflammation, and pain.
• Medications: Your doctor will prescribe pain relievers for discomfort and stool softeners to prevent painful straining during bowel movements. Take all medications exactly as directed for effective relief and smooth recovery.
• Rest: Avoid strenuous activities and prolonged sitting or standing to minimise pressure on the surgical area, gradually increasing activity as advised by your doctor.
• Preventing Constipation: To avoid pain and wound disruption, ensure soft, easy-to-pass bowel movements by drinking plenty of water, eating a high-fibre diet, and continuing prescribed stool softeners.

What Are the Possible Risks or Complications of a Haemorrhoidectomy?

While generally safe, a haemorrhoidectomy, like any surgery, carries a small risk of complications. These can include:

• Infection

  : Though rare, an infection can lead to a pus build-up (abscess). A short course of antibiotics might be given to mitigate this risk.

• Bleeding

  : You might experience some bleeding or pass blood clots, occasionally even a week or so after the operation.

• Faecal Incontinence

  : Involuntary passing of stools is a rare but possible complication.

• Urinary Retention

  : Some patients may experience temporary difficulty emptying their bladder.

• Stenosis

  : A narrowing of the anal canal can occur, though it is uncommon.