Hemorrhoidectomy is a surgical procedure that offers a permanent solution to hemorrhoid (piles) problems, which 50% of the adult population encounters at some point in their lives. Hemorrhoid issues can seriously affect your quality of life and make daily activities difficult.
In this article, you will find all the information you are curious about regarding hemorrhoidectomy in clear and understandable language. Preferred especially in third and fourth-degree hemorrhoid cases, this operation aims to remove the swollen and inflamed vessels in the anus. You will also learn in detail how the surgery is performed, its different techniques, the recovery process, and the points you need to pay attention to afterward.
What is hemorrhoidectomy and in which cases is it applied?
For many people suffering from hemorrhoids, hemorrhoidectomy is an effective solution resorted to when other treatment options remain insufficient. So, what exactly is this surgical procedure and in which cases is it necessary? Let us examine this topic in detail.
What is hemorrhoidectomy surgery?
Hemorrhoidectomy is an operation that involves the surgical excision and removal of vascular clusters formed in the anus. Hemorrhoids are a common health problem that occurs with the swelling and inflammation of the vessels in the anal region, leading to uncomfortable symptoms such as pain, itching, and bleeding. Primarily, this procedure is performed to completely remove the swollen and inflamed vessels in the anus. During the surgery, different surgical instruments such as a scalpel, scissors, cautery, Ligasure, or laser can be used.
This surgical intervention is a procedure that can be applied under both local and general anesthesia. The operation usually lasts between 10-60 minutes, and patients can mostly be discharged on the same day or the next day.
In which stages is it preferred?
Hemorrhoidectomy is not necessary for every hemorrhoid case. It is generally recommended in the following situations:
3rd and 4th-degree hemorrhoids: It is preferred especially in advanced cases. While 3rd-degree hemorrhoids can be pushed back in manually, 4th-degree hemorrhoids remain permanently outside and cannot be pushed back.
Severe symptoms: In cases where quality of life is seriously affected by intense pain, bleeding, or itching.
In the presence of complications: When thrombosed hemorrhoids (blood clot formation) or strangulated hemorrhoids (strangulation of the hemorrhoid) develop.
Cases where conservative treatment is insufficient: When symptoms cannot be controlled with medications, creams, suppositories, or lifestyle changes.
Additional anal problems: In the presence of additional problems such as fissures, fistulas, or ulceration along with hemorrhoids.
Additionally, the patient's general health status, chronic diseases, and lifestyle are also taken into consideration when deciding on surgery.
What is hemorrhoidectomy sphincterotomy?
Hemorrhoidectomy sphincterotomy is a procedure applied in some cases in conjunction with hemorrhoid surgery. Sphincterotomy is the procedure of cutting the internal sphincter muscle to lower anal canal pressure. This procedure can be applied together with hemorrhoidectomy, especially in cases accompanied by complaints such as anal fissure (anal crack).
This technique, also known as Lateral Internal Sphincterotomy, provides relief in cases where anal pressure is high. Sometimes, sphincterotomy alone may not be sufficient in hemorrhoid treatment, so it is recommended to be applied together with hemorrhoidectomy.
As a result, hemorrhoidectomy is the treatment method with the lowest recurrence rate in hemorrhoid treatment. While most patients can return to their daily routine within approximately 10 days after surgery, the full recovery period can vary from one week to one month.
How is hemorrhoidectomy surgery performed?
Having proper preparation and information about the procedure before hemorrhoidectomy surgery will help you go through the process more easily. Now, let us examine the surgery process step by step.
Difference between general and local anesthesia
Different anesthesia methods can be used for hemorrhoidectomy surgery. This choice varies according to both the patient's condition and the surgeon's preference:
General anesthesia: The patient is completely put to sleep and feels nothing. It may be preferred especially in complex cases.
Spinal (epidural) anesthesia: It is the most frequently preferred method. The area below the waist is numbed, and the patient does not feel pain during the surgery despite being conscious.
Local anesthesia and sedation: In some cases, only the surgical area is numbed, and the patient can be relaxed with mild sedative drugs.
Regardless of the type of anesthesia, you will not feel pain during the procedure. Pain usually begins 3-4 hours after the surgery when the effect of the anesthesia wears off.
Surgery duration and preparation
You need to make some preparations before hemorrhoidectomy:
Food and beverage consumption should be stopped the night before the surgery.
It is recommended to remain fasting for 8-10 hours before the surgery.
You need to stop taking blood-thinning medications such as Aspirin and Plavix at least one week before the surgery.
In some cases, laxatives may be given or an enema may be applied to empty the bowels.
The duration of the surgery varies depending on the technique applied. While simple hemorrhoidectomy procedures take about 20 minutes, this duration can extend up to 1-2 hours in more complex cases.
During hemorrhoidectomy, the surgeon carefully removes the swollen vessels and takes care not to damage the surrounding tissues. This approach accelerates the recovery process and reduces the risk of complications.
Hemorrhoidectomy sphincterotomy application
The application of sphincterotomy together with hemorrhoidectomy is a method preferred especially in cases where anal canal pressure is high. This procedure, also known as Lateral Internal Sphincterotomy (LIS), is the process of cutting the internal sphincter muscle with the aim of lowering anal canal pressure.
The procedure is performed as follows:
Usually, a 1-2 cm incision is made at the 3 o'clock position.
The intersphincteric region is reached, and the internal anal sphincter is rotated and suspended.
The sphincter is cut along the fissure, and bleeding control is performed.
The incision is closed with stitches.
When sphincterotomy is applied together with hemorrhoidectomy, it is done to reduce postoperative pain and accelerate recovery. It can also allow the hemorrhoid cushions to shrink.
Which method will be chosen in hemorrhoidectomy surgery depends on the stage of the disease and the surgeon's experience. Choosing the right technique both increases the success rate and accelerates the recovery process. Therefore, it is important to discuss all options in detail with your surgeon before the surgery.
What are the hemorrhoidectomy techniques?
There is more than one surgical technique developed for the hemorrhoidectomy operation. Each technique has its own unique advantages and situations in which it is applied. Now, let us examine these techniques more closely.
Open hemorrhoidectomy
Open hemorrhoidectomy (Milligan-Morgan technique) was developed in 1937 and is a method preferred especially in 3rd and 4th-degree hemorrhoids. In this technique, external and/or internal hemorrhoids are completely removed with a V-shaped incision starting from the skin tissue just below the anus, and the root of the vascular cluster is tied. The incisions are left open, meaning they are not closed with stitches.
Although this method is quite effective, the recovery process can take 5-6 weeks, and patient comfort is low. The most common complications include bleeding, pain, and narrowing of the anus.
Closed hemorrhoidectomy
Closed hemorrhoidectomy (Ferguson technique) is a modified version of the open technique. Unlike the open technique, in this method, after the excess hemorrhoid package is removed with an elliptical incision, the wound is completely closed with absorbable stitches. To avoid leaving dead space during the surgery, the stitches must also pass through the muscle tissue and the internal sphincter.
The advantage of the closed technique is that the recovery time is shorter and pain is easier to manage. Compared to the open technique, wound healing is faster.
Longo hemorrhoidectomy (Stapler method)
The Longo technique (Stapler hemorrhoidectomy), unlike other methods, does not aim to remove the excess hemorrhoid package. Instead, using a special device called a circular stapler, a ring-shaped thin part of the rectal mucosa is removed from above the dentate line. This procedure ties the vessels going to the hemorrhoid packages and pulls the sagging part upward.
The stapler tool is a cone-shaped device specially developed for hemorrhoid treatment, with a body approximately 3 cm in diameter, tubular, and capable of automatically cutting and stitching at the tip. One is used for each patient and is disposable.
The Longo technique is effective especially in 2nd, 3rd, and small 4th-degree internal hemorrhoids. The biggest advantage of this method is that since the surgery is performed inside the anus, which is poor in nerves, there is less pain and patients can return to their work earlier.
Laser hemorrhoidectomy
Laser hemorrhoid treatment is a comfortable method that allows patients' complaints to disappear painlessly when applied to the appropriate patient at the appropriate stage. This treatment is especially suitable for patients with stage 2 and partially stage 3 hemorrhoidal disease.
During the procedure, the laser probe is advanced into the hemorrhoid package, and energy is applied to ensure the hemorrhoid package shrinks. The goal of the procedure is to coagulate (shrink) the structures inside the hemorrhoid package and close the vessels feeding the hemorrhoid.
The biggest advantages of laser treatment are that there is no open wound, there is less pain, and the risk of infection is low. In addition, the recovery process is fast, and patients usually recover completely within 7-10 days.
Doppler-Guided THD / HAL (Arterial Ligation Method)
Doppler-guided THD (Transanal Hemorrhoidal Dearterialization) or HAL (Hemorrhoidal Artery Ligation) is a modern and comfortable method that allows hemorrhoids to be treated without cutting and removing them.
The goal of this method is to stop the excessive blood flow to the hemorrhoid packages, which is the main cause of hemorrhoids. During the procedure, Doppler ultrasound is used with the help of a special device placed inside the anus. Thanks to Doppler, the arteries feeding the hemorrhoids are detected one by one and tied with absorbable stitches.
If there is sagging (prolapse) in the hemorrhoids, the sagging tissues are hung upward in the same session and brought to their old anatomical position. Thus, both bleeding and sagging problems are treated together.
The most important feature of this method is that the hemorrhoid tissue is not cut or removed. No open wound forms around the anus.
Advantages of the THD / HAL method:
· ❖ No cutting, no stitches, no open wounds
· ❖ Pain is much less compared to classic surgeries
· ❖ Risk of bleeding is low
· ❖ Probability of infection is extremely low
· ❖ Patients are usually discharged on the same day or the next day
· ❖ The time to return to daily life and work is very short
· ❖ Anal muscles are not damaged, there is no risk of incontinence
The THD / HAL method gives extremely successful results, especially in 2nd and 3rd-degree hemorrhoids, in patients where bleeding is at the forefront and there is sagging. When the right patient selection is made, both high patient comfort and gratifying results are obtained.
How is the technique selection made?
The selection of the hemorrhoidectomy technique depends on many factors. The main criteria for choosing the appropriate surgical technique are as follows:
The patient's age and additional diseases: Laser ablation technique may be an option for elderly patients and patients using blood thinners.
The patient's main complaint: For example, if the main complaint is rectal discharge, bleeding, and sagging, the Stapler Hemorrhoidopexy (Longo) technique may be preferred.
Presence of both internal and external hemorrhoid disease: If there is stage 4 internal hemorrhoidal disease and thrombosed external hemorrhoidal disease, the most appropriate surgery will be the open technique (Milligan Morgan).
The patient's expectation: Patients' complaints and quality of life expectations are important in technique selection.
The point that should not be forgotten in hemorrhoid surgery is that there is no single surgical technique that is the newest, completely painless, and has no risk of recurrence for life. Therefore, it is important to create a personalized treatment plan for each patient.
Postoperative care and recovery process
Just as much as a successful hemorrhoidectomy operation, care in the postoperative period is of vital importance for your recovery. Proper care and recommendations accelerate your recovery process while also preventing possible complications.
Care recommendations after hemorrhoidectomy
It is necessary to rest and avoid excessive activity in the first days after surgery. You should stay away from sitting for long periods, lifting heavy objects, and strenuous physical activities. Light walks can help increase your blood circulation, but it is important to avoid heavy work for 2-3 weeks after surgery.
Take care not to strain during bowel movements. Do not postpone when you feel the urge to go to the toilet and do not sit on the toilet for too long. Keeping the area clean and dry after using the toilet reduces the risk of infection. There may be bleeding during your first toilet visit, and this can sometimes last for up to a week. You should consult your doctor for bleeding that lasts longer than a week.
How should the diet be?
Your dietary habits are very important during the recovery process. Constipation is the most undesirable situation after surgery. Therefore:
Consume at least 2-3 liters of water per day
Prefer fiber-rich foods (vegetables, fruits, whole grains)
Consume foods that leave residue regularly, such as legumes, nuts, broccoli, and apples
Coffee, cola, garlic, onion, hot pepper, fast food, and alcoholic beverages can cause diarrhea, so it is recommended not to consume them for a while after surgery.
Pain and swelling management
It is normal to feel pain in the first days after surgery. Use the painkillers prescribed by your doctor regularly. Since aspirin can increase bleeding, it should not be used within the first week. Instead, painkillers containing paracetamol or ibuprofen can be preferred.
Applying a cold compress to the surgical area can reduce swelling and pain. Pain-relieving creams can also be applied to the area.
Sitz bath and hygiene
A sitz bath is very effective in the recovery process after hemorrhoidectomy. Starting 12-24 hours after surgery, it is recommended to take a sitz bath twice a day for 10 minutes each. This bath, taken by sitting in warm water:
Relieves pain
Relaxes the muscles in the anal region
Accelerates recovery
Do not forget to dry the area thoroughly after the bath. You can use a towel or a hair dryer.
How long does the recovery period take?
The recovery period after hemorrhoidectomy varies according to the person and the technique applied. Most patients can return to their normal lives within 10 days. However, full recovery can usually take between 6 weeks and 2 months.
Wound healing is completed in 2-4 weeks. It is recommended to go to the doctor for a check-up within 7-14 days after surgery. If you experience any abnormal situation (severe pain, excessive bleeding, fever) during the recovery process, you should consult your doctor immediately.
Advantages and possible risks of hemorrhoidectomy
The hemorrhoidectomy procedure is an effective method that offers a permanent solution to advanced-stage hemorrhoid problems. As with every surgical intervention, this procedure also has advantages and risks that need to be known.
What are the advantages?
Hemorrhoidectomy significantly improves your quality of life in advanced-stage hemorrhoids. You largely get rid of uncomfortable symptoms such as pain, itching, and bleeding after surgery. In addition, when the recovery process is completed, you can return to your daily life comfortably. It is one of the methods with the highest success rate in hemorrhoid treatment and is 95 percent successful when performed correctly.
Hemorrhoidectomy not only relieves symptoms but also reduces the risk of complications that may occur in the future. Long-term comfort is provided with regular follow-up and recommended lifestyle changes.
Common side effects
Some side effects may be seen in the first days after surgery:
Mild pain and discomfort
Swelling in the surgical area
A small amount of bleeding
A stinging sensation during bowel movements
These complaints are usually temporary and can be alleviated with the painkillers recommended by your doctor. There may be temporary changes in your bowel habits during the recovery process.
Situations with risk of complications
Although hemorrhoidectomy is generally a safe procedure, it has some risks:
Inability to urinate (urinary retention)
Small tear around the anus (anal fissure)
Narrowing of the anal opening (anal stenosis)
Inability to hold stool (fecal incontinence)
Thrombosed hemorrhoid
Recurrence of hemorrhoid disease
These risks can be minimized in surgeries performed by an experienced surgeon and when postoperative instructions are followed.
Signs of infection after hemorrhoidectomy
Infection is a rare but important complication to watch out for. Consult your doctor immediately if you notice the following symptoms:
High fever
Increased redness and swelling in the surgical area
Foul-smelling or discolored discharge
Severe and progressively increasing pain
Chills and weakness
Early intervention is important to prevent the spread of infection.
In summary, Hemorrhoidectomy
As a result, hemorrhoidectomy offers an effective and permanent solution, especially in advanced-stage hemorrhoid problems. If your hemorrhoid complaints are lowering your quality of life and other treatments are not sufficient, this surgical option may be suitable for you. Remember that it is very important to have a detailed meeting with your doctor before deciding on surgery.
Hemorrhoidectomy techniques include open, closed, Longo (stapler), and laser methods. Each has its own unique advantages and areas of application. Your doctor will determine the most suitable technique for you by looking at your hemorrhoid stage and general health status.
In addition, the postoperative care process is extremely important for a successful recovery. Drinking plenty of water, eating fiber-rich foods, taking regular sitz baths, and avoiding heavy activities will accelerate your recovery process. Although it is normal to feel pain and discomfort in the first days after surgery, you can usually return to your daily life within two weeks.
However, although hemorrhoidectomy has a high success rate, it brings some risks with it, like every surgical procedure. You should be informed about infection, bleeding, and other possible complications and consult your doctor in suspicious situations.
In light of all this information, hemorrhoidectomy, which is a surgical option in hemorrhoid treatment, offers a healthy and comfortable life to many people with the right patient selection and appropriate technique use. Being patient during the recovery process and carefully applying your doctor's recommendations will help you get the best results.
Frequently Asked Questions
When can I return to work after hemorrhoidectomy?
The time to return to work varies according to the technique applied. You can return to your work within 3-5 days in laser procedures and within 1-2 weeks in the classic method. However, you should stay away from heavy work for 2-3 weeks.
Will bowel movement be difficult after surgery?
The first bowel movement after surgery can usually be painful. Therefore, your doctor may recommend stool softeners and creams. Drinking plenty of water and eating fiber-rich foods will reduce your toilet problem.
Does hemorrhoidectomy provide a permanent solution?
Hemorrhoidectomy provides a permanent solution when applied correctly. However, no doctor can guarantee one hundred percent that it will not recur after surgery. If you do not change your lifestyle, new hemorrhoid packages may form.
Is the Longo method less painful?
Yes, the Longo method is less painful compared to traditional techniques. In this method, since the surgery is performed in the area with low nerve density, patients feel less pain after surgery.
Can hemorrhoids recur after hemorrhoidectomy?
The risk of recurrence after surgery is low but does not disappear completely. Constipation, straining, and sitting for long periods are the most common causes of recurrence. The risk can be reduced with proper nutrition and lifestyle changes.
Is bleeding normal after surgery?
A small amount of bleeding after surgery is normal. However, you should consult your doctor in cases of mostly bloody bowel movements, bleeding with clots, or continuous bleeding.
What do hemorrhoidectomy prices depend on?
Prices vary according to the technique applied, the patient's condition, the quality of the materials used, and the city where the operation is performed. Modern methods such as laser and Longo, in particular, may be more costly.
What is sphincterotomy?
Sphincterotomy is a procedure where the sphincter muscle is partially cut to lower anal canal pressure. It can be applied together with hemorrhoidectomy to reduce postoperative pain and accelerate recovery.
Hemorrhoidectomy is a surgical method that offers a permanent solution in the treatment of advanced-stage hemorrhoids. Learn about the details, techniques, and recovery process of the surgery.
