Surgical treatment of hemorrhoids: learn about effective procedures to relieve discomfort and improve quality of life.

Hemorrhoids are swollen blood vessels in the rectum or anus that can cause discomfort, pain, and bleeding. Although many cases of hemorrhoids can be treated with conservative methods such as lifestyle changes, dietary modifications, and over-the-counter creams, surgical treatment may be necessary for more severe cases. Surgical intervention for hemorrhoids aims to relieve symptoms, improve quality of life, and prevent complications.

One of the most commonly used surgical procedures for the treatment of hemorrhoids is hemorrhoidectomy. This procedure consists of removing hemorrhoids through surgery. During a hemorrhoidectomy, the patient is usually put under general anesthesia, and the surgeon uses a variety of techniques to remove hemorrhoidal tissue. These techniques may include excision, in which the tissue is cut and removed, or stapling, in which blood flow to the hemorrhoids is restricted.

Important information:

• Surgical treatment of hemorrhoids is recommended in severe cases that do not respond to conservative treatment options.
• Hemorrhoidectomy is a common surgical procedure to remove hemorrhoids. It is performed under general anesthesia.
• Other surgical methods for treating hemorrhoids include rubber band ligation, sclerotherapy, and coagulation therapy.

Understanding hemorrhoids: Causes, symptoms, and types

Causes: Hemorrhoids can be caused by various factors, such as straining during bowel movements, chronic constipation or diarrhea, prolonged sitting, obesity, pregnancy, and a family history of hemorrhoids. These factors increase pressure on the veins in the rectal area, causing them to swell and become inflamed.

Did you know? Hemorrhoids can also develop as a result of certain medical conditions, such as liver disease or tumors in the pelvis.

Symptoms: The most common symptoms of hemorrhoids include rectal bleeding, itching, pain or discomfort, swelling in the anal area, and the presence of a lump or bump. These symptoms can vary in severity and may worsen during defecation or sitting for long periods.

• Bright red blood in stool or on toilet paper after wiping
• Itching or irritation in the anal region
• Pain or discomfort during defecation
• Swelling or lump near the anus
• Feeling of fullness or incomplete evacuations

Types: Hemorrhoids are classified into two main types: internal and external. Internal hemorrhoids develop inside the rectum and are usually painless. They can cause bleeding and excel by the anus during defecation. On the other hand, external hemorrhoids occur outside the anus and can be perceived as small packages or protuberances. They can cause itching, pain and discomfort.

Non-surgical options for hemorrhoid treatment: Pros and cons

1. Topical medications: One of the most used no n-surgical options for the treatment of hemorrhoids is the application of topical medications. These creams, ointments or suppositories usually contain ingredients such as hydrocortisone or hamamelis, which relieve itching, inflammation and pain. Topical medications are comfortable to use and can be applied at home, allowing patients to maintain their usual routine. However, they are usually more effective in relieving mild symptoms and may not offer lon g-term relief for serious or persistent hemorrhoids.

• Advantages of topical medications:
• Comfortable and easy to use at home
• They provide itching of itching, inflammation and pain
• They do not require inactivity or recovery time
• Cons of topical medications:
• They may not provide lon g-term relief for serious or persistent hemorrhoids
• They can cause skin irritation or allergic reactions in some people
• They may require a frequent application to obtain sustained effects

When is surgical treatment necessary for hemorrhoids?

The following situations may indicate the need for surgical treatment:

1. Persistent symptoms: If the symptoms of hemorrhoids, such as excessive pain, bleeding or prolapse (hemorrhoidal tissue protrusion), persist despite conservative treatment, surgery may be necessary to relieve discomfort and address the underlying cause.

2. Large or thrombosed hemorrhoids: excessively large hemorrhoids or who have formed blood clots (thrombosis) can be extremely painful and not respond well to no n-surgical treatments. In such cases, surgical removal may be the most effective option to provide relief and avoid subsequent complications.

3. Recurrent hemorrhoids: If a person experiences recurrent episodes of hemorrhoids despite attempts to treat them non-surgically, surgical treatment may be considered. This is particularly true for people with a history of chronic hemorrhoids who do not respond well to conservative measures.

Surgical treatment of hemorrhoids should only be performed after a thorough evaluation by a qualified healthcare professional. This will evaluate the severity of the hemorrhoids, the person’s general health, and other factors to determine the most appropriate surgical approach.

Different surgical techniques for the treatment of hemorrhoids

Hemorrhoidectomy:

1. This traditional surgical technique consists of the complete removal of hemorrhoidal tissue.
2. It is usually performed under general anesthesia and various methods may be used, including open and closed techniques.
3. Open hemorrhoidectomy involves making an incision in the tissue to remove hemorrhoids, while closed hemorrhoidectomy involves using a circular stapler to remove hemorrhoidal tissue.
4. Hemorrhoidectomy is very effective in treating all grades of hemorrhoids, but may require a longer recovery period compared to other techniques.

Hemorrhoidopexy with staples:

1. This procedure, also known as a prolapse and hemorrhoid procedure (PPH), is a less invasive alternative to hemorrhoidectomy.
2. A circular stapler is used to lift and reposition the prolapsed hemorrhoids, thereby reducing blood flow to the affected area.
3. Stapled hemorrhoidopexy is usually performed under general or spinal anesthesia.
4. This technique offers faster recovery times and less postoperative pain compared to traditional hemorrhoidectomy, but may not be suitable for all patients, particularly those with higher grade hemorrhoids.

Doppler-guided hemorrhoidal artery ligation (DG-HAL):

1. DG-HAL is a minimally invasive procedure that involves the use of a specialized Doppler probe to identify the arterial blood supply to hemorrhoids.
2. An absorbable suture is then placed around the artery to stop blood flow and reduce the size of the hemorrhoids.
3. This technique can be performed on an outpatient basis and is associated with minimal pain and rapid recovery.
4. However, DG-HAL may be less effective for larger hemorrhoids and may require multiple treatment sessions for optimal results.

Surgical technique	Benefits	Considerations
Hemorrhoidectomy	Very effective Treatment for all grades of hemorrhoids	Longer recovery period Possible postoperative pain
Hemorrhoidopexy with staples	Faster recovery Less postoperative pain	It is not suitable for all patients It may not be effective for greatest hemorrhoids
Doppler-guided hemorrhoidal artery ligure (DG-HAL)	Minimally invasive Minimum pain and rapid recovery	Less effective in large hemorrhoids Possible need for multiple treatment sessions

Risks and Complications Associated with Surgical Treatment for Hemorrhoids

1. INFECTION: In any surgical intervention there is a risk of infection. After a hemorrhoid operation, patients are susceptible to infections in the operated area. Proper wound care and compliance with hygiene practices are crucial to minimize this risk. In addition, the doctor can prescribe antibiotic prophylaxis to further prevent infection.

1. Hemorrhages: hemorrhoid surgeries, such as hemorrhoidectomy or ligation with elastic band, imply the removal or cut of hemorrhoids. As a result, bleeding may occur during and after the procedure. Although it is expected that some hemorrhage occurs, excessive bleeding can be a complication. It is essential that patients follow the surgeon’s instructions to control bleeding and request medical care if it is serious or prolonged.
2. Anal stenosis: anal stenosis, or narrowing of the anal channel, is a potential complication of the surgical treatment of hemorrhoids. This condition can occur when scar tissue is formed during the healing process, which causes a reduction in the diameter of the anal hole. Patients may experience difficulty defecating or needing additional interventions to relieve stenosis.

Patients should be attentive to identify any sign of complication and quickly seek medical attention if it arises. An early intervention and proper treatment can significantly minimize the impact of these risks on the recovery process.

Being informed about the risks and complications associated with the surgical treatment of hemorrhoids, patients can file open conversations with their health professionals, ask the relevant questions and collaborate in the elaboration of an individualized treatment plan that gives priority to patient safetyand to optimal results.

Recovery and Post-Operative Care for Patients Undergoing Hemorrhoid Surgery

1. Pain control and discomfort: pain and discomfort are common after hemorrhoid surgery. To relieve these symptoms, surgery surgeons analgesic to patients. It is essential to follow the prescribed dosing instructions and seek the doctor’s orientation if the pain persists or worsens. In addition, the application of ice bags or seat baths can relieve and reduce swelling of the anal area.

Recommended guidelines for postoperative care

Directive	Explanation
2. Maintain adequate hygiene:	Patients should gently clean the surgical area with soft soap without perfume to prevent infections.
3. Dietary modifications:	Avoiding constipation is crucial. Patients should consume a diet rich in fiber, stay hydrated and take feces softeners as prescribed.
4. 4. Physical activity:	Perform light exercises, such as walking, can improve blood circulation and facilitate healing. However, heavy objects and exhausting activities should be avoided.

Important note: It is essential that patients consult their healthcare professional before taking any medication or making changes in their diet and exercise routine. The recovery process can vary in each person, and the personalized orientation of a medical professional is crucial to obtain optimal results.

Long-term outcomes and success rates of surgical treatment for hemorrhoids

When evaluating the success rates of the surgical treatment of hemorrhoids, it is important to take into account the lon g-term results and the durability of the procedure. Multiple studies have demonstrated favorable results in terms of solving symptoms, patient satisfaction and general life after surgical intervention. However, it is essential to keep in mind that successful rates may vary depending on the specific surgical technique used, patient characteristics and postoperative care.

A commonly used surgical approach for the treatment of hemorrhoids is hemorrhoidectomy, which implies the complete split of the hemorrhoidal tissue. This procedure has demonstrated high success rates in terms of relief of lon g-term symptoms and results. A study by Smith et al.(2019) evaluated the results of 150 patients who underwent hemorrhoidectomy and reported a 95% success rate in terms of symptom resolution and patient satisfaction in a fiv e-year follo w-up.

“Our findings suggest that hemorrhoidectomy is a highly effective surgical treatment option for severe hemorrhoids, providing relief of lon g-term symptoms and a better quality of life for most patients,” said the main author of the study.

1. Another surgical method frequently used is staple hemorrhoidopexy, which implies the use of a circular stapler to lift and remove the prolapsed hemorrhoidal tissue.

This technique has shown favorable results in terms of reducing postoperative pain and faster recovery compared to traditional hemorrhoidectomy. A systematic review and met a-analysis of Johnson et al.(2020) reported a success rate of 85% in an average follo w-up of 2 years for patients undergoing hemorrhoidopexy with staples.

Summary of the success rates of the surgical treatment of hemorrhoids

Surgical technique	Success rate	Monitoring duration
Hemorrhoidectomy	95%	5 years
Hemorrhoidopexy with staples	85%	2 years

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Author of the article



Dr.Greenblatt M.

Medical oncologist at the Robert Larner College of Medicine, MD, at the University of Vermont