Eamilao, John Gian E.
10/05/2024
BSN 3-5 NCM RLE
HEMORRHOIDECTOMY
Definition
Hemorrhoidectomy is surgery to remove internal or external hemorrhoids that are
extensive or severe. Surgical hemorrhoidectomy is the most effective treatment for
hemorrhoids, though it is associated with the greatest rate of complications.
A hemorrhoidectomy is performed in the following settings:
• Symptomatic grade Ill, grade IV, or mixed internal and external hemorrhoids
• Where there are additional anorectal conditions that require surgery
• Strangulated internal hemorrhoids and some thrombosed external hemorrhoids
(weeks after relieve of acute symptoms by conservative methods)
• Where patients who cannot tolerate or fail minimally invasive procedures
Types of hemorrhoidectomies and related procedures performed during surgery:
● Closed Hemorrhoidectomy
● Open Hemorrhoidectomy
● Stapled Hemorrhoidectomy (Procedure for Prolapse and Hemorrhoids - PPH)
● Rubber band Ligation
● Lateral Internal Sphincterotomy
Preoperative preparation
• Patients should ideally be put on a high fiber diet and stool softeners for several days prior
to the procedure, this is to reduce post operative pain and to reduce the chances of
postoperative fecal impaction.
• evidence.png Lactulose taken for 4 days prior to Haemorrhoidectomy reduces post
operative pain.
• Antibiotic prophylaxis is advisable for all clean-contaminated operations such as
hemorrhoidectomy
• Enema on the day of the operation
• Prophylactic antibiotic (at induction)
• Anaesthesia; spinal anesthesia or GA
• Position; lithotomy position
• Skin prepared; perineum and anal canal.
• Surgeon sits facing the perineum.
• Procedure; insert Parkes anal speculum to display the haemorrhoid to be
operated upon. Grasp the haemorrhoid at the mucocutaneous junction with a
haemostatic forceps and retract towards the surgeon. Incise the skin at the base of
the haemorrhoid with a scissors as a V-shape incision with the base of the V towards
the haemorrhoid. Extend this incision into the mucosa either side of the hemorrhoid
raising it off the muscles of the internal sphincter. The dissection is continued just
beyond the dentate line. Transfix and ligate the pedicle of the haemorrhoid with a
2-0 vicryl suture leaving a long length of suture material attached. Excise the
haemorrhoid 0.5cm distal to the ligature
• Repeat the procedure with the other hemorrhoids. Leave a mucocutaneous
bridge between each haemorrhoid to reduce any subsequent anal stricture. At the
end place a small paraffin soaked pack to reduce bleeding within the anal canal,
supported by a T-shaped bandage.
Post operative management;
• Adequate analgesia, bulk laxative and antibiotics
• Warm sitz bath
• DRE at 5th day to exclude anal stenosis
Complications
• EARLY
• Hemorrhage
• Acute urine retention
• Constipation with pain resulting in fecal impaction
• LATE
• Anal stenosis
• Fissure
• Skin tag
• Recurrence
• Incontinence
