A hemorrhoidectomy is the surgical removal of a hemorrhoid, which is an enlarged, swollen and inflamed cluster of vascular tissue combined with smooth muscle and connective tissue located in the lower part of the rectum or around the anus. A hemorrhoid is not a varicose vein in the strict sense. Hemorrhoids are also known as piles.
The primary purpose of a hemorrhoidectomy is to relieve the symptoms associated with hemorrhoids that have not responded to more conservative treatments. These symptoms commonly include bleeding and pain. In some cases the hemorrhoid may protrude from the patient’s anus. Less commonly, the patient may notice a discharge of mucus or have the feeling that they have not completely emptied the bowel after defecating. Hemorrhoids are usually treated with dietary and medical measures before surgery is recommended because they are not dangerous, and are only rarely a medical emergency. Many people have hemorrhoids that do not produce any symptoms at all.
Hemorrhoids are categorized as either external or internal hemorrhoids. External hemorrhoids develop under the skin surrounding the anus; they may cause pain and bleeding when the vein in the hemorrhoid forms a clot. This is known as a thrombosed hemorrhoid. In addition, the piece of skin, known as a skin tag, that is left behind when a thrombosed hemorrhoid heals often causes problems for the patient’s hygiene. Internal hemorrhoids develop inside the anus. They can cause pain when they prolapse (fall down toward the outside of the body) and cause the anal sphincter to go into spasm. They may bleed or release mucus that can cause irritation of the skin surrounding the anus. Lastly, internal hemorrhoids may become incarcerated or strangulated.
There are several types of surgical procedures that can reduce hemorrhoids. Most surgical procedures in current use can be performed on an outpatient level or office visit under local anesthesia.
Rubber band ligation is a technique that works well with internal hemorrhoids that protrude outward with bowel movements. A small rubber band is tied over the hemorrhoid, which cuts off the blood supply. The hemorrhoid and the rubber band will fall off within a few days and the wound will usually heal in a period of one to two weeks. The procedure causes mild discomfort and bleeding. Another procedure, sclerotherapy, utilizes a chemical solution that is injected around the blood vessel to shrink the hemorrhoid. A third effective method is infrared coagulation, which uses a special device to shrink hemorrhoidal tissue by heating. Both injection and coagulation techniques can be effectively used to treat bleeding hemorrhoids that do not protrude. Some surgeons use a combination of rubber band ligation, sclerotherapy, and infrared coagulation; this combination has been reported to have a success rate of 90.5%.
Surgical resection (removal) of hemorrhoids is reserved for patients who do not respond to more conservative therapies and who have severe problems with external hemorrhoids or skin tags. Hemorrhoidectomies done with a laser do not appear to yield better results than those done with a scalpel. Both types of surgical resection can be performed with the patient under local anesthesia.