Hemorrhoid Surgery - Everything You Need to Know

Hemorrhoids are a common condition that can significantly impact daily life. While many cases can be managed with medical and instrumental treatments, surgery becomes necessary for severe or persistent cases. 

Hemorrhoid Surgery - Everything You Need to Know.

This article explores different surgical options for hemorrhoid treatment, their effectiveness, potential complications, and what to expect post-surgery.  

Is Surgery Always Necessary for Hemorrhoids?

The short answer is no. Surgery is only recommended for patients who continue to suffer despite medical and instrumental treatments.

However, immediate surgery may be considered for those with permanently externalized hemorrhoids or frequent episodes of external hemorrhoid pain.  

Types of Hemorrhoid Surgery

Traditional Surgery:

- Hemorrhoidectomy (Milligan-Morgan Technique): This is the most effective method, removing hemorrhoids completely. It involves creating three small wounds in the anal canal, making it suitable for both internal and external hemorrhoids.  

Minimally Invasive Techniques:

These procedures do not create wounds in the anal canal and are recommended for internal hemorrhoids that prolapse (protrude out but retract on their own or with assistance). 

Their goal is to reduce hemorrhoid size and secure them higher in the anal canal.  

• Doppler-Guided Hemorrhoidal Artery Ligation (HAL) with Mucopexy: Reduces blood flow to hemorrhoids and secures them in place.  
• Stapled Hemorrhoidopexy (Longo’s Technique): Removes a ring of mucosa at the hemorrhoid’s base using an automatic stapling device.  
• Laser and Radiofrequency Surgery: These methods destroy hemorrhoids and reposition them using a controlled healing process. However, they are less common and still under evaluation.  

Is Hemorrhoid Surgery Painful?

Yes, but modern pain management techniques have significantly reduced discomfort. 

The most painful period is during bowel movements and wound care within the first 7-10 days post-surgery. 

However, in between, pain is usually mild or absent with proper medication. 

Minimally invasive techniques result in less pain and allow patients to resume daily activities within a few days.  

Possible Complications of Hemorrhoid Surgery

• Common Side Effects: Bleeding, urgency to defecate, and mild pain.  
• Rare but Severe Complications: Difficulty urinating, anal stenosis (narrowing of the anal canal), or incontinence.  
• Laser and Radiofrequency Complications: These are minimal and infrequent, but the long-term effectiveness of these methods is still being evaluated.  

Do Hemorrhoids Return After Surgery? 

Surgery does not permanently eliminate the risk of hemorrhoids. The key to a successful procedure is preserving enough hemorrhoidal tissue, as it plays a role in fine anal continence. 

Some patients may experience minor recurrences, such as occasional bleeding or mild protrusions, but these symptoms are usually less severe and less frequent than before surgery. Most patients recommend surgery and regret not having done it sooner.  

Conclusion

Surgical treatment is reserved for patients with persistent hemorrhoids that do not respond to other treatments or those with severe external hemorrhoids. 

The most effective option is traditional hemorrhoidectomy, while minimally invasive techniques are best for prolapsing internal hemorrhoids. Proper patient education and a personalized approach to surgery selection are crucial for optimal results.  

Medical Sources

1. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) – Hemorrhoids

2. American Society of Colon and Rectal Surgeons (ASCRS) – Hemorrhoid Surgery Guidelines.

3. Mayo Clinic – Hemorrhoid Treatment and Procedures.

4. Cleveland Clinic – Hemorrhoid Surgery Recovery.