Surgery – Radical Haemorrhoidectomy

Indication

(a) severe long standing or recurring prolapsing, bleeding or troublesome haemorrhoids.

(b) acute severe thrombosed haemorrhoid

The operation is called radical haemorrhoidectomy, because the whole haemorrhoid including the lining surface of the haemorrhoid externally and the external skin is removed.

There are usually 3 main haemorrhoids – corresponding to the 3 main artery and venous branches suppling the area.

There are smaller accessory haemorrhoids. These are not necessarily removed because the amount of skin that can be removed is limited – excess removal can narrow the anal canal forming a stricture and cause problems with the bowel action.

The operation is usually carried out in hospital under general anaesthetic. A local anaesthetic or epidural or spinal anaesthetic can be added, to reduce the bleeding and help post-operative pain.

The operation consists of excision of the haemorrhoid with its corresponding external swollen skin. Haemorrhoid is very vascular, and a special suture called a transfixation suture used. This cannot fall off. The wound in the skin can be closed or left opened depending on the surgeon’s preference. A small-lubricated pack is inserted with local anaesthetic as part of the lubrication, and this is removed the next day.

Post Operatively

Haemorrhoidectomy has a reputation as being a very painful operation.
You made need 2-3 weeks off work.
The pain is worst after the initial bowel action, but does recur with each bowel action. There may be some bleeding with the bowel action.
You will be treated with painkillers. You may even have an injection whilst in hospital.
Some patients are very keen to get home soon after the operation, but we usually try to keep you until the first bowel action has been completed.
Baths and local applications can help with the discomfort.

Complications

Main possible complications are bleeding.
Bleeding may occur at the time of the surgery – primary haemorrhage.
Bleeding may occur just within the 2-3 days of surgery – secondary haemorrhage.
Bleeding may recur 10 days following surgery – secondary haemorrhage.
The secondary haemorrhage may be quite severe and profuse. This is not common but if it occurs it is quite dangerous. It is due to the raw surface of where the haemorrhoid has been removed becoming inflamed and suddenly giving way.
There are a variety of measures used to controlling this.
Other possible complications are infection – this is not usually a problem.
The general risks of any surgery – the anaesthetic.
In men acute retention of urine can occur because of the pain inhibiting the reflexes and a catheter may be required. In the elderly this can lead to the need for a prostrate operation.
Excessive removal of the skin in the long term can lead to a stricture.
Longer-term complications are – recurrence of the haemorrhoid. Occasionally excessive haemorrhoids have not been removed or newer haemorrhoids just develop.

Summary

A radical haemorrhoidectomy is an operation, which usually takes a surgeon about half an hour. It is not a complex operation but because of the pain involved there are several different techniques that have been recommended, including even stapling.

The patient usually tries to avoid the surgery because of its reputation, however all the conservative treatments may fail and surgery is required.