Our Summary

This research paper compares two different treatments for hemorrhoids: transanal hemorrhoidal dearterialization with mucopexy (THDm) and open hemorrhoidectomy (OH). In simpler terms, it compares a less invasive procedure (THDm) where blood vessels supplying the hemorrhoids are tied off and the hemorrhoids are lifted back into place, with a more traditional surgery (OH) where hemorrhoids are cut out.

By reviewing data from four different trials involving 316 patients, the researchers found that both treatments were equally effective. There wasn’t a significant difference in complications or side effects like bleeding, inability to control bowel movements, recurring prolapse (hemorrhoids sticking out), or trouble urinating. However, they did find that the operation time was longer for THDm when done with Doppler guidance (a tool to help locate the blood vessels), than without it. Also, patients who underwent THDm were able to return to normal activities quicker than those who had the traditional surgery.

The research concludes that both methods can be used for treating hemorrhoids, but future studies with more patients and long-term results are needed to confirm these findings and to decide whether using Doppler guidance during THDm is truly necessary.

FAQs

  1. What are the two treatments for hemorrhoids discussed in the research paper?
  2. What were the findings of the research in terms of effectiveness and side effects of the two hemorrhoid treatments?
  3. Are there any benefits of undergoing THDm over the traditional surgery, OH, as suggested by the research?

Doctor’s Tip

Some helpful tips a doctor might tell a patient about hemorrhoidectomy include:

  1. Follow your doctor’s post-operative care instructions closely, including taking any prescribed pain medications and stool softeners to help with bowel movements.
  2. Stay hydrated and eat a high-fiber diet to prevent constipation, which can worsen hemorrhoid symptoms.
  3. Take short walks and do gentle exercises to promote healing and reduce the risk of blood clots.
  4. Avoid heavy lifting and straining during bowel movements to prevent putting pressure on the surgical area.
  5. Contact your doctor if you experience excessive pain, bleeding, or signs of infection such as fever or pus at the surgical site.
  6. Attend follow-up appointments with your doctor to monitor your healing progress and address any concerns.

Suitable For

Hemorrhoidectomy is typically recommended for patients who have severe symptoms of hemorrhoids that are not responding to conservative treatments such as dietary changes, topical medications, and sitz baths. These symptoms may include severe pain, bleeding, prolapse (hemorrhoids sticking out), and difficulty with bowel movements. Patients with large internal or external hemorrhoids, thrombosed hemorrhoids (blood clot inside the hemorrhoid), or recurrent hemorrhoids may also be candidates for hemorrhoidectomy. It is important for patients to discuss their symptoms and treatment options with a healthcare provider to determine the best course of action for their individual situation.

Timeline

Before undergoing a hemorrhoidectomy, a patient will likely experience symptoms such as pain, itching, bleeding, and swelling in the anal area. They may have tried conservative treatments such as dietary changes, topical creams, and sitz baths without success.

After the hemorrhoidectomy, the patient will experience some pain and discomfort in the anal area, which can be managed with pain medication prescribed by the doctor. They may also experience some bleeding and discharge from the surgical site. It is important to follow the post-operative care instructions provided by the doctor, which may include taking stool softeners, avoiding straining during bowel movements, and keeping the area clean.

Over time, the pain and discomfort will gradually improve, and the patient will be able to return to normal activities. It may take a few weeks for the full recovery, and the doctor will schedule follow-up appointments to monitor the healing process and address any concerns.

What to Ask Your Doctor

  1. What are the risks and potential complications associated with a hemorrhoidectomy?

  2. How long is the recovery process after a hemorrhoidectomy and what can I expect in terms of pain and discomfort?

  3. Are there any alternative treatments or less invasive procedures that I could consider before opting for a hemorrhoidectomy?

  4. How many hemorrhoidectomies have you performed and what is your success rate with this procedure?

  5. Will I need to follow any specific post-operative care instructions or make any lifestyle changes after the surgery?

  6. How long will I need to stay in the hospital after the procedure?

  7. Will I need to take any medication or painkillers after the surgery, and if so, for how long?

  8. What are the chances of the hemorrhoids returning after the surgery, and what can I do to prevent this from happening?

  9. Are there any specific dietary or exercise recommendations that I should follow to help with the healing process and prevent future hemorrhoids?

  10. How soon can I resume normal activities, such as work, exercise, and sexual activity, after a hemorrhoidectomy?

Reference

Authors: Xu L, Chen H, Lin G, Ge Q, Qi H, He X. Journal: Tech Coloproctol. 2016 Dec;20(12):825-833. doi: 10.1007/s10151-016-1551-2. Epub 2016 Nov 25. PMID: 27888438