Our Summary

This research paper is about a study that compared two different surgical treatments for severe hemorrhoids (a condition where blood vessels in the rectum and anus become swollen and inflamed). The first treatment is the Milligan-Morgan hemorrhoidectomy (MMH). It’s currently the most commonly used surgery for hemorrhoids, but it can cause significant pain and bleeding after the operation. The second treatment is a combination of MMH and non-Doppler hemorrhoidal artery ligation (ND-HAL), a procedure to tie off the blood vessels supplying the hemorrhoids.

The study looked back at the medical records of 115 patients with severe hemorrhoids. About half of these patients had the MMH alone, while the other half had the combined MMH + ND-HAL. The researchers then compared several factors between the two groups, including how much blood was lost during surgery, the level of pain after surgery, the use of painkillers, post-operative complications (like bleeding and swelling), and the patients’ satisfaction with their treatment.

The results showed that patients who had the combined MMH + ND-HAL had less pain, used less painkillers, had less bleeding and other complications, and were more satisfied with their treatment than those who had the MMH alone. They also had a lower rate of hemorrhoids coming back (recurrence) a year after the surgery.

The researchers concluded that combining MMH and ND-HAL is a better treatment option for severe hemorrhoids than MMH alone.

FAQs

  1. What are the two surgical treatments for severe hemorrhoids compared in this study?
  2. What were the main findings from the study comparing MMH alone and the combined MMH + ND-HAL treatment for severe hemorrhoids?
  3. According to the study, which treatment option is better for severe hemorrhoids - MMH alone or the combined MMH and ND-HAL?

Doctor’s Tip

One helpful tip a doctor might give a patient about hemorrhoidectomy is to consider the option of combining Milligan-Morgan hemorrhoidectomy with non-Doppler hemorrhoidal artery ligation (ND-HAL) for potentially less pain, less bleeding, fewer complications, and a lower risk of recurrence. It is important to discuss all available treatment options with your doctor to determine the best course of action for your individual case.

Suitable For

Patients who are typically recommended for hemorrhoidectomy are those with severe hemorrhoids that have not responded to conservative treatments such as dietary changes, fiber supplements, and topical treatments. These patients may experience symptoms such as significant pain, bleeding, itching, and prolapse of hemorrhoids. Additionally, patients who have recurrent hemorrhoids or complications such as thrombosis (blood clots in the hemorrhoid veins) may also be candidates for surgery.

In particular, patients with grade III and IV hemorrhoids, as classified by the Goligher classification system, are often recommended for hemorrhoidectomy. These grades indicate more severe symptoms and prolapse of hemorrhoids. Patients with bleeding hemorrhoids that do not respond to other treatments may also be candidates for surgery.

It is important for patients to discuss their symptoms and treatment options with a healthcare provider to determine if hemorrhoidectomy is the best course of action for their individual case. Additionally, patients with certain medical conditions or risk factors may not be suitable candidates for surgery, so a thorough evaluation by a healthcare provider is necessary before undergoing a hemorrhoidectomy.

Timeline

Before the hemorrhoidectomy, a patient typically experiences symptoms of severe hemorrhoids such as pain, bleeding, itching, and swelling. They may have tried conservative treatments like dietary changes, topical creams, and sitz baths without much relief.

After the hemorrhoidectomy, the patient will undergo the surgical procedure either with MMH alone or MMH + ND-HAL. The recovery period involves pain management, monitoring for bleeding and other complications, and following post-operative instructions like dietary restrictions and wound care.

In the weeks following the surgery, the patient may experience some discomfort, bleeding, and swelling as the surgical site heals. Painkillers and sitz baths are often recommended to help manage these symptoms.

As the patient continues to recover, the pain and other symptoms should gradually improve. Follow-up appointments with the surgeon may be scheduled to monitor healing and address any concerns. Over time, the patient should experience relief from their hemorrhoid symptoms and have a lower risk of recurrence with the combined MMH + ND-HAL procedure.

What to Ask Your Doctor

Some questions a patient should ask their doctor about hemorrhoidectomy include:

  1. What are the potential risks and complications associated with a hemorrhoidectomy?
  2. How long is the recovery period after a hemorrhoidectomy, and what can I expect in terms of pain and discomfort?
  3. Will I need to take time off from work or make any lifestyle changes during the recovery period?
  4. Are there any alternative treatments to consider before opting for a hemorrhoidectomy?
  5. What is the success rate of a hemorrhoidectomy in treating severe hemorrhoids, and are there any chances of recurrence?
  6. Will I need to follow a specific diet or take any medications before or after the surgery?
  7. How experienced are you in performing hemorrhoidectomies, and what is your success rate with this procedure?
  8. Can you explain the difference between a traditional hemorrhoidectomy and a combined procedure like MMH + ND-HAL?
  9. What should I do if I experience any complications or side effects after the surgery?
  10. How soon after the surgery can I resume normal activities, including exercise and sexual intercourse?

Reference

Authors: Long Q, Wen Y, Li J. Journal: BMC Gastroenterol. 2023 Aug 31;23(1):293. doi: 10.1186/s12876-023-02933-x. PMID: 37653473