Our Summary

This research paper looks at how safe and effective it is to perform a type of surgery called ’excisional hemorrhoidectomy’ on patients with Crohn’s disease. Crohn’s disease is a type of inflammatory bowel disease and people with this condition often suffer from hemorrhoids. However, there are concerns about whether they can safely undergo surgery to remove the hemorrhoids due to potential complications with wound healing.

The researchers looked at the medical records of 36 adults with Crohn’s disease who had this surgery between 1995 and 2019. They collected data on patient characteristics, the nature and severity of their Crohn’s disease, and any complications they had after surgery such as bleeding, issues with wound healing, or the need for further treatment.

The results showed that 44% of the patients had tried non-surgical treatments for their hemorrhoids before having surgery. At the time of surgery, a quarter of the patients were taking corticosteroids, immunomodulators, or biologics - types of drugs that reduce inflammation and regulate the immune system. In the months following surgery, only 4 patients (11%) had complications.

The conclusion of the study is that this type of surgery can be performed safely on patients with Crohn’s disease who have not responded to non-surgical treatments for hemorrhoids. The researchers did not find any increased risk of new anal diseases or the need for additional surgery.

FAQs

  1. Is excisional hemorrhoidectomy safe for patients with Crohn’s disease?
  2. What were the common complications after the surgery noted in the study?
  3. What non-surgical treatments did the patients try before opting for surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about hemorrhoidectomy is to make sure to follow post-operative care instructions carefully to help promote healing and reduce the risk of complications. This may include taking any prescribed medications, maintaining good hygiene, eating a high-fiber diet, staying hydrated, avoiding straining during bowel movements, and avoiding sitting for long periods of time. It’s also important to follow up with your doctor for any concerns or issues that may arise during the recovery process.

Suitable For

Overall, patients with Crohn’s disease who are recommended for hemorrhoidectomy are those who have not responded to non-surgical treatments and are experiencing significant discomfort or complications from their hemorrhoids. Additionally, patients who are on medications for their Crohn’s disease may still be candidates for surgery, as long as their condition is well-controlled.

It is important for patients with Crohn’s disease to discuss their options with their healthcare provider and ensure that the risks and benefits of surgery are carefully considered. Close monitoring and follow-up care after surgery are also essential to ensure a successful outcome.

In conclusion, while there may be concerns about performing surgery on patients with Crohn’s disease, this research suggests that excisional hemorrhoidectomy can be a safe and effective treatment option for those who have not responded to other therapies. Further studies may be needed to confirm these findings and explore the long-term outcomes of surgery in this patient population.

Timeline

  • Before hemorrhoidectomy: The patient may have tried non-surgical treatments for their hemorrhoids, such as medications, dietary changes, or topical creams. They may also be taking medications for their Crohn’s disease, which could affect the surgical procedure.

  • Day of surgery: The patient will be admitted to the hospital or surgical center for the procedure. They will undergo general anesthesia or spinal anesthesia, depending on the surgeon’s preference. The surgeon will then remove the hemorrhoids using various techniques, such as excision, stapling, or cauterization.

  • Immediately after surgery: The patient will be monitored in the recovery room for a few hours before being discharged home. They may experience pain, swelling, and discomfort in the anal area, which can be managed with pain medications, sitz baths, and ice packs.

  • First few days post-surgery: The patient will need to follow a strict diet and take prescribed medications to prevent constipation and aid in healing. They should avoid strenuous activities, heavy lifting, and sitting for prolonged periods.

  • Weeks to months post-surgery: The patient will have follow-up appointments with their surgeon to monitor their healing progress and address any concerns or complications. They may gradually resume normal activities, including work and exercise, as they feel comfortable.

  • Long-term: The patient should continue to follow their surgeon’s recommendations for post-operative care, such as maintaining good hygiene, eating a high-fiber diet, and staying hydrated. They should also be vigilant for any signs of recurrent hemorrhoids or complications, such as bleeding, infection, or anal fistulas.

What to Ask Your Doctor

Some questions a patient with Crohn’s disease should ask their doctor about hemorrhoidectomy include:

  1. Is excisional hemorrhoidectomy a safe option for me given my Crohn’s disease and current medication regimen?
  2. What non-surgical treatments have I already tried for my hemorrhoids, and why are they not effective?
  3. What are the potential risks and complications associated with hemorrhoidectomy in patients with Crohn’s disease?
  4. How will my Crohn’s disease medications affect my recovery from surgery?
  5. Will I need to adjust my medication regimen before or after the surgery?
  6. How long is the recovery period expected to be, and what can I do to help facilitate healing?
  7. Will I need any follow-up appointments or additional treatments after the surgery?
  8. Are there any dietary or lifestyle changes I should make to prevent recurrence of hemorrhoids in the future?
  9. Can you provide me with information about your experience and success rates with performing hemorrhoidectomy on patients with Crohn’s disease?
  10. Are there any alternative treatment options I should consider before deciding on surgery?

Reference

Authors: Lightner AL, Kearney D, Giugliano D, Hull T, Holubar SD, Koh S, Zaghiyan K, Fleshner PR. Journal: Inflamm Bowel Dis. 2020 Aug 20;26(9):1390-1393. doi: 10.1093/ibd/izz255. PMID: 31633186