Our Summary

This research paper is a review of multiple studies on two different surgical treatments for severe hemorrhoids. The two treatments they looked at were excisional hemorrhoidectomy (EH), which is the standard surgical treatment, and a combination of EH and lateral internal sphincterotomy (LIS), which is a less common approach.

The researchers looked at data from 10 different randomized controlled trials involving 1560 patients. They found that patients who were treated with both EH and LIS had less post-surgery pain and lower resting anal pressure compared to those treated with EH alone. They were also less likely to develop anal stricture, a narrowing of the anal canal that can cause constipation and other problems.

However, the two treatments were similar when it came to complications like urinary retention, bleeding, and length of hospital stay.

The conclusion from this analysis is that adding LIS to the treatment plan can help to reduce post-surgery pain and the need for pain medication. It can also reduce the chance of developing anal stricture. However, it may increase the chances of fecal incontinence, a loss of bowel control.

FAQs

  1. What are the two surgical treatments for severe hemorrhoids discussed in the research paper?
  2. What are the benefits and potential complications of combining excisional hemorrhoidectomy (EH) and lateral internal sphincterotomy (LIS)?
  3. Does adding LIS to the treatment plan increase the chances of fecal incontinence?

Doctor’s Tip

A helpful tip that a doctor might tell a patient about hemorrhoidectomy is to make sure to follow post-operative care instructions carefully. This may include taking pain medication as prescribed, keeping the area clean and dry, and avoiding straining during bowel movements. It is also important to stay hydrated, eat a high-fiber diet, and avoid sitting for long periods of time to aid in the healing process. Additionally, regular follow-up appointments with your doctor are important to monitor your recovery and address any concerns or complications that may arise.

Suitable For

Overall, patients who are recommended for hemorrhoidectomy are those with severe and symptomatic hemorrhoids that do not respond to conservative treatments such as dietary changes, fiber supplements, and topical medications. These patients may experience symptoms such as severe pain, bleeding, itching, and prolapse of hemorrhoids.

Specific criteria for recommending hemorrhoidectomy may include:

  • Grade III or IV hemorrhoids, which are large and prolapsed
  • Chronic and persistent symptoms that significantly impact quality of life
  • Failure of conservative treatments to provide relief
  • Recurrent hemorrhoids or complications such as thrombosis or ulceration
  • Presence of complications such as anal stricture or fistula

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 situation.

Timeline

Overall, the timeline for a patient undergoing hemorrhoidectomy would typically involve the following steps:

  • Consultation with a doctor to discuss symptoms and potential treatment options
  • Preoperative preparation, which may include dietary changes, bowel preparation, and stopping certain medications
  • Surgery, which can be performed as an outpatient procedure or may require a short hospital stay
  • Recovery period, which may involve pain management, sitz baths, and avoiding strenuous activities
  • Follow-up appointments with the doctor to monitor healing and address any complications

After hemorrhoidectomy, patients may experience some discomfort and pain for a few days to a couple of weeks. It is important to follow the doctor’s instructions for postoperative care to ensure proper healing and minimize the risk of complications. Over time, most patients should experience relief from symptoms such as bleeding, itching, and pain associated with hemorrhoids.

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 hemorrhoidectomy?
  2. How long is the recovery period after hemorrhoidectomy?
  3. Will I need to take time off work or limit my activities during the recovery period?
  4. Are there any alternative treatments or less invasive options for treating severe hemorrhoids?
  5. What is the success rate of hemorrhoidectomy in relieving symptoms and preventing recurrence?
  6. How experienced are you in performing hemorrhoidectomy procedures?
  7. Will I need to make any lifestyle or dietary changes before or after the surgery?
  8. How will pain be managed during and after the surgery?
  9. What can I do to help prevent hemorrhoids from recurring in the future?
  10. Are there any specific instructions or precautions I should follow before and after the surgery?

Reference

Authors: Wang WG, Lu WZ, Yang CM, Yu KQ, He HB. Journal: Medicine (Baltimore). 2018 Aug;97(32):e11820. doi: 10.1097/MD.0000000000011820. PMID: 30095654