Our Summary

This research paper discusses a common and ancient rectal condition called haemorrhoidal disease (HD). This condition is characterized by the enlargement or displacement of anal cushions and its most frequent symptom is bleeding during or after bowel movements. The intensity of the disease is determined by the extent of the prolapse, which is a term for the falling down or slipping out of place of an organ or part.

The paper talks about several surgery treatments that can be used to treat this condition, including the Milligan and Morgan, Parks, Ferguson, and Whitehead techniques. Even though there have been significant advancements in non-surgical treatments, the paper concludes that surgical methods are still the most effective treatment for severe cases of haemorrhoidal disease.

FAQs

  1. What is haemorrhoidal disease (HD) and what are its symptoms?
  2. What are the most common techniques used in excisional haemorrhoidectomy treatments?
  3. Are excisional haemorrhoidectomy techniques the most effective treatment for all degrees of haemorrhoidal disease?

Doctor’s Tip

A doctor might advise a patient undergoing a hemorrhoidectomy to make sure they follow post-operative care instructions carefully, including taking prescribed pain medication, keeping the area clean and dry, and avoiding strenuous activities that could put pressure on the surgical site. It is also important to eat a high-fiber diet, stay hydrated, and avoid straining during bowel movements to prevent recurrence of hemorrhoids. Regular follow-up appointments with the doctor are also necessary to monitor healing and address any concerns.

Suitable For

Patients with severe haemorrhoidal disease, specifically those with III- and IV-degree prolapse, are typically recommended for a hemorrhoidectomy. These patients often experience significant symptoms such as persistent bleeding, prolapse, and discomfort that do not respond well to conservative treatments. Patients with recurrent or chronic hemorrhoids that significantly impact their quality of life may also be candidates for surgical intervention. It is important for patients to discuss their symptoms and treatment options with a healthcare provider to determine the most appropriate course of action for their individual situation.

Timeline

Before hemorrhoidectomy, a patient may experience symptoms of hemorrhoids such as bleeding during or after defecation, itching, discomfort, and pain. The patient may have tried conservative treatments such as dietary changes, topical creams, and sitz baths without success. The patient may have consulted with a healthcare provider who recommended surgery as the best treatment option.

After the decision is made to proceed with hemorrhoidectomy, the patient will undergo preoperative assessments and preparations. This may include blood tests, imaging studies, and medications to prepare the bowels for surgery. The patient will also receive instructions on fasting before the surgery and what to expect during the recovery period.

During the hemorrhoidectomy procedure, the surgeon will remove the hemorrhoids using one of the common techniques such as Milligan and Morgan, Parks, Ferguson, or Whitehead technique. The surgery can be performed under general anesthesia or local anesthesia with sedation. The patient will be monitored closely during and after the surgery for any complications.

After the hemorrhoidectomy, the patient will experience some discomfort, pain, and swelling in the anal area. The surgeon will provide instructions on wound care, pain management, and when to follow up for a postoperative visit. The patient may need to take stool softeners and pain medication to help with bowel movements and pain relief.

Over the following weeks, the patient will gradually recover from the surgery and the symptoms of hemorrhoids will improve. It is important for the patient to follow the surgeon’s instructions for proper wound care, diet, and activity restrictions to ensure a successful recovery. In most cases, patients can return to their normal activities within a few weeks after hemorrhoidectomy.

What to Ask Your Doctor

  1. What are the benefits of undergoing a hemorrhoidectomy compared to other treatment options for hemorrhoids?
  2. What are the potential risks and complications associated with a hemorrhoidectomy?
  3. How long is the recovery period after a hemorrhoidectomy and what can I expect during this time?
  4. Will I need to make any lifestyle changes or follow a special diet after the surgery?
  5. Are there any restrictions on physical activity or work following a hemorrhoidectomy?
  6. What is the success rate of a hemorrhoidectomy in treating hemorrhoids long-term?
  7. Are there any alternative treatments or procedures that could be considered before opting for a hemorrhoidectomy?
  8. How many hemorrhoidectomy procedures have you performed and what is your experience with this surgery?
  9. What type of anesthesia will be used during the hemorrhoidectomy procedure?
  10. Are there any specific instructions or precautions I should follow before and after the hemorrhoidectomy surgery?

Reference

Authors: Sena G, Gallo G, Vescio G, Carpino A, Diaco E, Papandrea M, Trompetto M, Sammarco G. Journal: Rev Recent Clin Trials. 2021;16(1):54-59. doi: 10.2174/1574887115666200319153439. PMID: 32189597