Hemorrhoid surgery: Techniques, Recovery, Candidates

Hemorrhoid surgery

Hemorrhoid surgery is a medical procedure used to treat severe hemorrhoids (Grade 3-4), in which the hemorrhoid prolapses outside the anus during straining, does not retract on its own, and must be manually pushed back inside (Grade 3), or large internal hemorrhoids that prolapse outside the anus (thrombosed hemorrhoids) remain there and cannot be pushed back inside manually (Grade 4), causing inflammation and severe pain.  

The colorectal surgeon diagnoses and performs hemorrhoidectomy using one of various techniques, including closed hemorrhoidectomy, stapled hemorrhoidopexy, or laser hemorrhoidoplasty, depending on the prolapsed grade and location of the hemorrhoids. Hemorrhoid surgery can completely remove Grade 3-4 hemorrhoids, resolve bleeding during bowel movements, and effectively reduce the risk of hemorrhoid recurrence.

What are the differences between closed, stapled, and laser hemorrhoid surgery techniques?

Hemorrhoid surgery techniques vary depending on the grade and location of the hemorrhoid, whether it's internal or external hemorrhoids, the size of the prolapse, the patient's needs, and the impact on their daily life. The colorectal surgeon will evaluate the case and recommend the most appropriate surgical technique.

Which hemorrhoid grade requires surgery?

Hemorrhoids suitable for surgical intervention are Grade 3 and Grade 4 hemorrhoids, as well as patients diagnosed by a doctor with the following conditions:

1. Fail conservative treatments, such as medication, sclerotherapy injections, rubber band ligation, or radiofrequency ablation (RFA).
2. Grade 3 hemorrhoids, where the hemorrhoid prolapses outside the anus during straining and must be manually pushed back in with a finger.
3. Grade 4 hemorrhoids, where the hemorrhoids prolapse outside the anus constantly and cannot be manually pushed back in with a finger. 
4. Thrombosed hemorrhoids with blood clot formation and a swollen lump, causing acute pain.
5. Inflamed hemorrhoids with severe pain, swelling, burning, and intense itching around the perianal skin.
6. Inflamed hemorrhoids at combined sites, both internal and external
7. Hemorrhoids presenting as hard, swollen, firm lumps at the anal verge that are dark purplish-blue in color and extremely painful to touch.
8. Bright red bleeding occurs during or after bowel movements, coughing, sneezing, or lifting heavy objects, or the presence of clear mucus discharge. 
9. Hemorrhoids with complications, such as strangulated hemorrhoids from loss of blood supply, necrosis, infection, or anemia from frequent bleeding.

What is the preparation for hemorrhoid surgery?

• Surgical evaluation: The doctor will evaluate your symptoms, location, stage, and severity to determine the most suitable treatment or surgical technique.
• Medical history and medications: The doctor will take your medical history and inquire about your underlying conditions and current medications; Stop blood-thinners medications and supplements for 1–2 weeks as instructed by your doctor.
• Fasting: Fast from all food and water for at least 8 hours before the surgery.
• Avoid smoking and alcohol: Abstain from smoking and drinking alcohol for at least 2 weeks to promote faster wound healing.

Hemorrhoid Surgery Procedures: Different Techniques

1. Closed Hemorrhoidectomy: Excises the prolapsed hemorrhoidal tissue and immediately sutures the wound closed with dissolvable sutures, bringing both wound edges back together.
2. Stapled Hemorrhoidopexy: Uses a circular stapling device to pull the prolapsed hemorrhoidal tissue back into place, then removes the excess tissue and closes the wound in a single step, leaving no external wound.
3. Laser Hemorrhoidoplasty: Uses laser thermal energy to seal off the blood vessels supplying the internal hemorrhoid tissue, causing the hemorrhoid to shrink and involute without excising any tissue.

Note: For all techniques, the doctor will administer general anesthesia or a spinal block to manage pain during surgery and ensure the patient is comfortable. Typically, hemorrhoid surgery takes 15-30 minutes.

How to care for yourself after hemorrhoid surgery?

Colorectal surgeons at MedPark Hospital recommend the following proper post-operative care guidelines to maintain cleanliness, reduce pain, speed up wound healing, and prevent constipation:

• Take pain medication strictly as prescribed to relieve wound pain. Take it with meals to reduce stomach irritation. Do not wait until the pain becomes severe before taking your medication.
• Drink plenty of water, at least 8-10 glasses (2-3 liters) a day, to prevent hardened stools, keep them soft, and avoid friction or tearing at the surgical wound from hardened stools.
• Avoid straining hard during bowel movements, sitting on the toilet for long periods, and lifting heavy objects to reduce pressure around the anus. Also, avoid sitting on chairs for long periods during the early stages of recovery to minimize pressure on the wound.
• Take stool softeners as prescribed, along with eating a high-fiber diet such as papaya, Namwa bananas, and whole grains. This increases fiber intake, softens stools, promotes easier bowel movements, and relieves constipation and lowers the chance of recurrence.
• Take a warm sitz bath 2-3 times a day or after every bowel movement for 15-20 minutes each time. Warm water improves blood circulation, relaxes the sphincter muscle, and relieves pain and swelling around the anus (doctor-recommended if time permits and convenient).
• Refrain from drinking alcohol and driving for at least 24 hours after surgery or after taking pain medication. Ensure you get adequate rest.

Is hemorrhoid surgery painful?

The level of post-operative pain depends on the surgical technique and each individual's physical condition.

• Closed hemorrhoidectomy: Moderate to severe pain during bowel movements in the first 1-2 weeks, which can be relieved with pain medication.
• Stapled hemorrhoidopexy: Less painful with a faster recovery, as the surgery is performed in an area without pain-sensing nerves.
• Laser hemorrhoidoplasty: The least painful with the fastest recovery, but it is not suitable for grade 4 hemorrhoids or very large hemorrhoids.

Note: Current medical technology is highly advanced, effectively reducing pain, minimizing blood loss, and enabling even faster recovery.

What is the recovery time for hemorrhoid surgery?

The recovery time after hemorrhoid surgery varies for each individual depending on the surgical technique used, as follows:

• Closed hemorrhoidectomy: Average recovery time of 14-21 days.
• Stapled hemorrhoidopexy: Average recovery time of 7 days.
• Laser hemorrhoidoplasty: The fastest recovery and least pain, with an average recovery time of 3-5 days.

Note: The wound healing time from the day of surgery until the wound is fully healed across all techniques averages about 2-4 weeks. Proper self-care and following the doctor's instructions will help patients recover within the expected timeframe.

Can hemorrhoid surgery cure hemorrhoids permanently?

Hemorrhoid surgery can remove the existing hemorrhoidal tissue, and in most cases, it provides a permanent cure. However, it cannot prevent new hemorrhoids from forming. Long-term results depend on the surgical technique, lifestyle adjustments, and proper bowel habits.

• Closed hemorrhoidectomy: Offer the highest chance of a permanent long-term cure rate of more than 95%, with the lowest risk of recurrence.
• Stapled hemorrhoidopexy: Has a lower recurrence rate, but slightly higher than closed hemorrhoidectomy in the long term.
• Laser hemorrhoidoplasty: Carries a risk of recurrence if behaviors that increase rectal pressure persist, such as straining during bowel movements or constipation.

Note: The hemorrhoids that are surgically removed cannot grow back. However, to prevent new hemorrhoid formation, you should focus on eating a high-fiber diet, drinking plenty of water, and avoiding strenuous straining during bowel movements or prolonged sitting on the toilet.

Where can I find hemorrhoid surgery in Bangkok?

Surgical Clinic, MedPark Hospital, Bangkok, Thailand, features a team of expert colorectal surgeons specializing in hemorrhoid surgery with extensive experience in treating all types of hemorrhoids—external, internal, combined, severe chronic inflamed hemorrhoids, and complex complications from hemorrhoid disease. Utilizing state-of-the-art equipment, technology, and advanced surgical techniques to minimize post-operative pain, accelerate wound healing, and deliver excellent long-term outcomes.

• Colorectal surgeons with combined experience of over 1,000 surgical cases. They can accurately diagnose and differentiate hemorrhoidal disease from other conditions, such as colon cancer or anal cancer, while precisely evaluating the severity and selecting the most appropriate surgical technique tailored to each individual.
• Leading surgical technology, fully equipped with FDA-approved medical instruments, surgical staplers, and lasers. Ensuring the smallest possible incisions, minimal pain, and the least blood loss, shortening recovery time so you can return to your normal life as quickly as possible.
• Comprehensive pre- and post-operative care by a collaborative team of specialized colorectal doctors, anesthesiologists, and nurses, working together on your care plan to reduce pain, minimize complications, and provide guidance on lifestyle and dietary adjustments to effectively prevent recurrence.

FAQ

1. Can hemorrhoids be resolved without surgery?

Hemorrhoids cannot be completely cured without surgery, but symptoms can be controlled and managed in the following ways:

• Lifestyle changes: Focus on eating a high-fiber diet, drinking enough water, taking warm sitz baths, and avoiding straining during bowel movements.
• Prescribed medications: Use topical creams, suppositories, or oral medications to reduce inflammation.
• Non-surgical treatments: Sclerotherapy injections, rubber band ligation, or radiofrequency ablation (RFA).

Note: For Grade 1-2 hemorrhoids, with lifestyle changes and early, proper treatment, symptoms can gradually improve, and the prolapse can shrink on its own.

2. How much does hemorrhoid surgery cost?

Hemorrhoid surgery costs at MedPark Hospital vary by patient, depending on surgical technique and the complexity of the treatment. You can make an appointment for symptom evaluations and treatment options via this website or directly contact the Surgery Clinic, 6th Floor, Counter D, Tel. 02-090-3076, to get an immediate diagnosis and treatment plan.