Hemorrhoidectomy

Hemorrhoidectomy is a surgery to remove hemorrhoids - enlarged veins that is found in and around the rectum and anus. Hemorrhoids may result from straining frequently due to constipation or child birth. Hemorrhoids can be classified into two types namely - external and internal. While external hemorrhoids occur below the anal sphincter and protrude at the anus, internal hemorrhoids occur above the anal sphincter and may be classified as first, second, third or fourth degree. External thrombosed hemorrhoids cause pain and they contain clotted blood. Normally the thrombosed external hemorrhoids are incised and the clot evacuated.

Hemorrhoidectomy becomes necessary when conservative measures fail to alleviate the severe burning, itching, swelling, protrusion, bleeding and pain in the anal area. Hemorrhoidectomy becomes appropriate when there are very large internal hemorrhoids, sometimes when internal hemorrhoids continue to cause symptoms after surgical treatment, when large external hemorrhoids cause significant discomfort in the anal area.

During the surgical procedure of hemorrhoidectomy, general anesthesia or spinal anesthesia is administered on the patient so that no pain is felt. Incisions are made in the tissue around the hemorrhoid. The hemorrhoid is removed and the swollen vein inside the hemorrhoid is tied off to prevent bleeding. The surgical area could either be closed with suture or left open. Surgery is performed using a scalpel, a cautery pencil or laser. Sometimes a circular stapling device is used to remove the hemorrhoid and close the wound. Here no incision is made. The hemorrhoid is lifted and stapled into place in the anal area. Recovery from hemorrhoidectomy may take about two to three weeks.

Normally the patient experiences pain after surgery . The doctor prescribes medicine to alleviate the pain. Some bleeding is normal after hemorrhoidectomy is performed, especially with the first bowel movement. Ice packs are recommended to be applied in the anal area to reduce swelling and pain. Sitz bath, with frequent soaks in warm water helps to relieve pain and muscle spasms. Stool softeners that contain fiber may help to make bowel movements smooth.

Hemorrhoids are found to recur in about 5% after hemorrhoidectomy. Hematoma, incontinence and infection in the surgical area and fecal impaction are some of the early side effects of hemorrhoidectomy. Late problems of hemorrhoidectomy could include stenosis or narrowing of the anal canal, formation of fistula between the anal and the rectal canal and rectal prolapse when the rectal lining slips out of the anal opening.

Proctoplasty

Proctoplasty is the plastic surgery of the anus or rectum. Reconstructive surgery and anaplasty are other broader terms for proctoplasty. Proctoplasty is performed predominantly on children born with ano-rectal anomalies. There are cases born without any opening at the anus. Congenital fistulae may be present in some infants. Surgery alone affords cure to cases of this nature. While cases born without any opening at the anus are treated as an emergency procedure, fistulae treatment can be delayed for about two to three years. For these cases, proctoplasty is an operation of choice, whenever possible.

Proctoplasty is also at times done during hemorrhoidectomy. Proctoplasty extends the removal of tissue higher into the anal canal so that redundant anal lining is also removed. Recently, transanal endoscopic assisted proctoplasty, which is considered as a safe procedure is adopted for anatomical reconstruction of the anorectum. In significant proportion of patients, it is also used for contemporaneous closure of the sigmoidostomy with imperforate anus without fistula. This is a novel surgical approach with less potential associated complications.

Hemorrhoids

Hemorrhoids or piles are caused when the veins around the anus or lower rectum get swollen and inflamed. Hemorrhoids are painful but surely not dangerous or life threatening. Hemorrhoids are very common among pregnant women. The pressure of the fetus on the abdomen and hormonal changes affect the blood vessels and force them to enlarge. These vessels experience severe pressure during childbirth thereby making hemorrhoid a common occurrence in women.

Causes for hemorrhoids

• Straining too much to pass stools
  
• Sitting for too long
  
• Chronic constipation
  
• Pregnancy
  
• Childbirth
  
• Obesity
  
• Cigarette smoking
  
• Excessive coughing
  
• Aging
  
• Diarrhea
  
• Anal intercourse
  
• Hypertension
  
• Lifting heavy weight
  
  

Types of hemorrhoids

Internal hemorrhoids: Veins that get swollen inside the anal canal are referred to as internal hemorrhoids. Internal hemorrhoids are not very painful as there are no pain receptors in this area. Most people who have internal hemorrhoids are not even aware. Internal hemorrhoids can bleed when they are irritated.

External hemorrhoids: Veins that get swollen near the opening of the anus are termed as external hemorrhoids. These hemorrhoids are at times painful and cause swelling and irritation.

Anal fissure: A thin tear in the anal area is an anal fissure. This hemorrhoid is itchy, painful and bleeds while passing stools.

Prolapsed hemorrhoids: These hemorrhoids are a type of internal hemorrhoid and they stretch down until they protrude outside the anus. This type of hemorrhoid can be painful.

Thrombosed hemorrhoids: A blood clot forms inside the external hemorrhoid thus causing thrombosed hemorrhoid. This type of hemorrhoid is very painful and can be felt as a stiff but tender mass in the anal area.

Typical symptoms of hemorrhoids include rectal pain and itching. There might bleeding during bowel movements. Increase fiber and fluid intake to avoid constipation. Use ice packs for relief. Use hemorrhoidal cream. Tub or sitz baths can provide relief. Exercise regularly and wear loose undergarments.

Common techniques followed in removal of hemorrhoids

Hemorrhoidectomy: At times severe internal or external hemorrhoids may require removal by surgery; this procedure is known as hemorrhoidectomy.

Sclerotherapy: A chemical solution is injected around the blood vessel so as to shrink the hemorrhoid.

Rubber band ligation: A rubber band is positioned inside the rectum around the bottom of the hemorrhoid. The band helps in cutting off blood circulation thereby forcing the hemorrhoid to wither away after a few days.

Infrared coagulation: A special device is used to burn hemorrhoidal tissue.

Laser coagulation: This is a new technique - electric current is applied to remove the hemorrhoids.