Haemorrhoidectomy

What are haemorrhoids?

Haemorrhoids, which are also known as “piles”, are swollen blood vessels that form in the anus and rectum. They are sometimes described as the varicose veins of the anus and rectum and are very common. Nearly half of us will be affected by haemorrhoids at some point during our lives.

What is a haemorrhoidectomy?

A haemorrhoidectomy is a surgical procedure to remove large or troublesome haemorrhoids. It is a common and generally safe operation, typically performed as a day case under general anaesthetic.

When is a haemorrhoidectomy recommended?

Many patients can manage their haemorrhoids with attention to diet or a topical treatment when symptoms are minor. For small internal haemorrhoids banding can be an effective treatment. When haemorrhoids are large, prolapse (drop down) and particularly when they are associated with large external tags, surgical removal (haemorrhoidectomy) may be recommended.

What does the procedure involve?

An enema is usually given an hour or so before the operation to clear the lower part of the bowel. The operation is performed under a general anaesthetic. During the operation the haemorrhoids and tags are removed using an electrical cutting device (diathermy). Usually the wounds are left open but sutures are sometimes used to close larger wounds. The operation takes around 45 minutes to complete.

What are the potential risks and complications?

There are small risks associated with any operation. Pre-operative assessments are made of any heart or lung conditions, as well as any coexisting medical condition. During the hospital admission patients wear stockings to prevent thrombosis (blood clots). Bleeding can occur after haemorrhoid surgery; most patients will notice small amounts of blood, particularly when they open their bowels. Usually this is a small amount but rarely it can be quite a lot, if that occurs patients must seek medical advice. Infection is very rare; if patients develop increasing pain, fevers or flu-like symptoms they should seek medical advice.

Longer-term complications are rare but include:

• Stenosis; narrowing of the back passage as a result of surgical scarring
• Damage to sphincter muscles resulting in leakage problems after surgery

After the procedure

Haemorrhoidectomy surgery can be painful afterwards. Patients will have some local anaesthetic injected into the area; this will numb the pain for a few hours. If the surgeon has placed a dressing pack in the anus this will be removed before discharge. Patients are allowed to eat and drink as soon as they feel able. Patients will normally be able to go home on the same day as the operation. Patients will be given painkillers to take by mouth; you should take these regularly to prevent pain coming on. Patients may also be given an antibiotic, Metronidazole (Flagyl) to take for 7 days after the operation; this has been shown to help with the discomfort. Patients will experience discomfort when they first open their bowels after the operation, it is important that they do not avoid going to the lavatory. This discomfort will get better. Patients are given a regular stool softener to take for 4-6 weeks and are advised to avoid straining. Patients are encouraged to keep mobile after the procedure. They should avoid heavy lifting or increased physical activities for about 6 weeks. Patients can normally resume driving after about 2 weeks, but this may vary. Patients are normally reviewed in clinic around 6 weeks after the operation, but they can be seen sooner if there are problems.