Hemorrhoidectomy is a surgical procedure to remove hemorrhoids, which are swollen and inflamed veins in the rectum and anus that can cause discomfort, pain, and bleeding. This procedure is typically considered when less invasive treatments, like rubber band ligation, sclerotherapy, or infrared coagulation, haven’t provided sufficient relief, especially in the case of large external hemorrhoids or internal hemorrhoids that have prolapsed (protrude outside the anal sphincter).

Procedure Details:

• Hemorrhoidectomy is usually performed under general anesthesia, spinal anesthesia, or local anesthesia with sedation.
• During the procedure, the surgeon makes incisions around the hemorrhoids and removes them. The surgical area may be left open (open hemorrhoidectomy) or closed with stitches (closed hemorrhoidectomy).
• Various techniques can be used, including conventional scalpel surgery, electrocautery, laser surgery, and harmonic scalpel procedures.

Indications:

• Large, prolapsed, or very symptomatic hemorrhoids that haven't responded to non-surgical treatments.
• Hemorrhoidal conditions complicated by clotting (thrombosis) or bleeding.

Recovery:

• The recovery period can be painful, and pain management is an important aspect of postoperative care.
• Recovery typically takes a few weeks, and patients may need to take a week or more off work.
• Patients are advised to consume a high-fiber diet, drink plenty of fluids, and avoid straining during bowel movements to ease recovery and prevent recurrence.
• Sitz baths (sitting in warm water) are often recommended to ease discomfort.

Risks and Side Effects:

• As with any surgery, there is a risk of complications such as bleeding, infection, and adverse reactions to anesthesia.
• Postoperative pain is a common issue.
• There can be complications related to bowel movements, including difficulty passing stools or, less commonly, fecal incontinence.
• Urinary retention is another potential complication.

Effectiveness:

• Hemorrhoidectomy is generally considered the most effective treatment for severe or recurrent hemorrhoids, with a low rate of recurrence.

Alternatives:

• Less invasive procedures, such as rubber band ligation, sclerotherapy, infrared coagulation, and HAL (hemorrhoidal artery ligation).
• Lifestyle changes and medications for managing less severe hemorrhoids.

Hemorrhoidectomy is typically reserved for the most severe cases due to its invasive nature and painful recovery. It’s crucial for patients to discuss all available options with their healthcare provider, considering the severity of their symptoms and the potential risks and benefits of each treatment approach.