Traditional surgery – Hemorrhoidectomy
The principle of the surgery is to decrease the blood flow to anorectal
ring, which is followed by the removal of redundant hemorrhoidal tissue.
Indications
- Grade II, III and IV hemorrhoids
- Failure of non-operative treatment of 2nd degree pile
- Thrombosed hemorrhoid
- Interoexternal pile when the external pile is well defined
Types
- Excision of hemorrhoids with (closed hemorrhoidectomy) or without (open hemorrhoidectomy) suturing
- Excision by using different energies
- Diathermy
- Harmonic scalpel
- Bipolar scissors
Stapled hemorrhoidopexy / Procedure for prolapsed and hemorrhoids (PPH)
Based on the concept of interruption of the superior and middle
hemorrhoidal vessels, and the upward lifting of the prolapsed anorectal
mucosa, followed by repositioning of the vascular cushions back into the
anal canal, causing atrophy of hemorrhoidal tissue
- For Grade 3 and 4 hemorrhoids
- No incisions are made in the somatically innervated, highly sensitive anoderm, which cause significantly less postoperative pain
- Side effects include rectal perforation, sphincter dysfunction and sepsis
- Advantages:
- Simple and quick procedure
- Less postoperative pain, shorter hospital stay and earlier return to normal activity
- Similar complication rate as conventional procedure
|
Staple hemorrhoidopexy
|
Traditional hemorrhoidectomy
|
Operative time
|
Quick, around 30 minutes |
40-60 minutes |
Postoperative pain
|
Much less |
Painful wound, subsided days to weeks later |
Recovery time
|
Fast, can resume normal activity on next day, avoid strenuous exercise |
Slow, requires days to week to resume normal duty |
Wound care
|
Not needed if not infected |
Daily wound dressing, for one to two weeks |
Hemorrhoidal artery ligation (HAL) and Transanal hemorrhoid dearterialization (TAH)
Video Demonstration
These are for treatment of bleeding and Grade 2 to 3 prolapsed
hemorrhoids. Dearterialization is to apply Doppler-USG for
identification and selective ligation of the branches of rectal artery,
thereby correcting the arterial hyperinflux, which is the main cause of
bleeding and swelling of the haemorrhoidal plexus. Mucopexy or rectoanal
repair is the reposition of the cushions in their anatomical site by
folding the muco-hemorrhoidal prolapsed
Benefits
- Minimally invasive and atraumatic
- Marginal post-operative pain
- No grave complications
The information aims to provide educational purpose only.
Anyone reading it should consult Surgery Specialist before considering treatment and should not rely on the information above.
