Hemorrhoidectomy: Types of Surgeries to Remove Hemorrhoids

This post was written with Consensus AI Academic Search Engine – please read our Disclaimer at the end of this article. Hemorrhoidectomy is a surgical procedure to remove hemorrhoids, which are swollen veins in the lower rectum and anus. Various techniques are employed to perform hemorrhoidectomy, each with its own advantages and disadvantages. This article explores the different types of hemorrhoidectomy surgeries, comparing their outcomes and effectiveness.

Open vs. Closed Hemorrhoidectomy

Open Hemorrhoidectomy

Open hemorrhoidectomy involves excising the hemorrhoidal tissue and leaving the wound open to heal naturally. This technique, often performed using the St. Mark’s Hospital method, has been shown to have a shorter operating time and lower analgesic requirements immediately post-surgery. However, it is associated with a longer healing time compared to the closed technique1 3.

Closed Hemorrhoidectomy

In closed hemorrhoidectomy, the wound is sutured closed after the hemorrhoidal tissue is removed, typically using the Ferguson technique. This method results in less postoperative pain and faster wound healing. However, it may have a higher morbidity rate compared to the open technique1 3.

Stapled Hemorrhoidopexy vs. Diathermy Hemorrhoidectomy

Stapled Hemorrhoidopexy

Stapled hemorrhoidopexy, also known as the procedure for prolapse and hemorrhoids (PPH), uses a circular stapling device to remove a ring of tissue, which reduces the hemorrhoids’ blood supply. This technique is less painful in the short term and allows for an earlier return to work. However, it may lead to new symptoms such as fecal urgency and anal pain in the long term4 9.

Diathermy Hemorrhoidectomy

Diathermy hemorrhoidectomy uses electric current to cut and coagulate tissue. It is effective for long-term treatment but is associated with higher postoperative pain compared to stapled hemorrhoidopexy. Patients undergoing diathermy hemorrhoidectomy typically take longer to return to work4.

Ligasure vs. Transanal Hemorrhoidal Dearterialization (THD)

Ligasure Hemorrhoidectomy

Ligasure uses a vessel sealing system to remove hemorrhoids. It is effective but may result in more postoperative constipation compared to THD. Patients treated with Ligasure also report higher pain levels in the short term2.

Transanal Hemorrhoidal Dearterialization (THD)

THD involves ligating the arteries supplying the hemorrhoids, reducing their blood flow. This technique is associated with better short-term outcomes, including less postoperative pain and fewer complications compared to Ligasure2.

ENSEAL® vs. Milligan-Morgan Hemorrhoidectomy

ENSEAL® Hemorrhoidectomy

ENSEAL® is a novel technique that uses a tissue-sealing device. It has been shown to reduce operating time, blood loss, and postoperative pain compared to the conventional Milligan-Morgan method. Patients undergoing ENSEAL® hemorrhoidectomy also experience a quicker recovery6.

Milligan-Morgan Hemorrhoidectomy

The Milligan-Morgan technique is a traditional open method for removing hemorrhoids. While effective, it is associated with longer operating times, more blood loss, and higher postoperative pain compared to ENSEAL®6.

Harmonic Scalpel vs. Ferguson’s with Electrocautery

Harmonic Scalpel Hemorrhoidectomy

The harmonic scalpel uses ultrasonic vibrations to cut and coagulate tissue simultaneously. This method results in less blood loss, reduced postoperative pain, and quicker recovery compared to Ferguson’s technique with electrocautery8.

Ferguson’s Hemorrhoidectomy with Electrocautery

Ferguson’s technique involves excising hemorrhoids and closing the wound with sutures, using electrocautery for hemostasis. While effective, it is associated with more postoperative pain and a longer recovery period compared to the harmonic scalpel method8.

Conclusion

Various surgical techniques are available for hemorrhoidectomy, each with its own set of benefits and drawbacks. Open hemorrhoidectomy offers shorter operating times but longer healing periods, while closed hemorrhoidectomy provides faster recovery with potentially higher morbidity. Stapled hemorrhoidopexy and THD are less painful in the short term but may have long-term complications. Novel techniques like ENSEAL® and the harmonic scalpel show promise in reducing operative time, blood loss, and postoperative pain, offering efficient alternatives to traditional methods. The choice of technique should be tailored to the patient’s specific condition and needs, considering both short-term and long-term outcomes.

Disclaimer

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