Surgical Treatment of Internal Hemorrhoids

The vast majority of patients who present to our office with complaints attributable to hemorrhoids can be managed without having to resort to an operation. The symptoms, evaluation and non-surgical treatments are described under “Office Treatment of Internal Hemorrhoids” on this website.  Unfortunately, we do frequently see patients whose hemorrhoids are either too large to be managed with non-operative means or they have additional anal pathology that needs to be addressed with an operation.  In this case the surgeon may recommend that the hemorrhoids be removed at the same procedure.

Surgical Options

There are two main operations performed for hemorrhoids.  The first is by far the most common. This is the standard hemorrhoidectomy during which the external and internal hemorrhoids are removed. This is done with one, two or three separate incisions depending on the extent of the patient’s hemorrhoid problem.  Once the tissue is removed sutures are used to repair the anal canal.  These are absorbable stitches and do not need to be removed latter. 

The operation is almost always done as an outpatient with deep sedation and local anesthetic.  The patient remains asleep the entire operation and will not sense any discomfort during the surgery. This is a tried and true operation that has been proven highly effective for relieving the patient’s hemorrhoid problems for the long term.  The early down side on the surgery is that the post operative period can be painful.  Patients need to anticipate at least a two week recovery at home during which they need to do frequent sitz baths, take the pain medications prescribed and remain on stool softeners and fiber supplements to make passage of their bowels easier. 

The second option for hemorrhoid surgery is a stapled hemorrhoidpexy. This operation is particularly useful in patients whose primary problem is prolapse of their internal hemorrhoids (the hemorrhoids protrude and do not go back in easily).  This is a relatively new operation which utilizes a stapling instrument to remove a portion of the upper rim of the hemorrhoids and staple the remaining tissue up in the canal where it belongs.  Basically, it is said to restore normal anatomy.  It does not, however, remove all the hemorrhoids. It is not particularly useful if a patient has substantial external hemorrhoids or large skin tags.

This is also an outpatient operation and utilizes the same type of anesthetic as the standard hemorrhoidectomy. The advantage this operation offers is in the degree of pain experienced and the rapidity of recovery. 

Although it is by no means a painless operation, it is, in most cases, associated with significantly less pain than the standard hemorrhoidectomy.  Many patients are able to return to normal activity within 4-7 days following surgery.  The postoperative course in patients undergoing a stapled hemorrhoidpexy is fairly variable and there are some patients who do experience more pain than expected.  It has proven to be an effective treatment for hemorrhoids but because it is a relatively new operation what the risk of recurrence will be in fifteen or twenty years is unknown.

Because most patients have both internal and external hemorrhoids, the standard hemorrhoidectomy remains the most commonly performed operation.  The surgical options and all the ramifications of the choices as well as the potential risks will be discussed with the patient at the time of their consultation with the surgeon