Haemorrhoidectomy

Introduction

A haemorrhoidectomy is a surgical procedure performed to remove hemorrhoids, which are swollen and inflamed veins in the rectum and anus that cause discomfort and bleeding. Hemorrhoids can be internal, occurring inside the rectum, or external, developing under the skin around the anus. This procedure is typically recommended when other treatments for hemorrhoids, such as dietary changes, topical medications, and minimally invasive procedures, have failed to provide relief.

Types of Haemorrhoidectomy

There are several different methods of performing a hemorrhoidectomy, and the choice of technique depends on the severity and location of the hemorrhoids, as well as the surgeon’s expertise and the patient’s overall health.

1.Conventional Haemorrhoidectomy

The conventional hemorrhoidectomy, also known as an excisional hemorrhoidectomy, involves the surgical removal of hemorrhoidal tissue using a scalpel, scissors, or a cautery device. This method is highly effective for treating severe hemorrhoids but can be associated with significant postoperative pain and a longer recovery period.

2.Stapled Haemorrhoidectomy

Also called a stapled hemorrhoidopexy, this technique involves the use of a circular stapling device to remove a ring of tissue from the anal canal. This procedure is less painful than a conventional hemorrhoidectomy and has a shorter recovery time. However, it is generally reserved for prolapsed hemorrhoids (hemorrhoids that have slipped out of the anal canal).

3.Laser Haemorrhoidectomy

In a laser hemorrhoidectomy, a laser beam is used to remove the hemorrhoidal tissue. This method offers the benefits of reduced bleeding, less postoperative pain, and a quicker recovery compared to conventional surgery. However, it may not be suitable for all types of hemorrhoids.

Indications for Hemorrhoidectomy

A hemorrhoidectomy is typically recommended for patients who have:

• Severe hemorrhoids that do not respond to other treatments
• Large external hemorrhoids causing significant discomfort
• Prolapsed internal hemorrhoids that cannot be manually pushed back
• Hemorrhoids accompanied by complications, such as thrombosis or persistent bleeding

Preparation for Surgery

Before undergoing a hemorrhoidectomy, patients are advised to:

• Discuss their medical history and any medications they are taking with their surgeon
• Undergo a physical examination and any necessary preoperative tests
• Follow specific instructions regarding diet and bowel preparation
• Arrange for someone to drive them home after the procedure

The Procedure

A hemorrhoidectomy is usually performed under general anesthesia, although local or spinal anesthesia may also be used. The patient is positioned with their legs elevated, and the surgeon proceeds to remove the hemorrhoidal tissue using the chosen technique. The procedure typically takes about 30 to 60 minutes.

Postoperative Care

After a hemorrhoidectomy, it is important to follow the surgeon’s postoperative care instructions to ensure a smooth recovery. These may include:

• Taking prescribed pain medications to manage discomfort
• Applying ice packs to reduce swelling
• Using stool softeners to prevent constipation and straining during bowel movements
• Maintaining proper hygiene and keeping the surgical area clean
• Gradually resuming normal activities as advised by the surgeon

Recovery and Potential Complications

The recovery period after a hemorrhoidectomy varies depending on the type of surgery performed and the individual’s overall health. Most patients can return to their normal activities within two to three weeks. However, some common complications associated with hemorrhoidectomy include:

• Pain and discomfort
• Bleeding
• Infection
• Urinary retention
• Stenosis or narrowing of the anal canal
• Recurrence of hemorrhoids

Nursing Care of Patient with Hemorrhoidectomy

Preoperative Care

Before undergoing a hemorrhoidectomy, it is essential for nursing staff to provide thorough preoperative care. This includes educating the patient about the procedure, potential risks, and expected recovery process. Additionally, nurses should ensure that the patient follows preoperative instructions, such as fasting and bowel preparation, to minimize complications during surgery.

Postoperative Care

Pain Management

Effective pain management is crucial for patients recovering from a hemorrhoidectomy. Nurses should administer prescribed pain medications and monitor the patient’s pain levels regularly. Encouraging the use of sitz baths can also help alleviate pain and promote healing.

Wound Care

Proper wound care is essential to prevent infection and promote healing. Nurses should regularly inspect the surgical site for signs of infection, such as redness, swelling, or discharge. Keeping the area clean and dry, and changing dressings as needed, are vital components of postoperative wound care.

Diet and Hydration

Encouraging a high-fiber diet and adequate hydration is essential for patients recovering from a hemorrhoidectomy. This can help prevent constipation and reduce strain during bowel movements, which is crucial for the healing process. Additionally, the use of stool softeners may be recommended to ease bowel movements.

Monitoring for Complications

Nurses should closely monitor patients for potential complications, such as excessive bleeding, urinary retention, and signs of infection. Prompt intervention and communication with the surgical team are necessary if complications arise.

Patient Education and Support

Providing comprehensive education and support to patients is a critical aspect of postoperative care. Nurses should educate patients on the importance of maintaining proper hygiene, gradually resuming normal activities as advised by the surgeon, and recognizing signs of complications. Offering emotional support and addressing any concerns or questions can also contribute to a smoother recovery process.

How to improve haemorrhoidectomy pain?

Healthcare providers continue to explore new strategies for reducing post-hemorrhoidectomy pain. Some research suggests that people experience less post-hemorrhoidectomy pain with:

• Warm Sitz Baths: Soaking in warm water for 15–20 minutes several times a day relaxes muscles and reduces swelling.
• Cold Compresses: Applying ice packs to the affected area can help numb pain and reduce inflammation.
• Oral Pain Relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help manage discomfort.
• Stool Softeners: Taking fiber supplements or stool softeners can prevent straining during bowel movements.
• Hydration & Diet: Drinking plenty of water and eating fiber-rich foods helps maintain soft stools and prevent constipation.
• Gentle Cleaning: Use moist wipes instead of dry toilet paper to avoid irritation.

Tips for Easier Bowel Movements

1. Stay Hydrated – Drink plenty of water to keep stools soft and prevent straining.
2. Increase Fiber Intake – Eat fiber-rich foods like fruits, vegetables, and whole grains to promote smooth digestion.
3. Use Stool Softeners – Over-the-counter stool softeners can help prevent constipation.
4. Take Warm Sitz Baths – Soaking in warm water relaxes the anal muscles and eases discomfort.
5. Avoid Straining – Try to relax and breathe deeply while passing stool to minimize pain.
6. Use Gentle Cleaning Methods – Moist wipes or a bidet can help prevent irritation.
7. Consider Pain Relief – Topical anesthetics or prescribed pain medications can help manage discomfort.

REFERENCES

1. Cristea C, Lewis CR. Hemorrhoidectomy. https://www.ncbi.nlm.nih.gov/books/NBK549864/). 2023 Feb 5. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
2. Khanna R, Khanna S, Bhadani S, Singh S, Khanna AK. Comparison of Ligasure Hemorrhoidectomy with Conventional Ferguson’s Hemorrhoidectomy (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002768/). Indian J Surg. 2010 Aug;72(4):294-7.
3. Lohsiriwat V, Jitmungngan R. Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8955987/) Medicina (Kaunas). 2022 Mar 12;58(3):418.
4. National Library of Medicine (U.S.). Hemorrhoid removal – discharge. https://medlineplus.gov/ency/patientinstructions/000674.htm.
5. Yeo D, Tan KY. Hemorrhoidectomy – making sense of the surgical options (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4258566/). World J Gastroenterol. 2014 Dec 7;20(45):16976-83.
6. Sadeghi PMM, Rabiee M, Darestani NG, Alesaheb F, Zeinalkhani F. Short term results of stapled versus conventional hemorrhoidectomy within 1 year follow-up. Int J Burns Trauma. 2021;11(1):69-74
7. Davis BR, Lee-Kong SA, Migaly J, Feingold DL, Steele SR. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of hemorrhoids. Dis Colon Rectum. 2018;61(3):284.292. doi:10.1097/DCR.0000000000001030

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