Hemorrhoid Removal:
Hemorrhoidectomy and Other Surgical Options
Hemorrhoidectomy
Stapled hemorrhoidectomyDoppler-guided hemorrhoidal artery ligation (HAL)
If your hemorrhoids are severe (Grade III or IV), and other treatment methods have been ineffective, your doctor may suggest surgery to remove them.
The traditional surgical procedure for hemorrhoid removal is called a hemorrhoidectomy. If you have a painful or bleeding thrombosed external hemorrhoid, this is the procedure your doctor will probably recommend. Here's what you need to know about this surgery. It is
- Reserved for the most severe hemorrhoids (Grade IV), and only the cases that have been resistant to other treatments
- Performed with the patient under a spinal or general anesthetic
- Painful, often severely, and requires several weeks for recovery
- Prone to short-term (and, sometimes, long-term) incontinence for some patients
- Usually performed as an outpatient procedure
- Incontinence and fecal leakage
- Urinary tract infections
- Loss of control of stools
- Frequent gas
In the past, doctors performed hemorrhoidectomies when rubber band ligation failed to cure Grade III or IV hemorrhoids. Today, they have other surgical options for curing more severe or chronic hemorrhoids:
Stapled hemorrhoidectomy
Doppler-guided hemorrhoidal artery ligation (HAL)
Stapled Hemorrhoidectomy
This surgery, which is also called "the procedure for prolapse and hemorrhoids," was introduced in the mid-1990s. Its purpose was to reduce the pain and complications from hemorrhoidectomies.During the stapled hemorrhoidectomy procedure, a circular staple is inserted into the anus to push hemorrhoidal tissue that has prolapsed, or dropped outside the anus, back inside and hold it in place. Because this position is above what is known as a pain line, fewer nerve endings are involved, resulting in less pain for the patient. First, excess hemorrhoidal tissue is cut out. This disrupts the flow of blood to the hemorrhoids.
Advantages of this procedure include less pain and shorter recovery periods, and fewer complaints of post-surgery complications. However, a major disadvantage is that the procedure is not as effective as hemorrhoidectomies in preventing recurrences of hemorrhoids. Also, some patients complain of pain during bowel movements and internal itching caused by the staples.
Doppler-Guided Hemorrhoidal Artery Ligation (HAL)
FDA-approved, the Doppler-guided hemorrhoidal artery ligation procedure (or HAL) was introduced in Europe in 1995 as an alternative to traditional hemorrhoidectomies. HAL uses a special scope, called a proctoscope, that depends on ultrasound to identify the arteries in the rectum that are feeding the hemorrhoids. The procedure then cuts off the flow of blood to the hemorrhoidal tissues. This causes them to shrink.Doppler-guided hemorrhoidal artery ligation has been practiced in the United States since 2005 on Grades II, III, and, sometimes, IV hemorrhoids. The procedure takes about 20 minutes and requires minimal sedation.
Three-year studies tracking some of the early recipients of the Doppler-guided hemorrhoidal artery ligation surgery find good results with a lower risk of complications and less pain. Recovery periods are also shorter, with some patients returning to work the next day. The HAL procedure also results in a much lower risk of recurrence than the stapling procedure.
| Surgical
Procedure |
Grades | Benefits | Cons | Cost/Coverage |
|---|---|---|---|---|
| Hemorrhoidectomy | IV | Removes the hemorrhoids permanently | Painful; longest recovery period; has the highest rate of complications, including incontinence for some | Consult
with your insurance company for coverage and cost |
| Stapled Hemorrhoidectomy | III, IV | Less painful than hemorrhoidectomy, earlier return to work | Highest incidence of recurrence, requiring more medical intervention | Consult
with your insurance company for coverage and cost |
| Doppler-Guided HAL | II, III, IV | Less painful than the other two procedures, return to work may be immediate | May not be as effective on Grade IV hemorrhoids as a hemorrhoidectomy (not enough research results yet) | Consult
with your insurance company for coverage and cost |
If surgery becomes necessary, talk to your doctor about the pros and cons of each procedure for you. Also, check with your insurance company to verify that the procedure you choose is covered in your plan.
Stapled hemorrhoidectomy
Doppler-guided hemorrhoidal artery ligation (HAL)
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