Hemorrhoids Treatment Surgical Procedures

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Hemorrhoids Treatment

Surgical Procedures

The vast majority of patients with symptom-causing hemorrhoids are able to be managed with non-surgical techniques. In the practice of a surgeon adept at managing hemorrhoids non-operatively, it is estimated that less than 10% of patients require surgery if the hemorrhoids are treated early.

Dilation. Forceful dilation of the anal sphincter by stretching the anal canal has been used to weaken the anal sphincter, the assumption being that the increased sphincter pressure is responsible for the hemorrhoids. Unfortunately, the dilation frequently damages the sphincter itself and many patients become incontinent or unable to control their stool after dilation. For this reason, dilation is rarely used to treat hemorrhoids.

Doppler ligation. Recently, the use of a special, illuminated anoscope with a Doppler probe that measures blood flow has enabled doctors to identify the individual artery that fills the hemorrho/idal vessels. The doctor then can tie off (ligate) the artery. This causes the hemorrhoid to shrink. The Doppler probe is expensive and seems to offer little advantage over rubber band ligation.

Sphincterotomy. Occasionally, the internal portion of the anal sphincter is partially cut in an attempt to reduce the pressure of the sphincter within the anal canal. This procedure is rarely used alone, and there is concern about incontinence (loss of control) of stool as a potential complication.

Hemorrhoidectomy. Non-operative treatment is preferred because it is associated with less pain and fewer complications than operative treatment. Surgical removal of hemorrhoids (hemorrhoidectomy) usually is reserved for patients with third- or fourth-degree hemorrhoids.

During hemorrhoidectomy, the internal hemorrhoids and external hemorrhoids are cut out. The wounds left by the removal may be sutured (stitched) together (closed technique) or left open (open technique). The results with both techniques are similar. At times, a proctoplasty also is done. A proctoplasty extends the removal of tissue higher into the anal canal so that redundant or prolapsing anal lining also is removed.

Postsurgical pain is a major problem with hemorrhoidectomy. Potent pain medications (narcotics) usually are required. The addition of nonsteroidal antiinflammatory drugs (NSAIDs) such as ketorolac (Toradol), celecoxib (Celebrex), or valdecoxib (Bextra) NOTE: April 7, 2005, Pfizer has agreed to suspend sales and marketing of Bextra in the U.S. , pending further discussions with the with the FDA. For more information, please read the FDA press release. , to narcotics enhances the relief of pain, yet patients still do not return to work for 2-4 weeks. Several other complications may occur following hemorrhoidectomy. Urinary retention (difficulty urinating) occurs in about 5% of patients. Although retention almost always is transient, it may require catheterization (insertion of a tube) to empty the bladder. Delayed bleeding or hemorrhage 7 to 14 days after surgery occurs in 1-2% of patients. Narrowing of the anus due to scarring, formation of fissures, and infection (1% of patients) also may occur. Incontinence of stool (inability to control the passage of stool) is uncommon unless the anal sphincter is damaged.

A thorough evaluation and proper diagnosis by the doctor is important any time bleeding from the rectum or blood in the stool occurs. Bleeding may also be a symptom of other digestive diseases, including colorectal cancer. The doctor will examine the anus and rectum to look for swollen blood vessels that indicate hemorrhoids and will also perform a digital rectal exam with a gloved, lubricated finger to feel for abnormalities.

Closer evaluation of the rectum for hemorrhoids requires an exam with an anoscope, a hollow, lighted tube useful for viewing internal hemorrhoids, or a proctoscope, useful for more completely examining the entire rectum.

o rule out other causes of gastrointestinal bleeding, the doctor may examine the rectum and lower colon (sigmoid) with sigmoidoscopy or the entire colon with colonoscopy. Sigmoidoscopy and colonoscopy are diagnostic procedures that also involve the use of lighted, flexible tubes inserted through the rectum.

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