Procedure in which enlarged hemorrhoidal vascular cushions are surgically removed in stage 3-4 hemorrhoidal disease that has not responded to medical and minimally invasive treatments.
Indication
- Stage 3 and 4 internal hemorrhoids (constantly prolapsing cushions that do not return manually or spontaneously)
- Hemorrhoidal disease causing recurrent bleeding leading to advanced anemia
- Failure to respond to conservative treatment (fiber, topical creams) and minimally invasive methods (rubber band ligation, sclerotherapy)
- Severely painful thrombosed (clotted) external hemorrhoids
- Persistent external hemorrhoid-related swelling and itching that affect hygiene and daily life
- Hemorrhoids accompanied by other anal conditions (fissure, fistula)
Preparation
- Necessary blood tests and ECG are performed before the procedure
- Fasting for 6-8 hours is required, depending on the general or spinal anesthesia plan
- Blood thinners are temporarily stopped with physician approval
- Enema or a light diet may be recommended for bowel preparation
- Active severe infection in the anal region is treated first if present
How it's performed
- The patient is placed in the lithotomy or prone position on the operating table
- Spinal, epidural, or general anesthesia is administered
- The anal canal is evaluated and the hemorrhoidal cushions are identified
- In the Milligan-Morgan technique, the cushions are excised and the wound is left open; in the Ferguson technique, the wound is closed with absorbable sutures
- In selected cases, alternative techniques such as stapled hemorrhoidopexy (PPH) or Doppler-guided artery ligation may be preferred
- Hemostasis is ensured and a loose dressing is applied to the anal region
Post-procedure
- A 1-day hospital stay is usually required; some patients may be discharged the same day
- In the first 1-2 weeks, regular bowel habits are supported with a fiber-rich diet, plenty of fluids, and stool softeners
- Warm sitz baths (10-15 minutes 2-3 times a day) help with pain and healing
- Pain relievers and topical creams when needed are used as recommended by the physician
- Return to daily life is achieved within an average of 2-4 weeks; a follow-up examination is performed at 4-6 weeks
Risks
- Pain, mild bleeding, and difficulty urinating in the early period
- Surgical site infection (rare)
- Anal stenosis or prolonged wound healing
- Temporary sensation of inability to control gas or stool (usually resolves within weeks)
- Possibility of long-term recurrence of hemorrhoids
FAQ
How much pain occurs after surgery?
Pain is significant during the first 7-10 days but can be managed with pain relievers, warm sitz baths, and stool softeners.
When can I return to work?
1-2 weeks is generally recommended for desk-based work, and 3-4 weeks for those performing physical labor.
Are there gentler methods besides surgery?
For stage 1-2 hemorrhoids, methods such as rubber band ligation, sclerotherapy, and infrared coagulation are used; surgery is generally reserved for advanced stages.
Do hemorrhoids recur?
The likelihood of recurrence is significantly reduced by a fiber-rich diet, plenty of water, and avoiding prolonged sitting on the toilet.
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