Hemorrhoid Surgery

Any treatment for hemorrhoids should begin with a conversation with a doctor. Either because of the type or severity of the hemorrhoids or because of the failure of other treatments (such as rubber band ligation), roughly 10-20% of patients suffering from hemorrhoids will require surgery. Several procedures exist to treat hemorrhoids, including minimally traumatic and minimally invasive options that usually cause less pain and a faster recovery. ^{75, 11, 76}

There is traditional open hemorrhoid surgery (a hemorrhoidectomy), where the surgeon makes incisions in the tissue around the affected area. Often a device that uses electric current is applied to seal small blood vessels around the area. The surgeon ties off the vein to prevent bleeding and then removes the hemorrhoid.

A traditional surgery can also be performed using advanced instruments, such as HARMONIC^® Devices. What makes HARMONIC Technology unique is that it uses high-speed vibration instead of electric current to make incisions. This may result in less damage to the tissue, which is important in the overall recovery after surgery. Unlike traditional instruments (called electrocautery), HARMONIC Devices have been proven to provide benefits, such as:

• Less postoperative pain.^{11, 76}
• Fewer painkillers required after the procedure.^{11, 76}
• Usually faster return to work.^{11, 76}

While other kinds of surgery are effective, minimally invasive procedures usually cause less pain and scarring. One such approach is called Procedure for the Prolapse of Hemorrhoids (PPH). This procedure was first introduced in Italy in 1997 and brought to the U.S. in October 2001. In a PPH, the surgeon uses a special device (circular stapling instrument) to remove a section of tissue inside the anal canal. Because there are few nerve endings in this area, there may significantly less pain in the first week after surgery than there is with conventional techniques.⁷⁵ This process “lifts up” the tissue and reduces blood flow to the internal hemorrhoids, causing them to shrink within 4-6 weeks.

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Hemorrhoid Surgery

One reason many people put off hemorrhoid surgery is the fear of the pain normally associated with the procedure. In fact, patients who undergo a traditional hemorrhoidectomy surgery may often experience a high level of discomfort, which requires painkillers after the operation, and a prolonged period of recovery. But minimally traumatic or minimally invasive approaches for hemorrhoid surgery have been shown to reduce the pain and recovery time.^{11, 75, 76}

One approach is to perform the traditional procedure using devices that can reduce the discomfort after surgery. Rather than using instruments that apply electrical energy (called electrocautery), surgeons can use HARMONIC^® Devices that remove tissue with high-speed vibrational energy. These HARMONIC Devices have been shown to reduce the pain after surgery, requiring less painkilling medicine.^{11, 76} Also, patients are more likely to return to work sooner: 35% of people whose surgeries were performed using HARMONIC Devices returned to work within a week, compared to 19% of patients who underwent the same procedure with electrocautery, and 75% of HARMONIC Device patients had returned to work by the end of the second week, compared to 44% of electrocautery patients.⁷⁶

Another technique, called the Procedure for Prolapse of Hemorrhoids (PPH), is a minimally invasive approach to removing hemorrhoids. This procedure results in less pain⁷⁵ than traditional procedures because it is performed in an area on the body with fewer pain receptors. As compared to traditional hemorrhoid surgery, it offers significant benefits such as:

• Less postoperative pain.⁷⁵
• Shorter time to becoming pain free.⁷⁵
• Faster return to work and normal activities – patients who undergo PPH return to work or normal activities on average 5.5 days sooner than do patients who undergo traditional hemorrhoidectomy.⁷⁵

Currently, there are more than 300,000 procedures for advanced hemorrhoids performed each year. These innovative approaches to hemorrhoid surgery are expected to become more common over the next several years. ²¹

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Talking to your Surgeon about Hemorrhoid Surgery

Once you’re referred to a surgeon, it is important to ask questions. Learn as much as you can about your surgeon, the surgery, and your own condition. Here are a few questions for you to get the conversation started.

• Which procedure do you recommend for my situation?
• How long will the procedure take?
• Will this procedure require a hospital stay and, if so, for how long?
• How long will the recovery process take?
• How soon can normal diet and activity be resumed?
• Will having the procedure require any long-term changes in work, diet, and/or activity?
• What are the potential risks and complications of conventional hemorrhoidectomy?
• What are the potential risks and complications of PPH hemorrhoid surgery?
• Have you experience with both conventional and PPH hemorrhoid surgery?

Don’t like the answers you get? Consider getting a second opinion. It’s important that you feel comfortable with the treatment and the surgeon you’ve selected.

To locate a surgeon in your area experienced in a minimally invasive approach for hemorrhoid surgery, use our Find a Physician tool.