What is the role of hemorrhoidectomy in the treatment of hemorrhoids?

Updated: Sep 24, 2019
  • Author: Kyle R Perry, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Surgical hemorrhoidectomy is the most effective treatment for all hemorrhoids [29]  and in particular is indicated in the following situations:

  • Conservative or nonsurgical treatment fails (persistent bleeding or chronic symptoms)

  • Grade III and IV hemorrhoids with severe symptoms

  • Presence of concomitant anorectal conditions (eg, anal fissure or fistula, hygiene trouble caused by large skin tags, a history of multiple external thromboses, or internal hemorrhoid trouble) requiring surgery

  • Patient preference

About 5-10% of people with hemorrhoids eventually require surgical hemorrhoidectomy. Proper anesthetic care (especially if local anesthesia with supplementary IV sedation), attention to perioperative fluid restriction, and careful postoperative instructions can ease the patient's recovery.

Postoperative pain remains the major complication, with most patients requiring 2-4 weeks before returning to normal activities. Other possible complications include urinary retention, anal stenosis, and incontinence.

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