Open vs. Closed Hemorrhoidectomies: What’s The Difference?

Medically reviewed by: Gary H. Hoffman, MD

If you do an Internet search on hemorrhoidectomies, you’ll quickly realize how many people fear having this procedure. If the online posts are to be believed, it’s one of the most dreaded surgeries. Many people are apprehensive because of the nature of the condition, while others worry because they’ve read horror stories about the recovery.

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Luckily, the great majority of people with hemorrhoids don’t need invasive procedures to find relief. For those who do, though, a hemorrhoidectomy is often the best option. While the first few days following surgery are often uncomfortable, almost all patients say they would have surgery again if given the choice.

Who Needs Hemorrhoid Surgery?

Most people find that their hemorrhoids can be reduced using only conservative treatment. This includes over-the-counter medications, a diet high in fiber, and stool softeners or laxatives recommended by their doctors.

Some choose not to have the surgery, because of what they’ve read or heard about the procedure. In the great majority of people, hemorrhoids are not threatening to their well-being. Instead, they disrupt a person’s quality of life. Most patients find that a week of recovering from surgery is much less downtime than months or even years of suffering without treatment.

Those who may benefit from surgery include people diagnosed with:

  • Grade III hemorrhoids that have not responded to other treatments
  • Grade IV hemorrhoids
  • Symptomatic external hemorrhoids
  • Hemorrhoids that occur both internally and externally

What is a PPH?  A THD?  What Is A Closed Hemorrhoidectomy?

The surgery that is most commonly used to treat symptomatic internal hemorrhoids is known as a Procedure for Prolapse and Hemorrhoids (PPH).  It, along with a similar procedure called THD, is a much less invasive, much less painful procedure.  Rarely, because of intervening circumstances, a surgical hemorrhoidectomy is needed, and this is most often a closed hemorrhoidectomy. This surgery has the lowest recurrence rate of all hemorrhoid treatments. During this procedure, the patient is either put under general anesthesia or given a local anesthetic.

The hemorrhoidal tissue is excised, and the wound is stitched closed using absorbable sutures that will not have to be removed later. The patient will be taken to a recovery room, where he or she will receive IV fluids and come out of the anesthesia.

Once fully conscious, the patient is typically required to urinate on his own before being released. This is because urinary retention is one of the most dangerous complications of this procedure. Other complications include bleeding, constipation, fecal incontinence, infection, and anal stricture. Most people, however, suffer only minor complications, if any.

What Is An Open Hemorrhoidectomy?

Open hemorrhoidectomies are not performed as commonly as closed procedures. It may be used, however, when the location of the hemorrhoidal tissue makes it difficult to stitch closed. A large amount of affected tissue may also require an open hemorrhoidectomy. Finally, it may be used in patients who are at high risk of postoperative infection. In some cases, the surgeon plans to perform a closed hemorrhoidectomy, but the need to leave the wound open becomes apparent during the surgery.

The procedure itself is very similar to a closed hemorrhoidectomy, with one major difference. During an open hemorrhoidectomy, the incision is not stitched closed. In some cases, it may be temporarily packed with gauze, which will be removed within the first 24 hours. Leaving the incision open allows the body to heal from the inside out, as it would naturally after an injury.

The possible complications following an open hemorrhoidectomy are similar to those of a closed procedure, but an open surgical wound is easier to clean if an infection does occur. In cases where there is not an increased risk of infection, the wound may be partially closed where possible and left open in areas where the skin cannot be stitched closed.

What Can I Expect After A Hemorrhoidectomy?

Both open and closed hemorrhoidectomies are effective at treating the condition, and there is no increased risk of complications with one over the other. In fact, studies have not shown any statistically significant differences between the two procedures when looking at possible complications or the pain experienced during the early days of recovery from hemorrhoidectomies.

With both methods of treatment, pain, and discomfort may last for up to ten days. Doctors often prescribe oral narcotics to help with pain management, although some suggest topical anesthetic ointments or over-the-counter medications. Frequent sitz baths are also recommended for relief from the pain and swelling. Laxatives or stool softeners may be prescribed to help ease bowel movements and prevent constipation caused by painkillers. Most people are able to return to work a week to ten days after surgery.

The reason closed hemorrhoidectomies are often preferred, however, is because incisions that have been stitched closed heal much faster than wounds that are left open to heal. According to one study, 86 percent of patients who underwent a closed hemorrhoidectomy had completely healed at a three-week follow-up appointment. Of the patients who had open hemorrhoidectomies, delaying wound healing was much more prevalent. Only 18 percent with open wounds had completely healed incisions at their three-week follow-up appointment.

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