What If I Require Hemorrhoid Surgery?

Medically reviewed by: Gary H. Hoffman, MD

Most people recover from hemorrhoid symptoms with only conservative treatments. If you have high-grade hemorrhoids, hemorrhoids that do not shrink with other treatments, or a complicated case, surgery may be the best option, though.

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If you are curious what types of surgery can treat hemorrhoids, we can discuss the options available to you based on your specific diagnosis during your office visit. A couple of decades ago, the only option might have been an invasive procedure that would keep you out of work for a couple of weeks and doing only light activities for six to eight weeks. Today, there are other options, and traditional hemorrhoidectomies are not as commonplace as they once were. In fact, many people can avoid surgery altogether thanks to in-office procedures including sclerotherapy, rubber band ligation, and infrared coagulation.

The most common types of hemorrhoid surgeries we perform include:

Procedure for Prolapsing Hemorrhoids (PPH)

Procedure for Prolapsing Hemorrhoids (PPH), sometimes called stapled hemorrhoid surgery or hemorrhoid stapling, is one of our most commonly performed outpatient hemorrhoid repair surgeries. Our colorectal surgeons are not only specially trained to perform PPH surgeries, but are known experts on the procedure. Since 2002, our doctors have worked to improve the way doctors approach a PPH operation, and even modified the instrumentation to make the procedure easier and more effective.

PPH is a great alternative to a traditional hemorrhoidectomy if you have internal hemorrhoids that did not respond to conservative treatment and in-office treatments are not a good option. Even large internal hemorrhoids respond well to this stapling procedure, which uses a special designed stapler to pin the hemorrhoids back into place, while removing excess internal tissue.  Any external skin tags left from previous hemorrhoids may also be excised during this procedure.

Recovery from PPH is much quicker than a traditional hemorrhoidectomy. The recurrence rate is slightly higher for this procedure than for open surgery, but it is still low. Overall, PPH is a very effective operation and works well for many people.

Transanal Hemorrhoidal Dearterialization (THD)

Transanal hemorrhoidal dearterialization (THD) is an outpatient surgery that utilizes doppler to identify the arteries that carry blood to the inflamed hemorrhoidal tissues. Once your surgeon finds the artery, a suture is put in place, cutting off the blood supply. This effectively ties off the blood flow from the artery into the tissue. The veins remain unharmed, allowing blood to leave the tissue, however. This helps the inflammation go down.

THD is a safe procedure, and very effective for most patients for whom THD is appropriate. It is performed under general anesthesia.  There is minimal pain after the surgery, and it only takes about half an hour in most cases. THD does seem to have a higher rate of hemorrhoidal recurrence when compared with other treatment methods.

Traditional Hemorrhoidectomy

In relatively rare cases, we still have to surgically remove hemorrhoids in a traditional operation known as a hemorrhoidectomy.  We can use this procedure to effectively remove internal or external hemorrhoids in almost any situation, although it is only occasionally our first recommendation for treatment.

The downside to a traditional hemorrhoidectomy is the severe pain and discomfort, along with the extended recovery time associated with the hemorrhoidectomy. Most of these operations are performed as day surgery, although some people will need to spend the night in the hospital. You will likely need pain medication, although some people opt for over-the-counter options instead of prescription medication. You can expect to miss at least a week of work, no matter your job. Many people miss up to two weeks. You will not be released for full activities until you are fully healed, which could take six to eight weeks.

Discuss Your Options with a Hemorrhoid Specialist

A number of factors go into the decision about which of these procedures is best for you. We conduct a thorough examination to grade your inflamed internal hemorrhoids, and to fully understand your case. Only then can we explain the treatment plan that offers you the quickest recovery with the least chance of recurrence. Conservative treatments are usually enough for external hemorrhoids, but inflamed, symptomatic, and prolapsing internal hemorrhoids may require in-office or surgical repair.

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