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What position are you in for hemorrhoid surgery?

Anal Surgery for Hemorrhoids Periprocedural Care

For all treatments, a conventional anal retractor (eg, a Parks or Fansler retractor) is required. For hemorrhoidectomy, the following additional equipment is required:

Scalpel
Scissors
Diathermy
Absorbable suture (if the open surgical wound is closed)
Next:

Patient Preparation

Anesthesia

For office treatments, local anesthesia is used. For surgical treatments, general anesthesia or local anesthesia combined with mild sedation may be used. No matter what type of anesthesia is employed, the procedure begins with local injection of the entire anal canal with bupivacaine or lidocaine with epinephrine.

Positioning

For both office and surgical treatments, place the patient in a jack-knife prone, lithotomy, or left lateral decubitus position.

Previous

References
  1. Beck DE. Hemorrhoids. Beck DE, Wexner SD, Rafferty JF, eds. Gordon and Nivatvongs’ Principles and Practice of Surgery for the Colon, Rectum, and Anus. 4th ed. New York: Thieme; 2019. Chap 7.
  2. [Guideline] Rivadeneira DE, Steele SR, Ternent C, Chalasani S, Buie WD, Rafferty JL, et al. Practice parameters for the management of hemorrhoids (revised 2010). Dis Colon Rectum. 2011 Sep. 54 (9):1059-64. [QxMD MEDLINE Link]. [Full Text].
  3. Senapati A, Nicholls RJ. A randomised trial to compare the results of injection sclerotherapy with a bulk laxative alone in the treatment of bleeding haemorrhoids. Int J Colorectal Dis. 1988 Jun. 3(2):124-6. [QxMD MEDLINE Link].
  4. Moesgaard F, Nielsen ML, Hansen JB, Knudsen JT. High-fiber diet reduces bleeding and pain in patients with hemorrhoids: a double-blind trial of Vi-Siblin. Dis Colon Rectum. 1982 Jul-Aug. 25(5):454-6. [QxMD MEDLINE Link].
  5. Xu L, Chen H, Lin G, Ge Q. Ligasure versus Ferguson hemorrhoidectomy in the treatment of hemorrhoids: a meta-analysis of randomized control trials. Surg Laparosc Endosc Percutan Tech. 2015 Apr. 25 (2):106-10. [QxMD MEDLINE Link].
  6. De Nardi P, Capretti G, Corsaro A, Staudacher C. A prospective, randomized trial comparing the short- and long-term results of doppler-guided transanal hemorrhoid dearterialization with mucopexy versus excision hemorrhoidectomy for grade III hemorrhoids. Dis Colon Rectum. 2014 Mar. 57 (3):348-53. [QxMD MEDLINE Link].
  7. Trenti L, Biondo S, Galvez A, Bravo A, Cabrera J, Kreisler E. Distal Doppler-guided transanal hemorrhoidal dearterialization with mucopexy versus conventional hemorrhoidectomy for grade III and IV hemorrhoids: postoperative morbidity and long-term outcomes. Tech Coloproctol. 2017 May. 21 (5):337-344. [QxMD MEDLINE Link].
  8. Jayaraman S, Colquhoun PH, Malthaner RA. Stapled versus conventional surgery for hemorrhoids. Cochrane Database Syst Rev. 2006 Oct 18. CD005393. [QxMD MEDLINE Link].
  9. Khan S, Pawlak SE, Eggenberger JC, Lee CS, Szilagy EJ, Wu JS. Surgical treatment of hemorrhoids: prospective, randomized trial comparing closed excisional hemorrhoidectomy and the Harmonic Scalpel technique of excisional hemorrhoidectomy. Dis Colon Rectum. 2001 Jun. 44(6):845-9. [QxMD MEDLINE Link].
  10. Jayne DG, Botterill I, Ambrose NS, Brennan TG, Guillou PJ, O’Riordain DS. Randomized clinical trial of Ligasure versus conventional diathermy for day-case haemorrhoidectomy. Br J Surg. 2002 Apr. 89(4):428-32. [QxMD MEDLINE Link].
  11. Ibrahim S, Tsang C, Lee YL, Eu KW, Seow-Choen F. Prospective, randomized trial comparing pain and complications between diathermy and scissors for closed hemorrhoidectomy. Dis Colon Rectum. 1998 Nov. 41(11):1418-20. [QxMD MEDLINE Link].
  12. Andrews BT, Layer GT, Jackson BT, Nicholls RJ. Randomized trial comparing diathermy hemorrhoidectomy with the scissor dissection Milligan-Morgan operation. Dis Colon Rectum. 1993 Jun. 36(6):580-3. [QxMD MEDLINE Link].
  13. Ui Y. Anoderm-preserving, completely closed hemorrhoidectomy with no mucosal incision. Dis Colon Rectum. 1997 Oct. 40(10 Suppl):S99-101. [QxMD MEDLINE Link].
  14. Patel N, O’Connor T. Suture haemorrhoidectomy: a day-only alternative. Aust N Z J Surg. 1996 Dec. 66(12):830-1. [QxMD MEDLINE Link].
  15. Senagore A, Mazier WP, Luchtefeld MA, MacKeigan JM, Wengert T. Treatment of advanced hemorrhoidal disease: a prospective, randomized comparison of cold scalpel vs. contact Nd:YAG laser. Dis Colon Rectum. 1993 Nov. 36(11):1042-9. [QxMD MEDLINE Link].
  16. Tan JJ, Seow-Choen F. Prospective, randomized trial comparing diathermy and Harmonic Scalpel hemorrhoidectomy. Dis Colon Rectum. 2001 May. 44(5):677-9. [QxMD MEDLINE Link].
  17. Armstrong DN, Ambroze WL, Schertzer ME, Orangio GR. Harmonic Scalpel vs. electrocautery hemorrhoidectomy: a prospective evaluation. Dis Colon Rectum. 2001 Apr. 44(4):558-64. [QxMD MEDLINE Link].
  18. Seow-Choen F, Ho YH, Ang HG, Goh HS. Prospective, randomized trial comparing pain and clinical function after conventional scissors excision/ligation vs. diathermy excision without ligation for symptomatic prolapsed hemorrhoids. Dis Colon Rectum. 1992 Dec. 35(12):1165-9. [QxMD MEDLINE Link].
  19. Wang JY, Chang-Chien CR, Chen JS, Lai CR, Tang RP. The role of lasers in hemorrhoidectomy. Dis Colon Rectum. 1991 Jan. 34(1):78-82. [QxMD MEDLINE Link].
  20. Iwagaki H, Higuchi Y, Fuchimoto S, Orita K. The laser treatment of hemorrhoids: results of a study on 1816 patients. Jpn J Surg. 1989 Nov. 19(6):658-61. [QxMD MEDLINE Link].
  21. Chung CC, Ha JP, Tai YP, Tsang WW, Li MK. Double-blind, randomized trial comparing Harmonic Scalpel hemorrhoidectomy, bipolar scissors hemorrhoidectomy, and scissors excision: ligation technique. Dis Colon Rectum. 2002 Jun. 45(6):789-94. [QxMD MEDLINE Link].
  22. Palazzo FF, Francis DL, Clifton MA. Randomized clinical trial of Ligasure versus open haemorrhoidectomy. Br J Surg. 2002 Feb. 89 (2):154-7. [QxMD MEDLINE Link].
  23. Bleday R, Pena JP, Rothenberger DA, Goldberg SM, Buls JG. Symptomatic hemorrhoids: current incidence and complications of operative therapy. Dis Colon Rectum. 1992 May. 35(5):477-81. [QxMD MEDLINE Link].
  24. Granet E. Hemorrhoidectomy failures: causes, prevention and management. Dis Colon Rectum. 1968 Jan-Feb. 11(1):45-8. [QxMD MEDLINE Link].
  25. MacRae HM, McLeod RS. Comparison of hemorrhoidal treatment modalities. A meta-analysis. Dis Colon Rectum. 1995 Jul. 38(7):687-94. [QxMD MEDLINE Link].
  26. Varma JS, Chung SC, Li AK. Prospective randomised comparison of current coagulation and injection sclerotherapy for the outpatient treatment of haemorrhoids. Int J Colorectal Dis. 1991 Feb. 6 (1):42-5. [QxMD MEDLINE Link].
  27. Ferguson JA, Mazier WP, Ganchrow MI, Friend WG. The closed technique of hemorrhoidectomy. Surgery. 1971 Sep. 70(3):480-4. [QxMD MEDLINE Link].
  28. Milligan ET, Morgan CN, Jones LE. Surgical anatomy of the anal canal and the operative treatment for hemorrhoids. Lancet. 1937. 2:119-1124.
  29. Devien CV, Pujol JP. Total circular hemorrhoidectomy. Int Surg. 1989 Jul-Sep. 74(3):154-7. [QxMD MEDLINE Link].
  30. Boccasanta P, Venturi M, Orio A, Salamina G, Reitano M, Cioffi U. Circular hemorrhoidectomy in advanced hemorrhoidal disease. Hepatogastroenterology. 1998 Jul-Aug. 45(22):969-72. [QxMD MEDLINE Link].
  31. Wolff BG, Culp CE. The Whitehead hemorrhoidectomy. An unjustly maligned procedure. Dis Colon Rectum. 1988 Aug. 31(8):587-90. [QxMD MEDLINE Link].
  32. Whithead W. The surgical treatment of hemorrhoids. Br Med J. 1882. 1:148-150.
  33. Bonello JC. Who’s afraid of the dentate line? The Whitehead hemorrhoidectomy. Am J Surg. 1988 Sep. 156(3 Pt 1):182-6. [QxMD MEDLINE Link].
  34. Ho YH, Seow-Choen F, Tan M, Leong AF. Randomized controlled trial of open and closed hemorrhoidectomy. Br J Surg. 1997. 4:1729-1730.
  35. Carapeti EA, Kamm MA, McDonald PJ, Chadwick SJ, Phillips RK. Randomized trial of open versus closed day-case haemorrhoidectomy. Br J Surg. 1999 May. 86(5):612-3. [QxMD MEDLINE Link].
  36. Arbman G, Krook H, Haapaniemi S. Closed vs. open hemorrhoidectomy—is there any difference?. Dis Colon Rectum. 2000 Jan. 43(1):31-4. [QxMD MEDLINE Link].
  37. Gençosmanoglu R, Sad O, Koç D, Inceoglu R. Hemorrhoidectomy: open or closed technique? A prospective, randomized clinical trial. Dis Colon Rectum. 2002 Jan. 45(1):70-5. [QxMD MEDLINE Link].
  38. Milito G, Lisi G, Aronadio E, Campanelli M, Venditti D, Grande S, et al. LigasureTM hemorrhoidectomy: how we do. Minerva Gastroenterol Dietol. 2017 Mar. 63 (1):44-49. [QxMD MEDLINE Link].
  39. Scheyer M, Antonietti E, Rollinger G, Lancee S, Pokorny H. Hemorrhoidal artery ligation (HAL) and rectoanal repair (RAR): retrospective analysis of 408 patients in a single center. Tech Coloproctol. 2015 Jan. 19 (1):5-9. [QxMD MEDLINE Link].
  40. Figueiredo MN, Campos FG. Doppler-guided hemorrhoidal dearterialization/transanal hemorrhoidal dearterialization: Technical evolution and outcomes after 20 years. World J Gastrointest Surg. 2016 Mar 27. 8 (3):232-7. [QxMD MEDLINE Link]. [Full Text].
  41. Ratto C. THD Doppler procedure for hemorrhoids: the surgical technique. Tech Coloproctol. 2014 Mar. 18 (3):291-8. [QxMD MEDLINE Link]. [Full Text].
  42. Boccasanta P, Capretti PG, Venturi M, Cioffi U, De Simone M, Salamina G. Randomised controlled trial between stapled circumferential mucosectomy and conventional circular hemorrhoidectomy in advanced hemorrhoids with external mucosal prolapse. Am J Surg. 2001 Jul. 182(1):64-8. [QxMD MEDLINE Link].
  43. Hetzer FH, Demartines N, Handschin AE, Clavien PA. Stapled vs excision hemorrhoidectomy: long-term results of a prospective randomized trial. Arch Surg. 2002 Mar. 137(3):337-40. [QxMD MEDLINE Link].
  44. Shalaby R, Desoky A. Randomized clinical trial of stapled versus Milligan-Morgan haemorrhoidectomy. Br J Surg. 2001 Aug. 88(8):1049-53. [QxMD MEDLINE Link].
  45. Jeong H, Hwang S, Ryu KO, Lim J, Kim HT, Yu HM, et al. Early Experience With a Partial Stapled Hemorrhoidopexy for Treating Patients With Grades III-IV Prolapsing Hemorrhoids. Ann Coloproctol. 2017 Feb. 33 (1):28-34. [QxMD MEDLINE Link]. [Full Text].
  46. Lin HC, He QL, Ren DL, Peng H, Xie SK, Su D, et al. Partial stapled hemorrhoidopexy: a minimally invasive technique for hemorrhoids. Surg Today. 2012 Sep. 42 (9):868-75. [QxMD MEDLINE Link].
  47. Lin HC, Ren DL, He QL, Peng H, Xie SK, Su D, et al. Partial stapled hemorrhoidopexy versus circular stapled hemorrhoidopexy for grade III-IV prolapsing hemorrhoids: a two-year prospective controlled study. Tech Coloproctol. 2012 Oct. 16 (5):337-43. [QxMD MEDLINE Link].
  48. Madoff RD, Fleshman JW,. American Gastroenterological Association technical review on the diagnosis and treatment of hemorrhoids. Gastroenterology. 2004 May. 126(5):1463-73. [QxMD MEDLINE Link].
  49. Poen AC, Felt-Bersma RJ, Cuesta MA, Devillé W, Meuwissen SG. A randomized controlled trial of rubber band ligation versus infra-red coagulation in the treatment of internal haemorrhoids. Eur J Gastroenterol Hepatol. 2000 May. 12(5):535-9. [QxMD MEDLINE Link].
  50. BARRON J. Office ligation treatment of hemorrhoids. Dis Colon Rectum. 1963 Mar-Apr. 6:109-13. [QxMD MEDLINE Link].
  51. O’Regan PJ. Disposable device and a minimally invasive technique for rubber band ligation of hemorrhoids. Dis Colon Rectum. 1999 May. 42(5):683-5. [QxMD MEDLINE Link].
  52. Armstrong DN. Multiple hemorrhoidal ligation: a prospective, randomized trial evaluating a new technique. Dis Colon Rectum. 2003 Feb. 46(2):179-86. [QxMD MEDLINE Link].
  53. Poon GP, Chu KW, Lau WY, Lee JM, Yeung C, Fan ST. Conventional vs. triple rubber band ligation for hemorrhoids. A prospective, randomized trial. Dis Colon Rectum. 1986 Dec. 29(12):836-8. [QxMD MEDLINE Link].
  54. Law WL, Chu KW. Triple rubber band ligation for hemorrhoids: prospective, randomized trial of use of local anesthetic injection. Dis Colon Rectum. 1999 Mar. 42(3):363-6. [QxMD MEDLINE Link].
  55. Templeton JL, Spence RA, Kennedy TL, Parks TG, Mackenzie G, Hanna WA. Comparison of infrared coagulation and rubber band ligation for first and second degree haemorrhoids: a randomised prospective clinical trial. Br Med J (Clin Res Ed). 1983 Apr 30. 286(6375):1387-9. [QxMD MEDLINE Link].
  56. Franklin EJ, Seetharam S, Lowney J, Horgan PG. Randomized, clinical trial of Ligasure vs conventional diathermy in hemorrhoidectomy. Dis Colon Rectum. 2003 Oct. 46(10):1380-3. [QxMD MEDLINE Link].
  57. Walker AJ, Leicester RJ, Nicholls RJ, Mann CV. A prospective study of infrared coagulation, injection and rubber band ligation in the treatment of haemorrhoids. Int J Colorectal Dis. 1990 May. 5(2):113-6. [QxMD MEDLINE Link].
  58. Leicester RJ, Nicholls RJ, Mann CV. Infrared coagulation: a new treatment for hemorrhoids. Dis Colon Rectum. 1981 Nov-Dec. 24(8):602-5. [QxMD MEDLINE Link].

Media Gallery

Hemorrhoids. Image reproduced from original with permission of the American Society of Colon & Rectal Surgeons.

Rubber band ligation. Image reproduced from original with permission of the American Society of Colon & Rectal Surgeons.

Electrocoagulation for hemorrhoids. Image reproduced from original with permission of the American Society of Colon & Rectal Surgeons.

Closed hemorrhoidectomy. Image reproduced from original with permission of the American Society of Colon & Rectal Surgeons.

Open hemorrhoidectomy. Image reproduced from original with permission of the American Society of Colon & Rectal Surgeons.

Stapled hemorrhoidopexy. Image reproduced from original with permission of the American Society of Colon & Rectal Surgeons.

Transanal hemorrhoidal artery ligation (HAL). Marking of rectal mucosa at location of best Doppler signal to identify site for ligation of hemorrhoidal artery and subsequent mucopexy. Courtesy of SpringerNature, Springer International Publishing AG.

Hemorrhoidectomy

Hemorrhoids are swollen veins inside or outside the anus. They may be caused by increased pressure, such as straining when having a bowel movement or pregnancy. Hemorrhoids can cause pain, bleeding, clots, and itching. This handout tells you how to care for yourself after they are removed.

After Surgery

Rectal Care

Take a sitz bath at least three to four times a day and after each bowel movement for several days. Sit in bathtub filled with 3-5 inches of warm water for at least 10-20 minutes. Do not add anything to the water Or use a sitz bath unit that fits over your toilet.

Sitz baths help you heal and lessen the pain of rectal spasms. For comfort, you may want to sit on a towel in your bathtub.

Avoid toilet paper. Instead, spray the area with warm water after a bowel movement. We will give you a spray bottle. You may want to use a handheld shower, or gently pat dry with a baby wipe, (free of perfume, dyes, and alcohol).

You will have yellow-red drainage for at least 7-14 days. Wear pads (free of perfume and dyes) in cotton underwear (use dye and fragrance free detergent) to monitor drainage. Change pads every 4 hours or as needed to limit wetness and prevent itching.

You may see more bloody drainage as you have bowel movements and become more active. You may have swelling at the anus with tissue sticking out from anus. You may also have a lump or skin tags grow around the anus. This is your body’s reaction to the incisions made at surgery. These lumps will shrink as you heal.

Activity

  • Plan for rest during the day. Expect to be up and around doing light duties each day to keep up your strength.
  • Change position often for comfort.
  • No driving while taking opioid pain pills.
  • You may resume sex when your doctor says it is okay.
  • Check with your doctor before you return to work. You may be out of work longer if your job involves lifting or sitting.

Pain

After surgery, you will have pain. At first, you will feel numb in your rectal area. Take your pain pills before you have pain and take them on a schedule for at least the first 1-2 days to stay ahead of the pain. Taking acetaminophen (Tylenol ®) and ibuprofen throughout the day helps keep the pain at a lower level.

The first 5 days you will have a lot of pain. Expect to have pain with your first bowel movement. Do not hold off on having a bowel movement. Follow the urge to go when you feel it.

If you had banding, the bands fall off in 3-10 days. You will bleed and have more pain.
If you have stitches, they dissolve in 10-14 days. You will bleed and have more pain.

After 5 days you may have less pain. It is normal to see blood on your stool for weeks after surgery.

Avoid Constipation

Buy the stool softener, docusate sodium. Take at least 2 each day. Take these if you use the opioid pain pills and until you have your first bowel movement. This will help stool pass more easily. Follow package directions.

Buy a bulk fiber laxative, such as Metamucil®. If taken every day, it can prevent hard stools. Follow package directions. Do not start until after your first bowel movement.

Drink at least 8 glasses (8 ounces each) of fluid each day. This helps you heal faster, helps your pain pills work better and can help prevent constipation. Drink enough fluid so that the color of your urine is light yellow or clear.

Diet

You may want to eat a soft or liquid diet until you have your first bowel movement, though this not a requirement after surgery. Avoid spicy and acidic foods as you heal.

When to Call

  • Large amounts of bright red blood from the rectal area that does not stop with firm pressure to the rectal area for 10 minutes
  • Fever over 100.4 F
  • Foul-smelling drainage
  • Excess swelling in the rectal area
  • Problems passing urine

Who to Call

Digestive Health Center
(608) 242-2800 or (855) 342-9900
After hours, weekends or holidays this number will be answered by the paging operator. Leave your name and phone number with area code. The doctor will call you back.

If you are a patient receiving care at UnityPoint – Meriter, Swedish American or a health system outside of UW Health, please use the phone numbers provided in your discharge instructions for any questions or concerns.

Last updated: July 2021

Disclaimer

Your health care team may have given you this information as part of your care. If so, please use it and call if you have any questions. If this information was not given to you as part of your care, please check with your doctor. This is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each person’s health needs are different, you should talk with your doctor or others on your health care team when using this information. If you have an emergency, please call 911. Copyright © 07/2021 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#4461

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