Operation

• Grade III : Hemorrhoids (piles) exteriorize when squeezing (effort) and must be manually pushed back into the anal canal.

• Grade IV : Hemorrhoids are permanently prolapsed exteriorized) outside the anal canal.

• Prolapsed and thrombosed hemorrhoids : Painful swollen hemorrhoids which are constantly exteriorized outside the anal canal, are swollen and very painful.

During surgery, 1 to 4 prolapsed haemorrhoids are removed. Intact flexible tissue must be preserved between the haemorrhoid parcels to prevent narrowing of the anus and to preserve the anal canal’s ability to distinguish between gas, liquid or solid stools. After surgery, sensation in anal sexual practice may change.

With 5-6% recurrences, this procedure is the most effective, but also the most painful.

It is generally recommended for haemorrhoids grade III – IV.

• Duration of surgery: +/- 30 – 60 min.
• Length of hospital stay : Day admission – 1 day.
• Healing time of the wound : > 3 weeks.

Pain

Severe pain symptoms are normal during the first 10 days.
+/- 5% of patients may develop a chronic wound (anal fissure) that may persist for several months.

Bleeding

→ 0,3 -6%

Immediately after the procedure, it is acceptable to lose some blood when defecating.
1-2% of patients will require reoperation for bleeding.

Urine retention

Temporary urinary retention may occur after surgery. The placement of a temporary urinary catheter is seldom necessary.

Anal stenosis

→ (rare <1%)

Extensive scar tissue around the anal canal after resection of multiple hemorrhoids will reduce the flexibility and elasticity of the anal canal. When expelling bowel movements, the rigid scar tissue will repeatedly rupture and cause pain.

Severe incontinence

→ (rare <1%)

If the sphincter muscle of the anus is severely damaged during surgery, it may cause symptoms of incontinence.

Long-term recurrence of hemorrhoids

→ Bleeding: 5%.

→ Recurrent prolapse of hemorrhoids: 6,9% after 5 years.

(Bennett et all 1963) (Murie et all 1980)

Reoperation

→ 2% (of which 90% bleeding)

Similis C : systematic review  and network  meta analysis comparing clinical outcomes  and effectiveness of surgical treatment for hemorrhoids Br J Surg  2015;102:1603-1618

Normal symptoms

• Anal pain is normal but should subside over time.
• A burning sensation and a constant false urge to defecate during the first 2 weeks.
• Seepage of serous (yellowish) anal fluid.
• Fluid loss may be bloody but should subside over time.

Abnormal symptoms

Contact your surgeon or GP, or go to the emergency room:

• If pain increases over time.
• If fever does not subside over time.
• If pus volume increases or foul smelling viscous fluid increases.
• If blood loss persists.

If symptoms seem abnormal to you, contact your GP (general practician).

If this is not possible, contact your surgeon.

If you are unable to contact your GP (general practician) or surgeon, go  to the St Elisabeth hospital emergency department.

Anal incontinence

There is frequent fluid loss In the immediate postoperative period (30-50%).
After 6-8 weeks most patients will not suffer from fluid loss.

Severe incontinence is very rare and results from severely injuring the anal sphincter during surgery.

( Surgery of the anus, rectum & colon  Third edition Keighley  – Norman)

Sexual function

After surgery, sensation, during anal sex may be altered. The anal canal may be narrowed and intercourse can be painful.