Operation

• Grade III hemorrhoids: The hemorrhoids emerge out of the anal canal when squeezing and must be pushed back manually into the canal.

• Grade IV hemorrhoids: Permanent hemorrhoidal prolapse. At rest, the hemorrhoids are partly or completely visible at the edge of the anal canal. Depending on the extent and volume of the visible hemorrhoids (prolapse), A Longo surgical procedure may be considered.

During surgery, the hemorrhoids are pulled up into the anal canal. The piles are lifted into the anal canal by use of a circular stapler that removes  a +/- 2 cm high cylinder from the inner edge (a collerette) of the lower rectum, thereby lifting the hemorrhoids 2 cm into the anal canal.  This procedure has the advantage not to remove the hemorrhoids. Compared with classical resection of hemorrhoids, this operation causes less pain, less bleeding and less constipation, and patients will return faster to work.

Giordano P Long term outcomes of stapled hemorrhoidopexy vs conventional hemorrhoidectomy: a meta-analasys of randomized control trials Arch Surg 2009; 144:266-272

Bleeding

• +/ -7,5%

During the first few days, loss of bloody fluid when defecating is common. Less than 1% of cases require postoperative operation for bleeding.

Pain symptoms

• 24%

False urge to defecate

• 8% ( 0 – 25%) 

Porrett Lj  Documented complications of stable hemorrhoidopexie : asystematic review . Int. Surg  2015; 100 : 44 -57

Urinary retention

• < 5% 

Rare complications

• Anal canal stenosis, infection, recto-vaginal fistula.

Reoperation

• < 2% (90% for bleeding)

Similis C: systématiciens review and network meta-analysis comparant 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.
• Burning sensation and constant urge to defecate and urinate during 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.

Change in sensation / perception in the anal canal

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