Hemorrhoidectomy is surgery to remove hemorrhoids.

These are swollen veins in the anal area. During this surgery, the doctor will cut out the swollen veins.
After surgery,

the pain and itching from your hemorrhoids should go away.

Hemorrhoids are classified into two types: those above internal sphincter are called - Internal
Hemorrhoids, and those appearing outside the external sphincter are called - external Hemorrhoids
( Ansari, 2014)

Internal Hemorrhoids are also classified by degree of prolapse (Thornton, Rosh, & Perry, 2015)

• First Degree - No prolapse and not protruded into anal canal

• Second Degree - Prolapse Outside the anal Canal during defecation but reduce spontaneously

• Third Degree - Prolapsed to the extent that they require manual reduction

• Fourth Degree - Prolapsed to the extent that they may be not reduced.

Hemorrhoids cause itching and pain and are the most common cause of bright red bleeding with
defecation. External Hemorrhoids are associated with severe pain from the inflammation and edema
caused by thrombosis ( clotting of blood within the Hemorrhoid). This may lead to ischemia of the area
and eventually necrosis. Internal Hemorrhoids not usually painful until they bleed or prolapse when they
become enlarge

Hemorrhoids can be developed in increased pressure in the lower rectum due to:

• straining during bowel movements

• sitting for long periods of time in the toilet

• having chronic diarrhoea or constipation

• being obese

• being pregnant

• having anal intercourse

• eating a low fiber diet

• Regular heavy lifting

Patient should be ordered NPO for 6-12 hours.

Position for surgery are:

• Prone Jack knife

• Lithotomy

• Sims left Lateral

Hemorrhoidectomy may be done when a person have:

Very large internal hemorrhoids.

Internal hemorrhoids that still cause symptoms after nonsurgical treatment.

Large external hemorrhoids that cause a lot of discomfort and make it hard to keep the anal area clean.

Both internal and external hemorrhoids.

Had other treatments for hemorrhoids (such as rubber band ligation) that have not helped.

When is it used?

Hemorrhoidectomy is one method of treating hemorrhoids. It is usually used only for severe

hemorrhoids or when other treatments do not help. Examples of alternative treatments are:

• to improve your bowel habits, increase the fiber in your diet, drink more water, and get

regular exercise

• to try anesthetic ointments or sitz baths

• to place tight bands around the hemorrhoids

• to destroy the hemorrhoids with freezing, electrical or laser heat, or infrared light

• to inject a chemical solution to shrink the hemorrhoid.

You should ask your health care provider about these choices.

Types of Hemorrhoid Surgery

1. Closed Hemorrhoidectomy

2. Open Hemorrhoidectomy

3. Stapled Hemorrhoidectomy ( Procedure for Prolapse and Hemorrhoids - PPH)

4. Rubber Band Ligation

5. Lateral Internal Sphincterotomy

OPEN HEMORRHOIDECTOMY

In an open hemorrhoidectomy, hemorrhoidal tissue is excised in the same manner as in a

closed procedure, but here the incision is left open. Surgeons may opt for open

hemorrhoidectomy when the location or amount of disease makes wound closure difficult

or the likelihood of postoperative infection high. Often, a combination of open and closed

technique is utilized. Complications following open hemorrhoidectomy are similar to those

that occur after closed hemorrhoidectomy.

Stapled Hemorrhoidectomy

(Procedure for Prolapse and Hemorrhoids - PPH)

The procedure involves a circular stapling device which

removes some of the tissue located upstream from the

hemorrhoids, thereby pulling the hemorrhoids upward,

returning the problematic hemorrhoidal tissue to its normal

position, and staples this tissue up into place. Most or all of

the staples later fall out over time.

RUBBER BAND LIGATION

Rubber band ligation is a procedure in which the hemorrhoid is tied off at its base with

rubber bands, cutting off the blood flow to the hemorrhoid. This treatment is only for

internal hemorrhoids. To do this procedure, a doctor inserts a viewing scope (anoscope)

into the anus.

LATERAL INTERNAL SPHINCTEROTOMY

Lateral internal sphincterotomy is an operation to treat an anal fissure, a tear in the opening of the anus
that can cause pain, itching, and bleeding. Anal fissures are caused by spasm of the anal muscles and can
cause anal pain that can be quite severe, usually during and after a bowel movement.
NURSING MANAGEMEN:

Administer topical medication as ordered.

Provide “donut cushion” for the patient to sit on if needed.

Administer stool softeners as ordered.

Instruct patient and/or family in dietary management.

Warm sitz baths or suppositories containing anesthetic agents can help to alleviate pain temporarily.

Medications

Your doctor will probably prescribe painkillers to ease the discomfort.

These may include:

Opioids. Opioids like oxycodone are typically taken every 2–4 hours according to the dosage your
surgeon prescribes. Typically it’s no more than one–two pills.

Nonsteroidal anti-inflammatory drugs (NSAIDS). NSAIDS like ibuprofen are available over-the-counter
(OTC) and by prescription in higher dosages. Check with your doctor for your recommended dosage
depending on your level or pain and the specific surgery you underwent.

Ativan. This is a spasm reducing medication that doctors often prescribe for hemorrhoidectomies. You
typically take it as needed every 6 hours.