In this detailed guide to the various treatment approaches for haemorrhoids, highly respected consultant general surgeon Ms Cinzia Sammartino sheds light on how the most suitable procedure is determined for each individual patient. The leading specialist also details what to expect from treatment itself and the recovery period to follow.
Which type of haemorrhoid surgery is best for me?
There are many types of procedures and surgeries to treat haemorrhoids. I believe that there isn't just one procedure which is right for every patient. Determining the right type of surgery in each individual case depends on the patient and the haemorrhoid disease.
In our consultations with patients, it’s also important to establish what the patient’s priorities are, i.e., do they prefer a non-invasive treatment, one which takes a few sessions with minimal recovery time, or alternatively a procedure which requires a longer recovery time, but fewer visits to hospitals? This allows us to create a treatment plan which best suits the needs and preferences of the patient.
What are the risks associated with haemorrhoid surgery?
The associated risks of haemorrhoid treatment depend on the type of procedure. Some treatments are very simple, minimally invasive and non-surgical and can provide very good results in treating haemorrhoids. This type of treatment may use low-level electricity, or banding, which is done in clinic. Fortunately, these types of procedures have virtually no complications, and those which can occur are very minor. Some patients experience low level pain or very slight bleeding which typically resolves in 24 to 48 hours.
There are also surgical procedures to treat haemorrhoids, such as haemorrhoidectomy, mucopexy, or ligation of the arteries, which require a longer recovery time. These surgical procedures are also associated with possible complications, including infection, bleeding and pain, but most importantly, temporary incontinence, which occurs in up to 10 per cent of cases.
What type of anaesthesia is used?
For outpatient procedures (which I call office procedures) like banding or low-level electricity treatment, we use a bit of gel or cream with anaesthetic inside which is more than enough to make the procedure pain-free and well-tolerated.
For other surgical procedures, the type of anaesthesia used depends on the degree of the disease, and of course, patient preference. Many people can have their procedure under local anaesthetic with an injection at the area where we need to go and operate, or it can be done under general anaesthesia.
The advantage of local anaesthesia is that it is less invasive and isn’t applied systemically, unlike general anaesthesia. However, general anaesthesia is safe and in the majority of cases where it is used, patients are able to go home on the same day and will have fully recovered from the anaesthesia within 24 hours.
How long do haemorrhoids procedures take?
This depends on which type of procedure is being performed. Banding and low level electricity treatments normally that takes between 10 to 20 minutes to complete. Surgical procedures like ligation of the artery, haemorrhoidectomy or mucopexy typically take around half an hour to 45 minutes to perform.
However, this does depend on the degree of the haemorrhoids. If the haemorrhoids are very large, a longer period of time is required to treat them, due to the amount of associated redundant tissue. A procedure for haemorrhoids of this size could take close to an hour to perform, while smaller isolated haemorrhoid disease can sometime take less than 30 minutes to treat.
How long does it take to recover from surgery of this type?
The recovery time following haemorrhoid treatment depends on the type of procedure that is carried out. With low level electricity and banding treatments, there is virtually no recovery time required, as these procedures don’t leave a wound or pain or inflammation of the tissue.
Surgical procedures, like haemorrhoidectomy, mucopexy and ligation, do require a recovery period. Haemorrhoidectomy requires the longest period of recovery, which can be up to six weeks, and some patients find it quite painful. There is less pain associated with mucopexy procedures and ligation of the hemorrhoidal artery, where the pain tends to disappear after the first week to 10 days.
What should I expect after the surgery?
Pain is one of the main symptoms that patients experience following surgery. Temporary pain is reported by one out of every 10 patients. In addition, some patients experience incontinence with wind and sometimes stools which normally resolves itself within the first few days to weeks.
Once the acute phase has passed, there is a chance that the haemorrhoids can come back. The likelihood of this occurring really depends on the person’s lifestyle, as haemorrhoids tends to come together with slow bowel transit, constipation and poor fluid intake. Therefore, it's very important that following haemorrhoid treatment, this aspect of general wellbeing and health habits are addressed to trying to prevent any recurrence.
To schedule a consultation with Ms Sammartino, visit her Top Doctors profile today.