Open hemorrhoidectomy is a surgical procedure to permanently remove large or severe hemorrhoids. It is recommended for grade 3 and grade 4 piles that have not responded to other treatments, offering the lowest recurrence rate among hemorrhoid surgeries.
Open hemorrhoidectomy is a surgical procedure to permanently remove large or severe hemorrhoids.
...It is recommended for grade 3 and grade 4 piles that have not responded to other treatments, offering the lowest recurrence rate among hemorrhoid surgeries.Read More
Open hemorrhoidectomy is a surgical procedure in which enlarged or prolapsed hemorrhoids are excised under anesthesia. It is considered the most effective treatment for severe grade 3 and grade 4 hemorrhoids that have not responded to conservative management or minimally invasive procedures such as rubber band ligation or sclerotherapy. The procedure involves making incisions around the hemorrhoidal tissue and removing it completely. While recovery takes longer than minimally invasive options, open hemorrhoidectomy offers the lowest recurrence rate among all hemorrhoid treatments. Pristyn Care provides this surgery with experienced colorectal surgeons and comprehensive post-operative care.
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Symptoms
Patients who may require open hemorrhoidectomy often experience:
Severe rectal bleeding during or after bowel movements
Large prolapsed hemorrhoids that cannot be pushed back inside
Significant pain and discomfort in the anal region
Chronic itching, swelling, and irritation around the anus
Mucus or blood discharge from the rectum
Difficulty sitting for extended periods
Failure of previous hemorrhoid treatments to provide relief
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Grades
Open hemorrhoidectomy is typically recommended for:
Grade 3: Hemorrhoids that prolapse and require manual reduction but have not responded to banding or other treatments
Grade 4: Permanently prolapsed hemorrhoids that cannot be pushed back inside and cause severe symptoms
Open hemorrhoidectomy can be performed using different techniques:
Milligan-Morgan technique: The most common open technique where hemorrhoid pedicles are excised and wounds are left open to heal
Ferguson technique: Similar to Milligan-Morgan but wounds are sutured closed for faster healing
Whitehead hemorrhoidectomy: Complete circumferential excision of hemorrhoidal tissue, reserved for severe cases
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Risk Factors for Hemorrhoids
Risk factors that may lead to severe hemorrhoids requiring open surgery include:
Chronic constipation and prolonged straining during bowel movements
Low-fiber diet and inadequate fluid intake
Prolonged sitting or standing for long hours
Pregnancy and multiple childbirths
Obesity and sedentary lifestyle
Aging, as tissues weaken with age
Portal hypertension or liver disease
Who Needs Open Hemorrhoidectomy?
Open hemorrhoidectomy is recommended for patients with grade 3 or grade 4 hemorrhoids, large thrombosed external hemorrhoids, or those who have failed conservative and minimally invasive treatments. Patients with recurrent hemorrhoids after previous procedures or with multiple large hemorrhoids are also candidates. The surgeon will evaluate severity through clinical examination and proctoscopy before recommending surgery.
Diagnosis
Diagnosis before open hemorrhoidectomy involves:
Physical examination: Assessment of the anal region to identify hemorrhoid size, location, and grade
Proctoscopy: Visualization of internal hemorrhoids using a rigid scope
Sigmoidoscopy or colonoscopy: To rule out other colorectal conditions causing rectal bleeding
Blood tests: To assess hemoglobin levels in patients with chronic rectal bleeding
Treatment: Open Hemorrhoidectomy
Open hemorrhoidectomy is performed under regional or general anesthesia as a day procedure or with a short hospital stay. The surgeon makes incisions to expose and remove hemorrhoidal tissue, then ties off blood vessels to prevent bleeding. The procedure addresses all significant hemorrhoid complexes in one session. Pristyn Care uses precise surgical techniques and modern equipment to minimize postoperative pain and ensure complete removal of hemorrhoidal tissue.
Hemorrhoidectomy Procedure Steps
Anesthesia: Spinal or general anesthesia ensures complete patient comfort
Positioning: Patient is placed in lithotomy or prone jack-knife position for optimal access
Exposure: Retractors expose the anal canal and identify all hemorrhoid complexes
Excision: The surgeon incises and removes each hemorrhoid along with underlying blood vessels
Hemostasis: Blood vessels are ligated to prevent postoperative bleeding
Wound management: In open technique, wounds are left open; in closed technique, they are sutured
Recovery: Patient is monitored in the recovery room before discharge
Recovery After Hemorrhoidectomy
Recovery after hemorrhoidectomy takes 2 to 4 weeks:
Pain and discomfort managed with prescribed pain medications for the first few days
Sitz baths 2 to 3 times daily relieve pain and keep the wound clean
High-fiber diet and plenty of fluids prevent constipation and straining
Light activities can resume in 1 to 2 weeks; strenuous activity after 4 to 6 weeks
Stool softeners prescribed to ease bowel movements during recovery
Complications of Hemorrhoidectomy
Open hemorrhoidectomy is safe but may involve the following risks:
Postoperative pain, the most common complaint, managed with medications
Rectal bleeding in the first few days after surgery
Urinary retention, especially in men after spinal anesthesia
Wound infection requiring antibiotic treatment
Anal stenosis (narrowing) in rare cases with extensive excision
Fecal incontinence in very rare cases due to sphincter involvement
FAQs on Open Hemorrhoidectomy
Is open hemorrhoidectomy the best treatment for grade 4 piles?
Yes, open hemorrhoidectomy is considered the most definitive treatment for grade 4 and recurrent grade 3 hemorrhoids. It offers the lowest long-term recurrence rate compared to other treatments. While recovery takes longer, the permanent relief it provides makes it the preferred option for severe hemorrhoidal disease.
How long does recovery take after open hemorrhoidectomy?
Recovery after open hemorrhoidectomy typically takes 2 to 4 weeks. Most patients can resume light activities within 1 to 2 weeks, while complete return to normal activities takes 4 to 6 weeks. Following post-operative instructions including diet, sitz baths, and medications significantly speeds up recovery.
Is open hemorrhoidectomy performed under general anesthesia?
Open hemorrhoidectomy is usually performed under spinal or general anesthesia, ensuring no pain during the procedure. The choice of anesthesia depends on the extent of surgery and the patient overall health. The procedure is done as a day surgery or with an overnight hospital stay.
What is the difference between open and closed hemorrhoidectomy?
In open hemorrhoidectomy (Milligan-Morgan technique), wounds are left open to heal on their own, which reduces infection risk. In closed hemorrhoidectomy (Ferguson technique), wounds are sutured closed, allowing faster healing. The choice depends on the surgeon assessment and patient condition.
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. Piyush Gulabrao Nikam is a very nice and polite person. He explained my problem clearly and listened to me patiently. I felt comfortable during the consultation. He gave proper guidance and answered all my questions calmly. Overall, I am satisfied with the treatment and would definitely recommend him to others.
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