Hemorrhoidectomy is a surgical procedure to remove hemorrhoids. It is typically used for severe cases of hemorrhoids that do not respond to other treatments. During a hemorrhoidectomy, the hemorrhoid tissue is cut out. This often leaves a wound that requires stitches to close and heal properly.
What are hemorrhoids?
Hemorrhoids are swollen and inflamed veins in the anus and lower rectum. They are classified into two main types:
- Internal hemorrhoids occur inside the rectum and are usually painless.
- External hemorrhoids occur under the skin around the anus and are painful.
Hemorrhoids develop when there is increased pressure in the veins of the anus and rectum. This can be caused by a variety of factors including constipation, diarrhea, pregnancy, obesity, prolonged sitting, and straining during bowel movements.
What is hemorrhoidectomy surgery?
Hemorrhoidectomy is surgery to remove hemorrhoids. It is done when other treatments, such as over-the-counter remedies, lifestyle changes, and office procedures have not worked. There are a few different techniques and approaches:
- Open hemorrhoidectomy – This is the most common technique. It involves making an incision around the hemorrhoid to completely remove it.
- Closed hemorrhoidectomy – The hemorrhoid tissue is removed with a device inserted through the anus, avoiding external incisions.
- Laser hemorrhoidectomy – A laser beam is used to burn and destroy hemorrhoid tissue.
Hemorrhoidectomy is performed under general, spinal, or local anesthesia. It aims to remove the hemorrhoids and the damaged, expanded hemorrhoidal supportive tissue.
Does hemorrhoidectomy require stitches?
In most cases, yes hemorrhoidectomy does require stitches. Here’s why:
- The procedure removes hemorrhoid tissue, leaving behind a wound.
- Stitches are needed to bring the edges of the wound together to promote proper healing.
- Sutures reduce bleeding from the surgical site and prevent complications.
- Stitches also help reduce pain and discomfort during the healing process.
There are a few techniques that may not require stitches:
- Closed hemorrhoidectomy does not usually require stitches since there is no external incision.
- Laser hemorrhoidectomy can sometimes seal the wound enough to not need sutures.
- Very small hemorrhoids removed through a closed technique may heal without stitches.
However, most of the time stitches are standard practice following a hemorrhoidectomy. The number of stitches can vary based on the specifics of the surgery and surgeon’s approach, but typically range from 3 to 8 stitches.
What types of stitches are used?
The stitches used to close a hemorrhoidectomy incision depend on the surgeon’s preference and training. However, the most common options include:
- Absorbable sutures – These stitches dissolve on their own over time. They include catgut and synthetic options like polyglactin 910 and polydioxanone.
- Non-absorbable sutures – These must be manually removed after the incision heals, usually in 7-14 days. Options include silk, polypropylene, or nylon.
Absorbable sutures are often preferred because they do not require removal. Within about 4-8 weeks, absorbable stitches will be broken down and absorbed by the body.
What is the recovery like after hemorrhoid surgery?
Recovery after a hemorrhoidectomy involves some postoperative care while the wound heals. This includes:
- Pain and discomfort at the surgery site for 1-2 weeks.
- Bleeding and drainage for up to 2 weeks.
- Sitz baths and topical pain relievers to manage discomfort.
- Eating a high fiber diet and staying well hydrated.
- Avoiding straining during bowel movements.
Most people are able to return to work within 1-2 weeks after surgery. Strenuous activity and heavy lifting should be avoided for 4-6 weeks. Complete healing can take about 6-8 weeks.
It’s important to keep the surgical area clean while healing and watch for signs of infection like increased pain, swelling, bleeding, or foul-smelling drainage. Contact your doctor if you have any concerns.
When can stitches be removed after hemorrhoid surgery?
If non-absorbable sutures were used, they will need to be removed once the wound has healed enough. This is typically done 7-14 days after surgery.
Your surgeon will have you come in for a follow up appointment to examine the incision site and remove stitches. This is usually a quick and painless process involving simply clipping the visible suture threads.
Absorbable stitches do not require removal. They slowly dissolve and absorb into the tissue over 4-8 weeks. The timing depends on the type of suture material used.
Risks and complications of hemorrhoidectomy
Like any surgery, hemorrhoidectomy carries some risks including:
- Bleeding
- Infection
- Damage to the sphincter muscles
- Rectal stricture
- Recurrence of hemorrhoids
Proper wound care and avoiding straining with bowel movements can help prevent complications. Contact your surgeon if you have bleeding that doesn’t stop, severe pain, fever, or signs of infection.
When to consider surgical removal of hemorrhoids
Hemorrhoidectomy may be an option when:
- Hemorrhoid symptoms do not improve with other treatments like over-the-counter remedies, lifestyle changes, and non-surgical office procedures.
- There are large external hemorrhoids that cause persistent pain and swelling.
- Internal hemorrhoids have prolapsed outside of the anus.
- There is significant bleeding from hemorrhoids.
Your doctor will examine your hemorrhoids and discuss whether hemorrhoidectomy is the best option based on factors like the location, size, and grade of your hemorrhoids.
Conclusion
In most cases, hemorrhoidectomy does require stitches in order to promote proper healing after the swollen hemorrhoid tissue is removed. Absorbable sutures that dissolve on their own are commonly used. Recovery typically takes about 1-2 weeks before returning to regular activities and up to 6-8 weeks for full healing. While hemorrhoidectomy is an effective treatment for severe hemorrhoids, it does come with some risks of complications. Work with your doctor to determine if hemorrhoid surgery is appropriate for your situation.