If hemorrhoids are treated early, surgery can usually be avoided. Many people who suffer from hemorrhoids feel embarrassed and put off seeing a doctor for a long time. As a result, surgical procedures are often necessary to manage the symptoms, which can sometimes be severe. Approximately 50,000 hemorrhoid surgeries are performed in Germany each year.
Here you’ll find more information and qualified doctors for hemorrhoid surgery.
Hemorrhoid Surgery - Frequently Asked Questions, Sclerotherapy, Rubber Band Ligation, Laser
Doctors classify hemorrhoids into four stages.
In the first and second stages of hemorrhoids, the enlarged vascular cushions around the rectal mucosa are not visible from the outside. If hemorrhoidal tissue protrudes through the anus during straining, it usually retracts on its own after a short time.
In the early stages,
- ointments,
- suppositories, and
- sitz baths.
In milder cases, hemorrhoids can initially be treated with procedures such as sclerotherapy, rubber band ligation, or modern laser therapies. The laser precisely and gently obliterates the dilated hemorrhoids, thereby stopping bleeding and relieving symptoms. If this is not sufficient, surgical removal of the hemorrhoids becomes necessary.
Sclerotherapy: In this procedure, a special solution is injected into the hemorrhoidal tissue to restrict blood flow. This causes the hemorrhoids to shrink, and the symptoms subside.
Rubber band ligation: In this procedure, a small device is used to place a rubber band around the hemorrhoidal node. This cuts off the blood supply; the tissue dies and falls off on its own after a few days.
Laser treatment: In this procedure, the enlarged hemorrhoids are ablated with exceptional precision and minimal trauma, which stops bleeding and relieves symptoms.
Third-stage hemorrhoids occur
- during bowel movements,
- when straining, or
- during exertion
and no longer retract on their own.
Hemorrhoids can be located in the rectum in front of the anus or outside it © Henrie | AdobeStock
In stage four, the enlarged hemorrhoids can no longer be pushed back into the rectum with the fingers. This stage is characterized by what is known as anal prolapse (protrusion of the anal canal mucosa through the anus).
Patients in the third and fourth stages often suffer from severe symptoms such as
- pain,
- a feeling of pressure,
- bleeding,
- discharge, and
- fecal incontinence.
In advanced stages, hemorrhoid removal is unavoidable and the only way to cure the condition. This can help alleviate pain.
What surgical procedures are available for hemorrhoids?
Various painless procedures are available for the removal of enlarged hemorrhoids. The procedure is performed under general or local anesthesia and is usually done on an inpatient basis; outpatient surgery is relatively rare.
Below, we describe the most common surgical procedures for hemorrhoids.
Milligan-Morgan
This classic procedure is used particularly frequently. In this procedure, the individual hemorrhoidal nodules are pulled out and surgically removed. The wound in the anal canal remains open, which is why the procedure is also referred to as an “open hemorrhoidectomy.”
The Milligan-Morgan procedure is particularly suitable for third- and fourth-degree prolapsed hemorrhoids.
Ferguson
The Ferguson method is a variation of the Milligan-Morgan procedure. It is primarily preferred in the United States. The procedure is performed in exactly the same way as the Milligan-Morgan method. At the end of the surgery, however, the surgeon closes the surgical wound with a longitudinal suture.
The procedure is therefore also referred to as a closed hemorrhoidectomy. The advantage of the closed incision is that postoperative pain subsides more quickly. However, there is a risk of scarring in the anal canal.
Parks
The Parks method is used for extensive fourth-degree hemorrhoids. It involves making a Y-shaped incision in the anal mucosa. The underlying tissue is excised, blood-supplying vessels are ligated, and the wound edges are sutured in a T-shape.
The Parks hemorrhoid surgery has several advantages:
- Postoperative pain is minimal,
- wound healing is rapid, and
- the anal mucosa is preserved.
Fansler-Arnold
This complex plastic-reconstructive procedure is performed for the most severe, stage-four hemorrhoids. After making a U-shaped incision, the surgeon folds a skin flap to the side, removes the hemorrhoidal tissue, and ligates the inflowing and outflowing blood vessels. The mucosal flap is then folded back into place and sutured. The result: rapid healing, minimal pain, and preservation of the sensitive skin in the anal region.
With this procedure as well, the patient experiences very little pain after the surgery. The wound heals quickly, and no sensitive skin of the anal canal is lost.
Stapler (or Longo)
The stapler method is a relatively new procedure used primarily for third-degree hemorrhoids. Unlike traditional procedures, no incisions are made here; instead, the prolapsed hemorrhoids are repositioned to their anatomically normal position in the anal canal using a special instrument placed above the hemorrhoids.
Since the procedure is performed in an area without pain nerves, little to no pain is expected after surgery. Since the surgery takes place in a mucosal area without pain nerves, there is little to no pain following the procedure.
What complications can occur after the procedure?
Overall, the risk of complications following hemorrhoid surgery is very low. With all surgical techniques, there is a risk of postoperative bleeding of varying severity. For this reason, patients typically remain in the hospital for three days.
Men may experience difficulty urinating (urinary retention). In rare cases,
- inflammation,
- abscesses, or
- fistulas.
Stenosis can also occur very rarely. Stenosis refers to a narrowing. In this context, it refers to a narrowing of the anal canal caused by the formation of scar tissue. In the first few weeks after the procedure, patients also frequently experience an increased urge to have a bowel movement.
What precautions should be taken after hemorrhoid surgery?
In the period following hemorrhoid surgery, certain measures can aid in postoperative healing and help relieve pain. Intensive aftercare is particularly important in cases of open wounds in the rectum and anal area.
Thorough and gentle hygiene supports the healing process. The anus should be carefully cleaned with lukewarm water after each bowel movement. Afterward, it is recommended to cover the wound with a cloth or a compress.
Zinc ointment protects the skin and promotes healing. To ensure the wound gets enough air, avoid wearing synthetic underwear. Pure cotton underwear is best, as it is breathable and absorbs moisture.
After surgery, stools should be kept soft by eating a high-fiber diet and drinking plenty of fluids. This helps prevent pain when using the restroom. However, stools that are too soft can contaminate the wound and cause severe pain.
Patients should under no circumstances take laxatives during the healing phase.
After hemorrhoid surgery, the period of incapacity for work is usually 1–4 weeks, depending on the surgical method and the nature of the patient’s job. It is often shorter for light, sedentary work and longer for physically demanding work. The exact duration depends on the progression of pain and wound healing, as recommended by the doctor.
