Piles Surgery

Listed below is the step by step procedure of piles surgery:

1. What is Piles Surgery ?
2. Why is Piles Surgery Required?
3. Pre-operative Preparation
4. Day Before Surgery
5. Procedure Day
6. Methods/Techniques of Piles Surgery
7. Post Procedure
8. Risks and Complications
9. FAQs

What is Piles Surgery ?

Surgical treatment to treat or reduce the complaints of piles complies piles surgery. Piles are also known as hemorrhoids. It is a conditions in which there is swelling of the veins of the rectum. It can be quite painful as it hampers with passage of stool.

In many cases, the swelling subsides with medical treatment and dietary restrictions which need to be followed for sometime, depending on the intensity of symptoms. Sometimes however the swelling may be so severe that it could protrude out of the anus. There may be associated bleeding as well in some cases. These are severe cases which may not respond to medicines and will need surgical intervention.

There are different types of surgical methods which can be used to treat hemorrhoids depending on the intensity of symptoms, signs and associated complications. Surgical intervention will act as a long term treatment and provide prolonged comfort to the patient.

Why is Piles Surgery Required?

Most of the times, dietary changes and exercise is recommended to piles patients in early stages. Use of over the counter creams and oils is suggested for reducing the pain and discomfort associated with the piles.

Piles surgery is recommended when no other treatments for hemorrhoids or piles show response. Based on the type of piles or hemorrhoids, treatments vary. For first, second and third degree hemorrhoids, home remedies, medications and manual methods are preferred approach. Conventional methods do not work for the piles or hemorrhoids which are sticking out of the anal canal.

In case of the fourth degree and higher degree of prolapsed hemorrhoids, surgical methods are required to be followed. In general, surgery is considered as last option for treatment of piles. Especially in cases where severe pain in experienced, piles surgery is recommended by the surgeons. Various types of piles surgeries can be done for the treatment of piles which include freezing, infrared light, injection and staples.

Pre-operative Preparations

Prior to surgery, patients may feel anxious. This is natural since surgical process is stressful. Surgeon gives basic details regarding surgical process to the patient and his/her close relatives. Prior information helps in preparing the patients for the surgery in safer way. Medications that can increase bleeding need to be avoided prior to a week of surgery. These medications include Aspirin, Ibuprofen and prescription blood-thinning medications.

Day Before Surgery

A day before surgery, bowel preparation is required to be done by the patients under the guidance of surgeons. The process of bowel preparation involves drinking of solution for the removal of all stool from the digestive tract of the patients. Removal of stools is achieved by causing bowel movements or by giving an enema to the patients.

All queries related to the surgery can be discussed before surgery and patients need to be sure of what they are going to face. Post surgery complications are also required to be informed to the patients prior to the surgery. Surgeons suggest the list of medications required to be taken before the surgery to the patients. All instructions given by the surgeon are needed to be followed. Copy of advanced care plan if any from the patient's side needs to be discussed with the surgeon.

Procedure Day

Piles surgery can be done within a day. After testing, an anesthesia is given to the patient to make them unconscious during the surgical process. Sometimes, it may just make the area under operation numb. The piles surgery usually takes 30 minutes to one hour. Eating and drinking instructions given by the surgeon are required to be followed on the day of surgery. Failing to do so may result in cancellation of surgical process. Patients need to take medications only with the consultation of surgeon. For maintaining cleanliness, patients need to take a bath prior to surgical process. Application of lotions, deodorants, nail polish and perfumes needs to be avoided. It especially needs to be noted that patients should not shave surgical site by themselves. Jewelery and contact lenses need to be removed prior to the surgery.

Methods/Techniques of Piles Surgery

Surgery for piles or hemorrhoids depends on the severity of pain and complications.

The patients who are not suitable for non-surgical treatments, surgical methods are preferred for the treatment of piles surgery. Listed below are the types of surgical procedures for piles treatment.

• Haemorrhoidectomy
• Hemorrhoidal artery ligation
• Stapling

Hemorrhoidectomy

This process involves surgical removal of the hemorrhoids and surrounding tissues. It is carried out using general anesthesia. After getting anesthesia, patient becomes unconscious and no pain can be felt while the surgery is going on.

During conventional haemorrhoidectomy, anus is gently opened so as to remove the hemorrhoids. A week or so is required to recover after this surgery. Post this surgery, patients experience severe pain which needs to be treated with painkillers. This pain remains for few weeks after the surgical process. Pain lasting more than expected time needs to be reported to the surgeon for timely recovery and avoidance of complications. There is a probability of recurrence of hemorrhoids after haemorrhoidectomy. This recurrence is less in surgical process than non-surgical treatment methods.

Hemorrhoidal Artery Ligation

Artery ligation of hemorrhoids or piles is a surgical operation which involves reduction of blood flow to the hemorrhoids. A general anesthesia is given prior to this operation. Insertion of a small probe into the anus is carried out. This probe generates high-frequency sound waves which helps the surgeon in finding the vessels responsible for blood supply to the hemorrhoids.

During artery ligation process, each blood vessel is closely stitched so as to block blood supply to the hemorrhoids. This stoppage of blood supply causes shrinking of hemorrhoids in some days and weeks. For prolapsing hemorrhoids, stitches can be used. It has been reported that hemorrhoidal artery ligation is safer alternative to hemorrhoidectomy or stapled hemorrhoidopexy since less pain is experienced in it. Also patient satisfaction is comparatively high in hemorrhoidal artery ligation surgical process.

In addition to the satisfaction and comfort, recovery time in hemorrhoidal artery ligation is also less compared to other surgical methods. Once hemorrhoids get prolapsed, a slight risk of bleeding and pain during defecation can be observed after artery ligation process. In few weeks, these symptoms get reduced.

Stapling or Stapled Hemorrhoidopexy

An alternative to a conventional hemorrhoidectomy is stapling. In some cases, it is used for the treatment of prolapsed hemorrhoids. A general anesthesia is used prior to the stapling process. There is high risk of complications involved in stapling process. This is why it is not used often.

An anorectum which is the last part of the large intestine is stapled during stapling process. As a result of this, there is less chance of prolapsing of hemorrhoids. There is reduction in blood supply to the hemorrhoids which results in gradual shrinking of hemorrhoids. Stapling is used occasionally due to risk of complications associated with it.

Compared to traditional hemorrhoidectomy, stapling process has less recovery time. Patients can return to their normal routine activities within a week after surgery. Complications involved in this process include fistula to vagina in women, development of channel between the vagina and the anal canal.

Post Procedure

Post surgery, patient may need to remain hospitalized for minimum three days. Depending on overall health and complications, stay at hospital may increase. As per the surgical procedure involved, pain may vary. Painkillers are given by the surgeon for getting relief from the pain and discomfort. Within a week following the surgery, pain gets reduced in most of the cases.

In some patients, urination problems can be observed after piles surgery. Urinary retention is most common among these problems. An medical emergency can occur if inability to pass urine is observed. For pain relief, surgeon can suggest sitz bath and ice packs. Many ways are recommended to prevent recurrence of hemorrhoids or piles post surgery.

Adopting or continuing a high-fibre diet after surgery is recommended to reduce recurrence of piles.

Risks and Complications

It is rare to see severe complications after piles surgery; however, some complications can be seen after surgery. These are listed below.

• Urinary retention
• Involuntary stool passage
• Bleeding
• Passing of blood clots
• Build up of pus or infection
• Development of a small channel between surface of the skin near the anus and the anal canal
• Stenosis i.e., anal canal narrowing

FAQs

1. Which preventive measures are required to be taken post piles surgery?

   A. Healthy lifestyle changes with the consultation of surgeon need to be done after piles surgery by the patients.

   It is recommended to follow high-fiber diet. Fluid intake needs to be increased and activities which can cause strain need to be avoided. Keeping the stools soft can help in easy defecation process.

2. Post piles surgery, when is an emergency medical advice required?

   A. An emergency medical treatment can be required in conditions given below post piles surgery.

   • Excessive bleeding
   • Urination issues
   • Fever
   • Swelling near anal area
   • Severe pain