Darlyn Amplayo

February 25, 2020

O.R-NCM 104

Article Topic:

Hemorrhoidectomy - making sense of the surgical options

Summary:
Hemorrhoids is one of the most common anorectal disorders, and it be either internal or

external. Hemorrhoids can be classified by the grades (4 grades of internal hemorrhoids) and the

degree of prolapse. The ideal operation of hemorrhoids are effective with less recurrence of post-

op pain and early return to normal activities. This article evaluates the different current surgical

options and make sense of the different modalities of surgery for hemorrhoids. The

pathophysiology of hemorrhoids is explained in the article. Hemorrhoids is defined as the

symptomatic enlargement and distal displacement of the anal cushions. The anal canal contains

three cushions and when engorged with blood, it maintains anal continence. Currently the theory

of hemorrhoids is that of the sliding anal canal. The deterioration of anal cushions that supports

tissues are replaced by collagen fibers. Findings show a severe inflammatory process affecting

the connective tissue and the walls of the arterial and venous blood vessels, which leads to

ischemia, mucosal ulceration and bleeding. One of the surgical method being used is the stapler

hemorrhoidectomy known as a procedure for prolapsed hemorrhoids. This method involves

excising a circumferential ring of mucosa four centimeters above the dentate line using a circular

stapler. This interrupts the superior hemorrhoidal vessels and restores the hemorrhoidal tissues

back to their anatomic position. Stapler hemorrhoidectomy causes less pain than closed

hemorrhoidectomy, but significant number of patients have complained of chronic pain post-op.

Another method mentioned is the closed hemorrhoidectomy (SH). This operation involves the

excision of hemorrhoidal cushions off the internal anal sphincter with diathermy rather than

scissors. Open diathermy hemorrhoidectomy have a significantly shorter operative time with
Darlyn Amplayo
February 25, 2020
O.R-NCM 104

lower analgesic requirements. In conclusion, none of the surgical methods approach is ideal to

the surgeon because there is recurrence of post-op pain and discomfort. The surgery needs to be

tailored not only to the grade of the hemorrhoids, but also the size, circumferential nature of the

disease , and prevailing symptomology.

Reaction:
This article was an interesting and very informative reading for me. Although, it did not

write about the experience or the steps that happened in the operating room, but it compared

different methods done for hemorrhoids. It clearly explained what hemorrhoids are by its

pathophysiology and the way I understood it is the swollen veins the lower part of rectum and

anus. I liked that the purpose of the research is to find a method that would is safe and can cause

less pain to the patient. It is important to be able to compare the different methods so they can

know which methods are more effective. Although the results of the research shows that the

methods did not matter because both causes post-op pain, but SH causes less pain but chronic. At

least this way, the doctors are aware and can decide later on if this will still be an appropriate

method to use for the procedure. Also, in conclusion, the researchers have come up with new

factors that they thought would help in the surgery such as the size, circumferential nature of the

disease , and prevailing symptomology rather than just the grade of hemorrhoids. I agree with the

researchers that it is important to determine each factors, so they can determine if it is severe or

not.