Open Haemorrhoidectomy

What is open haemorrhoidectomy ?

Also called Excisional haemorrhoidectomy (or Milligan - Morgan Procedure) involve excision of symptomatic haemorrhoid by surgery. It is considered at a gold standard procedure for symptomatic haemorrhoids (Large bleeding or prolapsing haemorrhoids).

What preparation do I need for open haemorrhoidectomy ?

Open haemorrhoidectomy is usually done under general anaesthesia. You need to be fasted for 6 hours before surgery. You doctor may order a enema or suppositories to empty distal part of large bowel before procedure. It can be a day procedure or may be over night stay in some cases and may need someone to drive you home after procedure. This operation can be painful and you may need few days or weeks off work.

How is open haemorrhoidectomy done?

The procedure is done under general anaesthesia administered by experienced anaesthetist. Your surgeon may also give local anaesthetist during procedure as well.

Your surgeon will first perform examination of anus and lower part of rectum to assess haemorrhoids. The surgeon than excise (cut out) the entire problematic component, including the internal and external component of haemorrhoids and skin tags if required. It can be done as a one, two or three site excision, but it does require healthy skin and tissue to be left as a bridge between excision sites to prevent stenosis of anus. Surgeon may use energy devices like diathermy or Ligasure to decreases the risk of bleeding.

It is likely the most successful operation in terms of symptom resolution, and recurrence rates, but it is the more invasive and more painful of the all options for haemorrhoid treatment.

What are the complication of open haemorrhoidectomy?

The most common problem after open haemorrhoidectomy is pain. Your surgeon will prescribe you a combination of simple and some strong pain killer to help with your pain. Sitz bath, stool softener and avoiding straining will also help to minimise your pain.

The haemorrhoidal area is very vascular are and there is a small risk of bleeding after surgery. It can happen within few hours or few days. Most bleeding still settles with observation only, some cases may need another procedure to control bleeding.

The major complications like anal stenosis or incontinence of bowels are extremely rare with experienced surgeon.

How do I manage after open haemorrhoidectomy ?

You should take medications including pain killers and antibiotics as informed by your surgeon. Avoid pain killers that can cause constipation like Codeine and opioids. Avoid constipation or straining during toilet. Take stool softener like Metamucil or Movicol as prescribed and drink plenty of water. Doing regular sitz baths ( Sit in the 8 to 10 centimetres of warm water ) for 15 to 20 minutes 3 times a day and after bowel movements. Pat the area dry and cover with a simple pad. It will help to improve your pain and keep the wound clean.

Small amount of bleeding or mucus discharge from the wound is expected for few days after surgery. Seek immediate help if there is significant pain or significant bleeding.

Some patients may have some leakage of soft or liquid stools but this is temporary and will be improved with doing Kegel exercises.