Post-Surgery Swelling Concerns After Minimally Invasive Hemorrhoid Surgery

Postoperative swelling that does not subside after minimally invasive hemorrhoid surgery?

Dear Dr.
Chang,
I underwent a Legasure procedure 18 days ago to excise two external hemorrhoids and one mixed hemorrhoid (and possibly one or two internal hemorrhoids).
Post-surgery, I have been taking sitz baths twice daily and rinsing with warm water or using wet wipes after each bowel movement.
Starting from the fourth day post-operation, I noticed significant swelling and pain at the surgical site, particularly at the site of the mixed hemorrhoid, which seems to be larger than before the surgery.
The other two external hemorrhoids have also formed small round masses.
During my first follow-up appointment five days after the procedure, the doctor indicated that everything was normal.
However, as I approach the third week, the protruding swelling is causing me considerable concern.
I sent photos to my doctor, who acknowledged that the swelling is indeed significant and advised me to continue with warm baths and rest, noting that recovery time varies from person to person.
Dr.
Chang, is it normal or common for the swelling to be larger and more pronounced than the pre-operative hemorrhoids during the recovery period after a Legasure procedure? How long can I expect the recovery to take? Are there any oral or topical medications or methods that can help reduce the swelling and minimize the occurrence of excess skin? I have been feeling quite distressed due to the post-operative swelling and have been regretting the surgery.
Thank you for your patience in reading this! I sincerely look forward to your insights and recommendations!

CC, 40~49 year old female. Ask Date: 2022/03/05

Dr. Zhang Shuhao reply Surgery

In general, after a complete excision of internal and external hemorrhoids, there will be significant swelling at the surgical site.
The degree and duration of the swelling are related to the severity of the original hemorrhoids, and it is common for patients to experience swelling for four to six weeks postoperatively.
Continuous warm sitz baths along with anti-inflammatory medications are usually sufficient for management.
The use of Ligasure does not exacerbate the level of swelling.
During the surgery, to prevent postoperative anal stenosis, it is necessary to preserve some of the anal skin folds; however, whether or not excess skin develops varies from person to person.
Based on your description, this is considered a normal postoperative course.
The effectiveness of the surgery can only be accurately assessed after the swelling subsides.
If, in the following years, you are no longer troubled by hemorrhoid symptoms, then the surgery will have been worthwhile.
You can discuss your concerns with your surgeon, but there is no need to question the meaning of life.

Reply Date: 2022/03/05

More Info

After undergoing minimally invasive hemorrhoid surgery, such as the Legasure procedure, it is not uncommon for patients to experience swelling and discomfort in the surgical area. This response can be concerning, especially when the swelling appears more pronounced than the original hemorrhoids. Let's break down the situation and provide some insights into what you might expect during recovery, as well as some strategies to manage swelling and discomfort.

Understanding Post-Surgical Swelling
Swelling after surgery is a natural part of the healing process. When tissue is cut or manipulated, the body responds with inflammation, which can lead to swelling, redness, and pain. In your case, the fact that the swelling began on the fourth day post-surgery is consistent with the typical timeline for post-operative inflammation. It is important to note that the area around the surgical site may appear larger than before due to the body's healing response.

Duration of Swelling
The duration of swelling can vary significantly from person to person. Generally, you can expect the swelling to gradually decrease over the course of several weeks. For many patients, significant improvement is often seen within two to four weeks post-surgery. However, complete resolution of swelling and discomfort may take longer, especially if there were multiple hemorrhoids treated or if the surgery was more extensive.

Management Strategies
1. Sitz Baths: Continuing with sitz baths is highly recommended. Soaking in warm water can help soothe the area, reduce swelling, and promote healing. Aim for 15-20 minutes, several times a day, especially after bowel movements.

2. Pain Management: Over-the-counter pain relievers such as acetaminophen or ibuprofen can help manage discomfort. Always consult with your physician before taking any medication to ensure it is appropriate for your situation.

3. Topical Treatments: There are various topical treatments available that can help reduce inflammation and soothe the area. Creams containing hydrocortisone or witch hazel may provide relief. Again, consult your doctor before applying any topical medication.

4. Dietary Considerations: Maintaining a high-fiber diet and staying well-hydrated can help prevent constipation, which can exacerbate discomfort during recovery. Consider incorporating fruits, vegetables, and whole grains into your meals.

5. Rest and Activity: While it is important to stay active to promote circulation, avoid strenuous activities or heavy lifting that could strain the surgical site. Listen to your body and rest as needed.

When to Seek Further Medical Attention
If the swelling does not begin to improve after a few weeks, or if you experience increased pain, fever, or any signs of infection (such as pus or excessive redness), it is crucial to contact your healthcare provider. They may want to assess the surgical site to rule out any complications.

Conclusion
In summary, experiencing swelling after Legasure hemorrhoid surgery is a common occurrence and can be attributed to the body's natural healing process. While it can be distressing, following the recommended post-operative care, including sitz baths, pain management, and dietary adjustments, can help facilitate recovery. Remember, healing takes time, and it is essential to be patient with your body as it recovers. If you have any ongoing concerns or if the swelling does not improve, do not hesitate to reach out to your healthcare provider for further evaluation and guidance.

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