Post-Surgery Complications: Anal Deformity and Perineal Issues After Hemorrhoidectomy

Post-hemorrhoidectomy anal deformity, with injury to the perineal area?

On July 3rd, I underwent a self-funded Thunderbeat minimally invasive surgery at Shin Kong Wu Ho-Su Memorial Hospital, where I had a complete excision of both internal and external hemorrhoids.
The procedure involved removing two external hemorrhoids, each about the size of half a thumb, located at the 12 o'clock and 6 o'clock positions.
After the surgery, I noticed that the perineum and anus were separated, with a wound underneath the perineum.
The perineum has split into three parts, and on the far left side, there is a piece of tissue that is almost falling off (approximately the size of one-third of a thumb).
The doctor mentioned that this is my own skin, and removing it could lead to anal stenosis.
Is this correct? I am concerned because that piece of tissue that is about to fall off and the split perineum can become contaminated with feces, requiring me to flip it open to clean it properly when washing.
This situation is quite troublesome for me at work.
Has the surgery already damaged my perineum and caused deformity of the anus? Is there a need for further reconstructive surgery? It has been about three weeks since the surgery, and I am experiencing only minimal bleeding and manageable pain.
Thank you for your response, doctor.

Miss Lin, 50~59 year old female. Ask Date: 2023/07/21

Dr. Zhang Shuhao reply Surgery

The appearance of the wound after external hemorrhoid surgery can be unpredictable, as it may change due to surrounding skin tension and scar tissue formation.
However, as long as the symptoms of hemorrhoids improve and there is no damage to the external anal sphincter, with no impact on anal function, the surgery can be considered successful.
If there are concerns regarding appearance or hygiene, it is advisable to wait until the wound has fully healed and stabilized before assessing the need for any corrective procedures.
Generally, evaluations can be conducted by either a colorectal surgeon or a plastic surgeon.

Reply Date: 2023/07/21

More Info

Post-surgery complications following a hemorrhoidectomy can indeed lead to various issues, including anal deformity and perineal problems. Your experience after the Thunderbeat minimally invasive surgery for hemorrhoids raises several important considerations regarding healing and potential complications.

Firstly, it is not uncommon for patients to experience changes in the anatomy of the perineal area and the anal region after surgery. The separation of the perineum and the anal area, as you described, could be a result of surgical trauma or healing processes. The presence of tissue that appears to be "almost falling off" could be a remnant of skin or subcutaneous tissue that was not fully excised during the procedure. This can happen if the surgeon aims to preserve as much healthy tissue as possible to prevent complications like anal stenosis (narrowing of the anal canal).

Your doctor's concern about cutting away that tissue to avoid anal stenosis is valid. The anal canal's integrity is crucial for proper bowel function, and any alteration can lead to complications such as incontinence or difficulty with bowel movements. However, if the tissue is at risk of becoming necrotic or infected due to exposure to fecal matter, it may need to be addressed.
In terms of hygiene, the difficulty you are experiencing with cleaning the area is significant. Proper hygiene is essential to prevent infections, especially in surgical sites. If the area is difficult to clean due to the anatomical changes, it may lead to further complications, including infections or abscess formation.
Given that you are three weeks post-surgery and experiencing only minor bleeding and manageable pain, it suggests that your healing process is progressing. However, the concerns you have about the appearance and functionality of the perineum and anal area should not be overlooked. If the tissue continues to cause issues or if you notice signs of infection (such as increased redness, swelling, or discharge), it is crucial to follow up with your surgeon or a colorectal specialist.

Regarding the need for further surgical intervention, such as a reconstructive procedure, this would depend on a thorough evaluation by a qualified healthcare provider. They would assess the extent of the deformity, the functionality of the anal canal, and any potential risks associated with additional surgery.
In summary, while some degree of anatomical change can occur after hemorrhoid surgery, persistent issues that affect hygiene and comfort warrant further evaluation. It is advisable to maintain open communication with your healthcare provider about your concerns and to seek a second opinion if necessary. They can provide guidance on whether further intervention is needed and help you navigate the recovery process effectively.

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