Effective Surgical Options for Severe Hemorrhoids: A Guide for Patients in Taipei - Surgery

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When it comes to managing severe hemorrhoids, particularly in cases of prolapse and recurrence after previous treatments, there are several surgical options available that can be considered. Given your history of undergoing a hemorrhoid ligation procedure three years ago, it is understandable that you are seeking further intervention, especially since you are experiencing a recurrence of internal hemorrhoids and worsening external hemorrhoids.


Surgical Options for Severe Hemorrhoids
1. Hemorrhoidectomy: This is the most common surgical procedure for treating severe hemorrhoids, especially when they are large or recurrent. It involves the complete removal of the hemorrhoids and is typically performed under general anesthesia. While this procedure is effective, it can be associated with postoperative pain and a longer recovery time compared to other methods.

2. Stapled Hemorrhoidopexy: This technique involves using a stapling device to reposition the hemorrhoids back into their normal position in the anal canal and cut off their blood supply. This method is less painful than traditional hemorrhoidectomy and usually results in a quicker recovery. However, it may not be suitable for all patients, particularly those with significant external hemorrhoids.

3. Laser Hemorrhoidectomy: This is a newer technique that uses laser technology to remove hemorrhoids. It is less invasive and can result in less pain and quicker recovery times. However, it may not be widely available in all hospitals.

4. Doppler-guided Hemorrhoidal Artery Ligation (DG-HAL): This is a minimally invasive procedure that involves locating the arteries supplying blood to the hemorrhoids and ligating them. This can reduce the size of the hemorrhoids without the need for excision. It is associated with less pain and a quicker recovery.


Considerations for External Hemorrhoids
For external hemorrhoids, surgical intervention is not always necessary unless they are causing significant pain or complications, such as thrombosis. In many cases, conservative treatments such as dietary changes, topical medications, and sitz baths can provide relief. However, if the external hemorrhoids are large and symptomatic, surgical options such as excision may be warranted.


Postoperative Considerations
After any surgical procedure for hemorrhoids, patients may experience some common postoperative symptoms, including:
- Pain and Discomfort: This is often managed with pain medications.

- Bleeding: Some bleeding can occur, especially after bowel movements.

- Infection: As with any surgical procedure, there is a risk of infection.

- Recurrence: There is always a possibility of hemorrhoids returning after treatment, especially if lifestyle factors are not addressed.


Recommendations for Hospitals in Taipei
In Taipei, several reputable hospitals and clinics specialize in colorectal surgery and can provide effective treatment for severe hemorrhoids. Some of the well-known institutions include:
- National Taiwan University Hospital: Known for its comprehensive surgical services and experienced colorectal surgeons.

- Taipei Medical University Hospital: Offers a range of minimally invasive surgical options.

- Chang Gung Memorial Hospital: Renowned for its advanced surgical techniques and patient care.


Conclusion
It is essential to consult with a colorectal surgeon who can evaluate your specific condition and recommend the most appropriate surgical option based on the severity of your hemorrhoids and your overall health. They will also discuss the potential risks and benefits of each procedure, helping you make an informed decision. Additionally, addressing lifestyle factors such as diet, hydration, and bowel habits can significantly impact the management of hemorrhoids and prevent recurrence.