the Drawbacks of Circular Hemorrhoidectomy Surgery

What are the disadvantages of hemorrhoidectomy?

Hello, Dr.
Ke.
I would like to inquire about the circular excision surgery for hemorrhoids.
It seems that many hospitals are adopting this surgical method to serve patients, and various reports mention numerous benefits of such procedures.
However, it appears that Keelung Municipal Hospital has not yet introduced this surgery.
If I may ask, aside from the benefits mentioned in the reports regarding this surgery, are there any drawbacks to this procedure? This is a question from a patient who needs surgery for hemorrhoids.

Xiao Wu, 40~49 year old female. Ask Date: 2008/05/25

Dr. Ke Fangxu reply Surgery

Dear Xiao Wu,
Actually, our hospital has previously performed a circular excision procedure, and there were no technical issues in its execution.
The reason for not proceeding with this surgery involves other considerations.
There is already a lot of information online regarding its benefits, so I will only address my personal views:
1.
This type of surgery does not actually remove the hemorrhoids; it merely interrupts the blood supply to the hemorrhoidal tissue, leaving residual hemorrhoidal tissue postoperatively.
2.
Generally, the treatment effect may not be good for patients with large or severely prolapsed hemorrhoids.
3.
Medical associations and literature recommend this type of surgery for bleeding-type hemorrhoids; however, most bleeding-type hemorrhoids can be improved with medication or outpatient treatments.
4.
The likelihood of complications is higher compared to traditional surgery, and if complications occur, they tend to be more severe and more difficult to manage.
5.
The out-of-pocket cost ranges from 15,000 to 25,000 TWD, depending on the hospital.
6.
There is no consensus on whether recurrence is more likely.
Based on the above considerations, our hospital does not actively offer circular excision surgery for hemorrhoids.
I also urge you to think carefully before making a decision.
I want to emphasize that these are just my personal opinions and views, and I kindly ask vendors not to approach me for discussions.
Thank you!

Reply Date: 2008/05/25

More Info

Circular hemorrhoidectomy, also known as stapled hemorrhoidopexy, is a surgical procedure that aims to treat hemorrhoids by removing excess tissue and repositioning the remaining tissue. While this technique has gained popularity due to its minimally invasive nature and quicker recovery times compared to traditional hemorrhoidectomy, it is essential to understand the potential drawbacks associated with this procedure.

1. Risk of Complications: Like any surgical procedure, circular hemorrhoidectomy carries risks. Common complications include bleeding, infection, and pain. Some patients may experience severe pain postoperatively, which can be more pronounced than with traditional methods. Additionally, there is a risk of developing complications such as anal stenosis, which is a narrowing of the anal canal that can lead to difficulties with bowel movements.

2. Recurrence of Symptoms: While circular hemorrhoidectomy can provide relief from hemorrhoidal symptoms, there is a possibility of recurrence. Some studies suggest that the recurrence rate may be higher compared to traditional hemorrhoidectomy, particularly in patients with more severe hemorrhoidal disease. This can lead to the need for additional treatments or surgeries in the future.

3. Limited Applicability: This procedure may not be suitable for all patients. For instance, individuals with large external hemorrhoids or those with significant rectal prolapse may not be ideal candidates for circular hemorrhoidectomy. The decision to proceed with this surgery should be based on a thorough evaluation by a qualified healthcare provider.

4. Postoperative Care and Recovery: Although recovery times are generally shorter with circular hemorrhoidectomy, patients may still experience discomfort and require a period of adjustment. Postoperative care is crucial, including dietary modifications to ensure soft stools and prevent straining during bowel movements. Patients may also need to avoid heavy lifting and strenuous activities for a period following the surgery.

5. Potential for Fecal Incontinence: There is a risk, albeit low, of fecal incontinence following circular hemorrhoidectomy. This can occur if the procedure inadvertently affects the anal sphincter muscles. Patients should discuss this risk with their surgeon and consider it when weighing the benefits and drawbacks of the surgery.

6. Lack of Long-Term Data: While many studies have reported positive outcomes with circular hemorrhoidectomy, long-term data on its effectiveness and safety are still limited. Patients should be informed that the long-term success of this procedure is still being evaluated, and they should have realistic expectations regarding the outcomes.

In conclusion, while circular hemorrhoidectomy offers several advantages, including reduced postoperative pain and quicker recovery, it is essential to consider the potential drawbacks. Patients should engage in a thorough discussion with their healthcare provider to evaluate their specific condition, the severity of their hemorrhoids, and the most appropriate treatment options available. Understanding both the benefits and risks will empower patients to make informed decisions regarding their treatment for hemorrhoids.

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