Evidence-Based Interventions: haemorrhoid surgery

Evidence-Based Interventions: Haemorrhoid Surgery

Understanding Haemorrhoids

Haemorrhoids, also known as piles, are swollen veins in the lower rectum and anus, causing discomfort, pain, itching, and occasional bleeding. They can be classified as internal or external based on their location. While haemorrhoids are a common condition, affecting about 1 in 4 people in the United Kingdom at some point in their lives, they often require medical attention when home treatments prove ineffective.

When is Haemorrhoid Surgery Necessary?

Haemorrhoid surgery is considered when conservative treatments such as lifestyle changes, topical medications, and non-surgical interventions fail to provide relief. Indications for surgical intervention include chronic pain, significant bleeding, and prolapse of haemorrhoidal tissue. A comprehensive assessment by a healthcare professional is essential for determining the suitability of surgical intervention.

Types of Haemorrhoid Surgery

Several surgical options exist for treating haemorrhoids. The main evidence-based interventions include:

Haemorrhoidectomy

Haemorrhoidectomy is the surgical removal of haemorrhoids and is considered the most effective treatment for large, severe or recurrent haemorrhoids. There are two main types: open haemorrhoidectomy where wounds are left open to heal naturally, and closed haemorrhoidectomy where wounds are stitched closed. This procedure provides long-term relief but involves a longer recovery period and more postoperative pain management.

Stapled Haemorrhoidopexy

Stapled haemorrhoidopexy, also known as stapling, is a less painful alternative to traditional haemorrhoidectomy. It involves using a circular stapling device to reposition the haemorrhoidal tissue and cut off the blood supply, leading to shrinkage. This technique is associated with a quicker recovery period and less postoperative discomfort but may carry a higher risk of haemorrhoid recurrence.

Haemorrhoidal Artery Ligation (HAL)

HAL, also known as Doppler-guided haemorrhoidal artery ligation, involves locating and tying off the arteries supplying blood to the haemorrhoids using a Doppler ultrasound probe. This minimally invasive procedure reduces blood flow to the haemorrhoids, causing them to shrink. HAL is associated with less postoperative pain and quick recovery, making it a preferred option for some patients.

Postoperative Care and Recovery

Postoperative care following haemorrhoid surgery is crucial for ensuring a successful recovery. This includes pain management, maintaining a high-fibre diet, staying hydrated, and following proper hygiene practices to minimise infection risk. Patients should expect a recovery period of several weeks before returning to normal activities. Regular follow-up appointments with a healthcare provider are essential to monitor healing and manage any complications.

Conclusion

Haemorrhoid surgery is an effective intervention for managing severe or persistent haemorrhoids. With various evidence-based surgical options available, it is important to consult with a specialist to determine the most appropriate treatment based on individual circumstances. By understanding the different types of haemorrhoid surgery and postoperative care requirements, patients in the United Kingdom can make informed decisions for optimal health outcomes.