Hemorrhoid Surgical Removal

Hemorrhoids, commonly referred to as piles, are dilated and inflamed vascular structures in the rectal and anal region. They occur when the veins in the lower rectum or anus become engorged with blood, often leading to swelling, irritation, and discomfort. While hemorrhoids are a normal part of the anal canal’s anatomy, their enlargement and inflammation can cause pain, bleeding, itching, and difficulties during bowel movements. The condition is prevalent across all age groups, with varying degrees of severity, ranging from mild, self-resolving cases to chronic, symptomatic hemorrhoids that require medical intervention.

Although many hemorrhoidal cases respond well to lifestyle modifications, pharmacological management, and non-invasive treatments, some individuals experience persistent or severe symptoms that significantly impact their daily lives. In such cases, surgical intervention may be necessary to remove or reduce the swollen vascular tissue, restoring normal function and alleviating discomfort. Hemorrhoids may present as internal, external, or mixed variations, each influencing the degree of symptoms and treatment approach.

Given the vascular nature of hemorrhoids, their progression is often influenced by increased intra-abdominal pressure, altered venous circulation, and prolonged straining. In some cases, complications such as thrombosis, prolapse, or chronic inflammation may develop, making it essential to assess and manage the condition appropriately. Surgical removal or minimally invasive interventions can provide long-term relief for individuals who do not respond to conservative measures, improving their quality of life and overall colorectal health.

Why Cuba

In Cuba, hemorrhoidectomy procedures are carried out with precision and expertise by skilled surgeons who focus on patient safety, symptom relief, and long-term outcomes. Renowned for its high-quality medical care, Cuba offers thorough preoperative evaluations, cutting-edge surgical techniques, and attentive post-operative management to promote a smooth recovery and reduce the risk of complications. Surgeons adopt an individualized approach, selecting the most effective and minimally invasive techniques whenever possible to ensure optimal comfort, reduced post-surgical discomfort, and faster healing for patients undergoing hemorrhoids removal.

Causes of Hemorrhoids

Hemorrhoids develop when there is increased pressure on the veins in the rectal and anal area, causing them to enlarge and become engorged with blood. Over time, this can lead to inflammation, clotting (thrombosis), and protrusion, resulting in painful symptoms.

Several factors contribute to the development of hemorrhoids, including:

• Chronic Constipation or Straining: Increased pressure during bowel movements can cause veins to swell.
• Prolonged Sitting or Sedentary Lifestyle: Sitting for extended periods can restrict blood flow to the rectal area.
• Pregnancy and Childbirth: Increased abdominal pressure during pregnancy can lead to hemorrhoidal enlargement.
• Obesity: Excess weight places additional pressure on rectal veins.
• Low-Fiber Diet: Insufficient dietary fiber can lead to hard stools and straining.
• Heavy Lifting: Frequent heavy lifting increases intra-abdominal pressure, contributing to hemorrhoid formation.

Types and Classification of Hemorrhoids

Hemorrhoids are classified based on their location and severity:

Internal Hemorrhoids (Located Inside the Rectum)

• Usually painless but may cause bleeding during bowel movements.
• May prolapse (bulge out of the anus) if they become large.

External Hemorrhoids (Located Under the Skin Around the Anus)

• Painful, swollen, and tender, often accompanied by itching.
• Can form blood clots (thrombosed hemorrhoids), causing severe pain.

Mixed Hemorrhoids (Combination of Internal and External)

• Present both inside and outside the anal canal, requiring comprehensive treatment.

Symptoms of Hemorrhoids

Hemorrhoidal symptoms vary depending on type and severity, but common signs include:

• Bright red bleeding after bowel movements.
• Itching, irritation, or burning in the anal region.
• Swelling or lumps near the anus.
• Pain or discomfort, especially while sitting or passing stool.
• Mucous discharge from the anus.

While mild cases may improve with lifestyle changes, severe or persistent symptoms may require surgical removal.

Pre-Surgical Diagnosis and Evaluation

Before recommending surgery, a thorough assessment is conducted, including:

• Physical Examination: Evaluates external hemorrhoids, perianal swelling, and signs of irritation or infection. The surrounding skin, anal sphincter tone, and potential fissures or fistulas are also assessed to rule out other anorectal conditions.

• Digital Rectal Examination (DRE): Checks for internal hemorrhoids, tenderness, unusual masses, or signs of rectal prolapse. This exam also helps assess sphincter strength and potential abnormalities in rectal tone, which may indicate underlying conditions such as rectal prolapse or chronic constipation.

• Anoscopy / Proctoscopy: Uses a small, lighted scope to inspect internal hemorrhoids, inflammation, and possible rectal polyps. This procedure provides a clearer view of the anal canal and lower rectum, helping determine the size, location, and severity of internal hemorrhoids.

• Colonoscopy (if necessary): Rules out other digestive conditions such as colorectal cancer, inflammatory bowel disease (IBD), or diverticular disease in patients with persistent rectal bleeding or a history of gastrointestinal disorders. It also helps identify other potential causes of symptoms, such as polyps or vascular malformations, that may require additional treatment.

These tests help confirm the diagnosis and determine the severity of the condition, guiding the choice of surgical procedure.

Surgical Options for Hemorrhoids

A hemorrhoidectomy is recommended for patients who:

Have large, persistent, or prolapsed hemorrhoids that do not respond to non-surgical treatments.

• Experience chronic pain, discomfort, or significant bleeding.
• Have thrombosed hemorrhoids (painful blood clots).
• Struggle with recurring hemorrhoidal issues despite conservative management.

Several surgical techniques are available for hemorrhoid removal, ranging from traditional surgery to minimally invasive methods:

Conventional Hemorrhoidectomy (Traditional Surgical Excision)

• This method involves surgically removing hemorrhoidal tissue using a scalpel, electrocautery, or laser. The incision is then sutured closed or left open to heal naturally, depending on the technique used.

• Considered a traditional open surgical procedure, it involves direct excision of affected veins and may require local, regional, or general anesthesia.

• This procedure is recommended for individuals with large, severe, or recurrent hemorrhoids that have not responded to non-surgical treatments. It is particularly effective for advanced prolapsed or thrombosed hemorrhoids.

Stapled Hemorrhoidectomy (Minimally Invasive Procedure)

• This method utilizes a circular stapling device to remove excess hemorrhoidal tissue and reposition prolapsed hemorrhoids back into their normal anatomical position. It also disrupts the blood supply to hemorrhoidal tissue, causing it to shrink over time.

• This is a less invasive alternative to conventional surgery, with reduced post-operative pain and a shorter hospital stay.

• It is typically performed for patients with prolapsed internal hemorrhoids, particularly grades II to IV, where the hemorrhoids extend beyond the anal canal.

Laser Hemorrhoidectomy (Advanced Minimally Invasive Technique)

• This procedure uses a focused laser beam to shrink and seal off hemorrhoidal tissue, causing it to gradually regress and disappear. The laser also cauterizes blood vessels, reducing bleeding and the risk of infection.

• This is a minimally invasive approach with no incisions, making it less traumatic to surrounding tissues compared to traditional surgery.

• The procedure is particularly effective for smaller to moderate internal and external hemorrhoids.