Excisional Hemorrhoidectomy

The definitive operation for large or prolapsing hemorrhoids — it is the most effective option we have, and we'll be straight with you: the first two to four weeks of recovery are genuinely sore.

Request a consultationSurgery is arranged with a coordinator by phone.

Setting: Operative
Anesthesia: General or spinal anesthesia in the operating room, typically as a same-day procedure
Back to work: Most people take 1 to 2 weeks off work, and the area can ache for 2 to 4 weeks
Pain relief: A multimodal plan — warm sitz baths, stool softeners, anti-inflammatories, and topical medication — with narcotics kept to a minimum
Success rate: Greater than 95%
Recurrence: Less than 5%

What it is

What is an Excisional Hemorrhoidectomy?

Excisional hemorrhoidectomy is the surgical removal of hemorrhoidal tissue and is considered the most effective treatment for advanced hemorrhoidal disease. It is the gold standard against which all other treatments are compared. The procedure involves the careful dissection and removal of the enlarged and symptomatic hemorrhoidal cushions. It can be performed using an 'open' (Milligan-Morgan) or 'closed' (Ferguson) technique. In the closed technique, the mucosal and skin incisions are sutured closed after the hemorrhoid is removed, which is thought to promote faster healing. In the open technique, the wounds are left open to heal by secondary intention, which may reduce the risk of infection. Both techniques are highly effective and the choice often depends on surgeon preference and training.

Am I a candidate?

Who is a Good Candidate for Hemorrhoidectomy?

Excisional hemorrhoidectomy is typically reserved for patients with symptomatic Grade III and IV internal hemorrhoids, large or bulky external hemorrhoids, or mixed internal/external hemorrhoids that have failed conservative management and office-based procedures. It is also the treatment of choice for patients with recurrent hemorrhoids after other procedures or for those with strangulated, incarcerated hemorrhoids. Patients with significant symptoms such as persistent bleeding, severe prolapse, or difficulty with hygiene are often ideal candidates.

How it's done

1You're asleep or numbed from the waist down — general or spinal anesthesia in the operating room.
2The enlarged hemorrhoid cushions are carefully removed through the anus, preserving the sphincter muscle beneath and healthy bridges of tissue between excision sites.
3Each wound is either closed with dissolvable stitches (the 'closed' technique) or left open to heal on its own (the 'open' technique) — both are standard and effective.
4Home the same day for most people, with the pain plan and stool-softening regimen already started.

What to expect

Same day
Home once you're comfortable. Soreness builds as the anesthetic wears off — take the pain plan seriously from the first dose, not after it hurts.
First week
Honestly, the hardest stretch. Bowel movements will hurt. Warm sitz baths several times a day, stool softeners, fiber, and fluids make a real difference.
1–2 weeks
Most people return to work — desk work sooner than physical work. A little bleeding with bowel movements is normal; heavier bleeding, which occasionally happens later in healing as tissue separates, needs a call to the office.
2–4 weeks
The ache steadily fades and most normal activities are back. Deep healing continues quietly for several more weeks after that.
Long term
The payoff for the tough recovery: of all hemorrhoid treatments, this one is the least likely to need repeating.

Risks & considerations

What are the Risks?

Excisional hemorrhoidectomy is a safe procedure, but it is associated with significant postoperative pain and has a risk profile that is higher than office-based treatments. Potential risks include:

Pain: This is the most common and significant issue. Postoperative pain can be severe for the first several days to a week and requires careful management with a multimodal pain regimen.
Bleeding: Minor bleeding with bowel movements is common. Delayed, significant bleeding can occur 7-14 days after surgery when the sutures dissolve or the eschar separates from the healing tissue, and may require a return to the operating room.
Urinary Retention: Difficulty urinating is a common short-term side effect after anorectal surgery, sometimes requiring a temporary catheter.
Infection or Abscess: The wound can become infected, though this is uncommon.
Anal Stenosis: A narrowing of the anal canal can occur if too much anoderm is removed, especially in a circumferential fashion. This is prevented by preserving adequate bridges of normal tissue between excision sites.
Fecal Incontinence: Minor difficulty controlling gas or slight soiling can occur, but significant permanent incontinence is rare if the sphincter muscles are not injured during the procedure.

Sources