Types of Anorectal Surgical Treatment

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Hemorrhoidectomy

This is a low-risk surgery with excellent outcomes but it HURTS!!!! The entire external and internal column in one to two locations are removed. The area is usually stitched closed. The stitch(es) may come out early. This is completely normal and by design. The area will be VERY SWOLLEN for one month after surgery. You may have blood with your bowel movements. It is very improvement to avoid constipation.

Recovery: 2-3 weeks of severe pain followed by 2-3 weeks of moderate pain

THD Hemorrhoid Dearterialization / Hemorrhoid Ligation and Pexy

This is a low risk surgery with excellent outcomes but it is not a good option for patients with a lot of external hemorrhoids. The internal portion of all of the hemorrhoid blood vessels (up to 6) are sutured to cut off the blood flow to the hemorrhoid tissue only. Like hemorrhoidectomy the area can be SWOLLEN for up to one month after surgery. You may have blood with your bowel movements. It is very improvement to avoid constipation.

Recovery: usually up to 3-5 days of significant pain then minimal pain following this time period

Anal Skin Tag Excision or Fulguration

This is a low risk surgery that sometimes can be minimally painful and sometimes can be quite painful. It depends on how much tissue is removed. This is removal of only the external portion of the hemorrhoid(s). Sometimes the area is stitched close. The stitch(es) may come out early. This is completely normal and by design. The area will be VERY SWOLLEN for one month after surgery. You may have blood with your bowel movements. It is very improvement to avoid constipation.

Recovery: highly variable based on how much tissue is removed, can be from 5 days to 4 weeks of significant pain following surgery

Fistulotomy

A probe is placed through the entire length of the fistula tract and the entire tract is cut open. This is only done if the tract goes through a minimal amount of anal sphincter muscle. The success rate is high and complications are uncommon.

Recovery: 1-2 weeks of pain, can take up to 1-2 months to fully heal,

Seton Placement (non-cutting)

A small drain is placed into the fistula tract to help thicken the tissue and prevent skin closure. Preventing skin closure prevents an abscess from forming. This is typically only a long-term treatment for patients with inflammatory bowel disease (IBD). For most patients, this is step before the LIFT procedure.

Recovery: minimal unless combined with a fistulotomy (can be done for part of the tract that does not go through anal sphincter)

Ligation of the Intersphincteric Tract (LIFT)

This is done at least 6-8 weeks after a seton is placed. The fistula tract is located between the muscle and cut there, on the internal opening of the tract, and on the external opening of the tract. The goal is to divide little or no anal sphincter. The success rate is 60-70%. For those this is not successful in, the fistula tract the persists, is now treatable with fistulotomy.

Recovery: 1-2 weeks of pain, can take up to 1-2 months to fully heal,

Cutting Seton Placement

A suture or silicone drain is placed through the fistula tract. When the fistula tract only goes through a small part of the external anal sphincter only (there is an internal one as well), this can be used. The suture or drain is slowly tightened over weeks. This allows the body to heal as the tract is divided, allowing the sphincter muscle to maintain its function at the fistula is treated.

Recovery: each appointment when the drain or suture is tightened can have 1-2 days of pain following the procedure, the total time can be 1-2 months for full healing,

Botox

Botox in injected into the internal anal sphincter to allow the anal fissure to heal. The procedure is typically done with sedation to allow patients to relax enough for the external and internal anal sphincters to be palpated. This can be done in the office with premedication or in a surgery center. If a patient has incontinence, this can make it worse.

Recovery: usually minimal (injection sites only)

Endoanal Advancement Flap

This is for patients with anal fissures and incontinence issues. A piece of nearby tissue is dissected and brought over to cover the fissure then sutured in place.

Recovery: 2-3 weeks of moderate pain (can be severe at times) followed by 2-3 weeks of mild - moderate pain