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Hemorrhoid surgery is performed by cutting out the diseased rectal veins with a scalpel. Hemorrhoids may also be treated with an injection, of a solution that causes the vein to close off, or vigorous dilation of the anal canal. All of these procedures can be referred to as hemorrhoidectomies. A local anesthetic is used in most of the techniques. In situations, where surgery is more extensive, a general or spinal anesthetic may be given. The individual is usually placed in a kneeling position with head down and rear in the air across an operating table supplied with a bench for the knees, a position that significantly compromises one’s dignity but is otherwise not too uncomfortable. Many procedures need insertion of a speculum to hold the anal canal open so that the surgeon may see what he is doing; some doctors dilate the anal canal enough to extensively expose hidden hemorrhoids. In the rubber-band ligation procedure, each hemorrhoid is grasped with a special device that carries a rubber band on the tip. The most exposed part of the hemorrhoid is grasped and pulled into a channel in this instrument, which causes the rubber band on the tip of the instrument to pop free and snap around the stalk of the hemorrhoid, thereby cutting off its blood supply. The hemorrhoid quickly shrinks and dies, actually falling off within the next few days. Some doctors dress the area with medicated gause. In incisional (cutting) procedure, the skin is open, and the doctor lovates the vein, cuts it out and cauterizes any bleeding vessels. Depending on the amount of tissue removed and the relation of the remaining skin to the underlying mucous tissue of the rectum, skin flaps may be used for repair. The sphincter muscle can be also cut for reducing postoperative pain. In cryosurgery, the hemorrhoids are touched with a cryoprobe, which is usually cooled by liquid nitrogen. This procedure, which limits freezing to small areas is associated with decreasing postoperative pain. In a procedure involving sclerosing or hardening solution, the doctor finds the vein, injects it with a chemical which causes inflammation of the vein, producing scar tissue that replaces the soft tissue of the hemorrhoid. Laser treatment of hemorrhoids is still under study, but has shown considerable promise. In this procedure the laser beam coagulates and cuts, destroying the prolapsed veins and stopping bleeding at the same time. After any of these hemorrhoid surgeries, the individual is transferred to the hospital room or back home, depending on the severity, age, etc. All of these surgeries are performed by colon-rectal surgeons at a hospital. Only laser procedures may be done in outpatient departments of the hospital, and individuals may usually return home after the procedure immediately. After the hemorrhoid surgery, pain, need for enema, and urinary retention may occur in patients who have a type of hemorrhoid surgery known as closed ferguson – a special suturing technique, a way of sewing the tissue closed after a hemorrhoid has been removed. After laser treatment all of these complications become significantly reduced. The freezing of hemorrhoids and pain is about the same as with closed surgery. Freezing hemorrhoid surgery procedure in many cases produces a foul-smelling discharge as the frozen tissue decays. Urinary retention and painful defecation may occur after almost any incisional procedure. You should remember to maintain a high-fiber diet and take laxatives such as methylcellulose (Citrucel) or Metamucil (Psyllium seed) to treat hemorrhoids after the surgery.
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