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Internal HemorrhoidAka: Hemorrhoidectomy, Anopexy

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  1. See Also
    1. Hemorrhoid
    2. Hemorrhoid Management
    3. External Hemorrhoid
  2. Definition
    1. Dilation of anorectal vessels above Dentate Line
  3. Symptoms
    1. Painless rectal bleeding
    2. Incomplete Defecation
    3. Prolapsed rectal mass
      1. Early: Prolapses with straining and then retracts
      2. Later: Prolapses with coughing, sneezing, lifting
        1. Chronic mucus discharge with excessive wetness
        2. Local anal irritation and soils clothes
      3. Irreducible, incarcerated prolapsed Hemorrhoid
  4. Signs: With Anoscopy
    1. Anorectal mass above Dentate Line
      1. Rectal mucosa bulging with reddish-purple mass
    2. Locations
      1. Right Anterior
      2. Right Posterior
      3. Left Lateral
  5. Complications
    1. Iron Deficiency Anemia (from heavy bleeding)
    2. Incarcerated prolapsed Hemorrhoid
  6. Grading of Internal Hemorrhoid
    1. Grade I
      1. Present without prolapse
      2. Usually asymptomatic
    2. Grade II
      1. Some prolapse with spontaneous regression
    3. Grade III
      1. Prolapse with manual replacement
    4. Grade IV
      1. Prolapse with inability to replace Hemorrhoid
  7. Management
    1. Older Techniques
      1. Surgical Excision
        1. Absence from work for up to 4-6 weeks
      2. Sclerotherapy
        1. Used in Europe but not in United States
      3. Cryosurgery
        1. Rectal discharge
    2. Newer Techniques
      1. Infrared Coagulation (IRC)
      2. Bipolar Electrocoagulation (BICAP)
        1. Indicated for Grades I to III Internal Hemorrhoids
        2. Radiofrequency ablation
          1. Apply to Hemorrhoid for 2 seconds
          2. Apply several places along Hemorrhoid
      3. Rubber Band ligation (Baron Ligation)
        1. Indicated for Grades I to IV Internal Hemorrhoid
      4. Low-Voltage direct current (Ultroid)
        1. Indicated for Grades I to IV Internal Hemorrhoid
      5. Stapled Hemorrhoidectomy (Stapled Anopexy)
        1. Common procedure in Europe
        2. High rate of persistent complications (30%)
          1. Pain post-Defecation
          2. Fecal urgency
  8. References
    1. Schrock in Feldman (1998) Sleisenger GI, p. 1964-7
    2. Cheetham (2000) Lancet 356:730
    3. Hulme-Moir (2001) Gastroenterol Clin North Am 30:183
    4. Hussain (1999) Prim Care 26(1):35

Excision of hemorrhoid NOS (C0019108)

ConceptsTherapeutic or Preventive Procedure (T061)
ICD949.46, 49.46
EnglishExcision of hemorrhoids, Excision of pile, Haemorrhoidectomy, HEMORRHOIDECTOMY
Spanishhemorroidectomia
Parent ConceptsHemorrhoid operation (C0176866), Excision of hemorrhoid NOS (C0019108), Excision of vein (C0191017), Large intestine excision (C0192834), Excision of pelvic tissue (C0198703), Duplicate concept (C1274013)
SourcesCOSTAR, ICD9CM, MTHICD9, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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