Hemorrhoidectomy: Complete Guide

Hemorrhoidectomy — surgical removal of hemorrhoidal tissue — remains the most effective, most definitive treatment for advanced hemorrhoidal disease, with the lowest long-term recurrence rate of any option covered on this site. It’s also, honestly, the most painful (see How painful is hemorrhoidectomy, honestly), which is why it’s reserved for cases that need this level of treatment.

Key takeaways

Hemorrhoidectomy involves surgically excising hemorrhoidal tissue, typically under spinal or general anesthesia.
It has the lowest recurrence rate among all hemorrhoid treatments, making it the standard for grade III–IV disease.
Recovery is more involved than any office procedure, typically taking a few weeks, with the most significant pain in the first several days.

What the procedure involves

Hemorrhoidectomy involves surgically excising the hemorrhoidal tissue directly, typically performed under spinal or general anesthesia in an operating room or ambulatory surgical setting (rather than an in-office procedure). The two most common techniques — Milligan-Morgan (open) and Ferguson (closed) — differ mainly in whether the surgical wound is left open to heal or stitched closed; see Milligan-Morgan vs. Ferguson technique for the specific comparison.

Why it’s the most effective option

Because the tissue is physically removed rather than shrunk, scarred, or repositioned (as with office procedures), hemorrhoidectomy has the lowest recurrence rate of any treatment covered on this site — this is the primary reason it remains the standard for grade III–IV hemorrhoids and cases that haven’t responded to less invasive options, despite its more difficult recovery.

What to expect around the procedure

Anesthesia: spinal or general, discussed with your surgical team beforehand (see Anaesthesia options)
Setting: typically a same-day (outpatient) surgical procedure, though some cases may involve a short hospital stay
Duration: the procedure itself typically takes well under an hour, though total time at the facility (including anesthesia recovery) is longer

Recovery, honestly

This is the area where hemorrhoidectomy differs most from office procedures — pain in the days following surgery is significant for most patients, generally described as the most difficult part of the entire process, and is covered in detail in its own dedicated page given how central it is to deciding on and preparing for this surgery. Full recovery, including return to normal activity without discomfort, typically takes a few weeks, considerably longer than the day or two typical after most office procedures.

Success rates

Multiple studies report recovery/symptom resolution rates above 90–95% for hemorrhoidectomy, among the highest of any treatment option covered on this site — reflecting its status as the most definitive treatment available, at the cost of the more significant recovery described above.

Common complications

Significant post-operative pain (the most commonly reported issue — see the dedicated page on this)
Urinary retention, particularly in the immediate post-operative period
Bleeding
Anal stenosis (narrowing) — a longer-term risk, more associated with more extensive or circumferential procedures
Fecal incontinence — uncommon but possible, particularly with certain more extensive techniques

How this compares to less invasive options

Compared to stapled hemorrhoidopexy and other less invasive surgical alternatives, traditional excisional hemorrhoidectomy generally involves more pain but a lower recurrence rate — see Comparing surgical options for the fuller picture.

Want the honest, specific answer on pain before deciding? See How painful is hemorrhoidectomy, honestly.

This page is for general education. Whether hemorrhoidectomy, and which specific technique, is right for you is a decision made with your colorectal surgeon.