What Happens During a Hemorrhoidectomy? A Step by Step Look

During a hemorrhoidectomy, you're put to sleep or numbed, and a surgeon cuts away the hemorrhoid tissue, closes off the blood vessel that feeds it, and then stitches the wound shut or leaves it open. It's the most complete form of hemorrhoid treatment, and it's usually done in an operating room at a hospital or an outpatient center.

Maybe you've done the creams, the fiber, the warm soaks. Maybe you've had a band or two in the office. Now there's a date on the calendar, and you want to know what really goes on while you're out. That's fair. Knowing the steps takes a lot of the fear out of it.

Surgery isn't the first step for most people. A review in American Family Physician explains that removing hemorrhoids is kept for advanced grade III or IV hemorrhoids, for ones that keep coming back, and for ones that cause a lot of trouble. Smaller ones usually do fine with simpler care.

What happens during a hemorrhoidectomy, step by step

Every surgeon has their own routine, but the day usually goes like this:

1. You check in, change into a gown, and meet the anesthesia team.
2. You get your anesthesia. You're asleep, sedated, or numb from the waist down.
3. Many surgeons also inject a numbing medicine around the area. It keeps working for a while after you wake up.
4. The surgeon looks at each hemorrhoid and decides how much tissue to take.
5. A small cut is made around the hemorrhoid. The blood vessel inside is tied or sealed so it won't bleed.
6. The hemorrhoid is removed. The surgeon tries to leave strips of normal skin between each cut.
7. The wound is closed with stitches that dissolve, or left open. A soft dressing goes on top.
8. You wake up in a recovery room. Many people go home the same day, with someone else driving.

That's it. You won't see or feel the operation itself. The hard part, for most people, comes in the days after.

Surgical procedure for hemorrhoids

"Hemorrhoid surgery" isn't one single operation. It's a family of them. Dr. Gary Hoffman, a colon and rectal surgeon in Los Angeles, reminds patients in a short video that "Hemorrhoids are present from birth and they cushion anything that goes out of the anal canal." They become a problem when they swell, bleed or fall out. Past office care, he says, "then there's surgery, and there are all kinds of different operations."

The main ones are the classic cut out operation, stapling, and tying off the arteries that feed the hemorrhoid. A 2019 review from Cleveland Clinic says surgery is the most effective choice for advanced internal hemorrhoids, and that cutting them out has the lowest return rate of any approach. It also causes more pain than the others.

Before the operation: getting ready

Hemorrhoidectomy preparation

Getting ready starts a week or two before. Your surgeon goes over your health, your medicines and the plan. If you take a blood thinner, the Cleveland Clinic review notes that doctors often have patients stop it about a week before. Only stop it if your doctor tells you to. You'll get clear rules about when to stop eating and drinking. Some surgeons also want your bowel empty, so you may use an enema at home or on arrival. Set up your home before you go: soft food in the fridge, a ride, and a few days off.

Hemorrhoidectomy anesthesia

You won't be awake and feeling things. The American Society of Colon and Rectal Surgeons says a hemorrhoidectomy may be done under sedation, general anesthesia, or a spinal block. Sedation means you sleep lightly and breathe on your own. General anesthesia puts you fully to sleep. A spinal block numbs you from the waist down. A review in American Family Physician adds that local numbing shots around the area have greatly cut the pain people feel after surgery. Ask your team which one you'll get, and why.

Hemorrhoidectomy surgery position

This is the part people feel shy about, so here's the plain answer. You're placed so the surgeon can see the area well. Some surgeons have you lie face down with your hips raised a little on the table. Others have you lie on your back with your legs held up in padded supports. Sometimes you lie on your side. The choice depends on the surgeon and on where your hemorrhoids are. You're already asleep or numb by then, and you're covered except for the small area being worked on.

How long is hemorrhoid surgery

The operation itself is usually the shortest part of your day. Check in, anesthesia and time in the recovery room take longer. How long the surgeon works depends on how many hemorrhoids come out, how large they are, and the tool used. One review in American Family Physician found that a heat sealing device cut operating time by about nine minutes on average compared with the classic method. Your surgeon can give you a time for your own case.

The techniques surgeons use

Ferguson hemorrhoidectomy technique

The Ferguson technique is the classic closed operation. The surgeon cuts out the hemorrhoid, seals the vessel, then sews the edges of the wound back together with stitches that dissolve on their own. In the United States, this is the usual way it's done. American Family Physician notes that hemorrhoids are mostly removed through a closed hemorrhoidectomy here. The goal is a smaller wound on the outside, and less raw tissue for stool to pass over in the first weeks.

Closed hemorrhoidectomy

A closed hemorrhoidectomy simply means the wound is sewn shut at the end. The Ferguson method is the best known version. Closing the wound isn't always possible. If the area is very swollen, or the cuts are wide, the surgeon may leave part of it open. A systematic review cited by Cleveland Clinic found that the closed technique gave less pain after surgery, better wound closure and less bleeding than the open one.

Closed vs open hemorrhoidectomy

In an open hemorrhoidectomy, often called the Milligan Morgan method, the wound is left open to close by itself from the inside out. Here's how the two compare in the Cleveland Clinic review:

Your surgeon picks the method that fits your anatomy and their experience.

Stapled hemorrhoidectomy

The stapled operation works differently. Nothing is cut from the outside. The surgeon uses a round stapling tool inside the anal canal. It removes a ring of lining above the hemorrhoids and staples the edges together, which pulls the hemorrhoids back up where they belong. The Cleveland Clinic review says pain is lower than with the classic operation. But American Family Physician reports that hemorrhoids and prolapse come back more often after stapling. So it trades an easier first week for a higher chance of a second round later.

Hemorrhoidectomy with PPH

PPH stands for "procedure for prolapse and hemorrhoids." It's another name for the stapled operation. American Family Physician points out that the name is a bit misleading, because the tissue removed isn't the hemorrhoid itself. It's the lining just above it. The Cleveland Clinic review adds that PPH is not an option for external hemorrhoids or for internal ones with a clot. It also has a few complications of its own, like narrowing of the canal or injury to the muscle, which your surgeon should explain before you agree.

Procedures for internal hemorrhoids, and gentler options

Internal hemorrhoids procedure

Internal hemorrhoids sit above the opening, where there are few pain nerves. That's why many can be handled in the office with a band, a shot or heat, often with little pain. Surgery comes up when they fall out and stay out, or keep coming back. One option in between is tying off the small arteries that feed them, guided by a Doppler probe. The Cleveland Clinic review reports that after one year, they came back in 5.3% of grade II cases and 13% of grade III cases. After five years, it was 12% and 31%.

Non invasive hemorrhoid surgery

"Non invasive surgery" isn't really a thing. Surgery means an operation. What people usually mean is an office procedure, like rubber band ligation, a shot that makes the hemorrhoid scar down, or infrared heat. A 2025 summary of the newest surgeons' guideline in American Family Physician says these office procedures are preferred over surgery when they fit, because they give similar benefits with fewer complications. They work best for smaller internal hemorrhoids. Large ones that keep falling out usually need more.

Who does the operation

Who performs hemorrhoidectomy

The NIH says a hemorrhoidectomy is done by a doctor, most often a surgeon. That can be a general surgeon or a colon and rectal surgeon. The American Society of Colon and Rectal Surgeons explains that board certified colon and rectal surgeons finish training in general surgery and then extra training in colon and rectal surgery, and they pass exams from two national boards. It's fair to ask how often your surgeon does this operation and which method they prefer.

What doctor treats hemorrhoids

Most people start with their primary care doctor. That doctor can look, ask the right questions, and suggest home care first. If that's not enough, you may see a gastroenterologist, a digestive doctor who can do a scope and some office procedures. For surgery, you'll see a general surgeon or a colon and rectal surgeon. If you have rectal bleeding, start with your doctor in any case. Bleeding can come from other causes, and you shouldn't guess.

What surgery changes, and what it leaves to you

Right after surgery, expect pain, some spotting and a strange feeling of fullness. The recovery from a hemorrhoidectomy has its own page. Whether surgery is worth it for you, and what it costs, is a talk to have with your surgeon.

Here's the part people don't hear much. The American Society of Colon and Rectal Surgeons says that after a hemorrhoidectomy, it's uncommon to have any significant recurrence. That's good news. But the operation removes the hemorrhoids that were causing trouble. It doesn't remove the habits that pushed on them. Hard stools, long sits on the toilet and straining still land on the tissue that's left.

That's why surgeons send you home with the same basics: fiber, plenty of water, short bathroom visits and regular walks. They protect your wounds now, and they take pressure off the area for the years after. The decision to operate, and which method, stays between you and your surgeon.

Sources

• Cengiz and Gorgun, Cleveland Clinic Journal of Medicine, 2019, Hemorrhoids: A range of treatments
• Mott and colleagues, American Family Physician, 2018, Hemorrhoids: Diagnosis and Treatment Options
• American Family Physician, 2025, summary of the ASCRS guideline on hemorrhoids
• American Society of Colon and Rectal Surgeons, Hemorrhoids expanded information
• NIDDK (NIH), Treatment of hemorrhoids
• LAColonRectal, How Long Do Hemorrhoids Last? (YouTube)

This article is for general information and is not medical advice. If you have rectal bleeding, severe pain or a change in your bowel habits, see your doctor.

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