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Grade III–IV hemorrhoids."},"contraindications":["Uncontrolled bleeding disorder or unmanageable therapeutic anticoagulation","Active anorectal sepsis or severe perianal infection (relative)","Severe uncontrolled cardiopulmonary disease making anesthesia unsafe","Active severe inflammatory bowel disease with anorectal involvement (relative)","Anorectal malignancy requiring different management","Pregnancy (relative; usually managed conservatively)","Poor baseline continence (relative precaution)"],"days_in_clinic":{"min":0,"max":1,"unit":"nights","qualifier":"Typically day surgery or one night of observation for conventional excisional hemorrhoidectomy."},"diagnostic_duration_minutes":null,"diagnostic_preparation":null,"diagnostic_referral_needed":null,"diagnostic_result_time_hours":null,"exercise_resume_weeks":{"min":2,"max":4,"unit":"weeks","qualifier":"Walking earlier; strenuous exercise and heavy lifting after 2–4 weeks."},"final_result_months":{"min":1,"max":2,"unit":"months","qualifier":"Complete wound healing and resolution of swelling after conventional hemorrhoidectomy."},"fly_home_after_days":{"min":7,"max":14,"unit":"days","qualifier":"Delayed bleeding peaks around days 5–14. Fly after the 7–14 day check, once sitting is comfortable."},"follow_up_visits":[{"purpose":"wound_check","requirement":"routine","after":{"min":7,"max":14,"unit":"days","qualifier":"First postoperative review, typically 1–2 weeks after surgery."}},{"purpose":"assessment","requirement":"routine","after":{"min":42,"max":60,"unit":"days","qualifier":"Final review of healing, bowel function and symptoms."}}],"indications":["Symptomatic grade III–IV internal hemorrhoids","Grade II hemorrhoids failing conservative or office-based treatment","Combined internal and external hemorrhoids with prolapse","Thrombosed or strangulated hemorrhoids in selected cases","Recurrent bleeding causing anemia"],"main_risks":["Significant postoperative pain","Urinary retention","Bleeding, including delayed bleeding","Infection or abscess","Constipation or fecal impaction","Anal stenosis","Temporary or permanent incontinence (flatus/stool/soiling)","Skin tags or recurrence","Anesthesia-related risks"],"pain":"Moderate to severe pain for the first several days, especially with bowel movements, gradually improving over 1–2 weeks; managed with multimodal analgesia, stool softeners and sitz baths.","preparation":["Surgical and anorectal assessment, sometimes colonoscopy by age and symptoms","Routine anesthesia assessment and blood tests as indicated","Review of medicines with the surgical team","Fasting before general anesthesia as instructed","Rectal enema or bowel preparation as advised","Arrange transport and adult support after discharge","Dietary fiber and stool softening plan"],"recovery_timeline":[{"phase":"First 48 hours","description":"Recovery from anesthesia, pain control, first bowel movement management, and monitoring for urinary retention and bleeding.","restrictions":["No driving","Avoid straining","Rest"]},{"phase":"Days 3–14","description":"Pain and discharge gradually decrease; sitz baths, fiber and stool softeners continue; light activity resumes and desk work often starts around day 7–14.","restrictions":["Avoid heavy lifting","Avoid prolonged sitting or straining"]},{"phase":"Weeks 2–4","description":"Most return to normal daily activity; mild bleeding or discharge may continue.","restrictions":["Avoid strenuous exercise until cleared"]},{"phase":"Weeks 4–8","description":"Wounds heal fully and bowel habits normalize.","restrictions":[]}],"rehabilitation_days":{"min":5,"max":14,"unit":"days","qualifier":"Time to ordinary activities. Median about 6 days in outpatient series; conventional surgery 1–2 weeks. Energy devices may shorten."},"result_longevity":"Excised hemorrhoids do not regrow, and long-term results are usually durable, though new hemorrhoidal disease can develop, particularly with constipation or straining.","revision_rate_pct":{"min":1,"max":5,"unit":"percent","qualifier":"Repeat surgery for recurrent prolapse, symptoms or stenosis, over about 1–5 years. Symptomatic recurrence is higher (about 5–20%), mostly non-surgical."},"scars":"Healing wounds at the anal canal and perianal skin leave minimal visible scars; small skin tags may remain.","sessions_or_stages":{"sessions":{"min":1,"max":1,"unit":"visits","qualifier":"Single operative session."},"stages":[{"code":"hemorrhoidectomy","label":"Excisional hemorrhoidectomy under anesthesia","after":{"min":0,"max":0,"unit":"days","qualifier":"Performed on the day of surgery."}}],"qualifier":"One operation; follow-up checks are not counted as treatment sessions."},"success":{"metric":"Resolution of bleeding and prolapse symptoms","value":90,"unit":"percent","horizon":"1 year","population":"Adults after excisional hemorrhoidectomy for grade III–IV hemorrhoids","evidence_status":"limited"},"techniques":[{"name":"Conventional excisional hemorrhoidectomy (Milligan-Morgan open / Ferguson closed)","suits_whom":"Grade III–IV or mixed internal-external hemorrhoids","recovery":"Most early pain; usually 1–2 weeks to ordinary activities"},{"name":"Vessel-sealing device hemorrhoidectomy (LigaSure/harmonic)","suits_whom":"Grade III–IV or mixed internal-external hemorrhoids","recovery":"Often slightly less early pain and shorter operating time"}],"treatment_conditions":["day_case"],"treatment_duration_hours":{"min":0.5,"max":1,"unit":"hours","qualifier":"Operating time for one conventional hemorrhoidectomy, excluding anesthesia and recovery."},"initial_assessment_documents":["Colonoscopy or sigmoidoscopy report","Proctology or colorectal clinic consultation notes","List of blood thinners","Recent blood test results","Previous anorectal surgery reports (if available)"],"travel_trips":{"min":1,"max":1,"one_trip_possible":true,"qualifier":"Single operation; stay about 7-14 days until wound check and safe flying. 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