Surgical intervention - various types of hemorrhoidectomy
According to the classification of Russian proctologists, an acute and chronic form of hemorrhoids is possible. But in Europe and America, the disease is considered chronic, proceeding with periods of remission and exacerbations. Timely treatment of venous formations of the rectum with the help of conservative agents allows you to achieve good results and avoid surgery. Unfortunately, the late treatment of patients to the doctor reduces the likelihood of effective therapy. Hemorrhoid surgery remains the only way to eliminate severe symptoms. According to statistics, 20% of patients need it.
With the use of minimally invasive techniques, the need for classical surgical techniques has significantly decreased. Lost time creates negative conditions for getting rid of hemorrhoids. The severe course of the pathology, frequent exacerbations and complications remain indisputable indications.
The need for surgery for hemorrhoids
The doctor judges the need for surgical treatment after examining the patient, clarifying the signs, the frequency of exacerbations. The importance is attached to determining the type and stage of the disease, the presence of concomitant pathology, the main causes of the disease. The operation is indicated if it was not possible to compensate for violations in the hemorrhoids with the help of drugs, diet, regimen and exercise, in cases of ongoing relapse after minimally invasive methods.
III-IV stages of hemorrhoids occurring with bleeding, intense pain, prolapse of nodes, cracking and chronic anemia are the criteria for choosing a surgical approach. Complications such as paraproctitis, rectal prolapse, require mandatory intervention.
With an internal variety of pathology, an operation to remove hemorrhoids is indicated if the patient:
- severe bleeding is repeated, anemia is determined by a blood test,
- the nodes have reached considerable size, do not set in the intestine, are infringed by the sphincter,
- it is not possible to anesthetize the anus with conservative anti-inflammatory methods, the symptom causes suffering when walking, the pain does not go away at rest,
- the tightness of the anal sphincter is disrupted, and mucus, feces and gases are constantly released from the intestine,
- there is a high risk of complications (thrombosis, fissures, pinching of the node with the development of inflammation and necrosis), infection and spread to surrounding tissues.
In cases of the external form, surgical treatment of hemorrhoids is resorted to with the following:
- intense pain syndrome
- severe perianal tissue edema (around the anus),
- the large size of the nodes, the inability to walk and sit,
- formation of cracks in the rectal canal,
- risk of pinching, acute thrombosis, infection.
Cases of contraindications for surgery
Surgery is sometimes contraindicated in patients because of the high risk of complications. Such cases include:
- bleeding disorders
- exacerbations of chronic intestinal diseases of an inflammatory nature,
- secondary hemorrhoids arising from a malignant tumor, cirrhosis of the liver or decompensation of cardiac activity II-III degree,
- existing concomitant diseases with insufficiency of the liver, kidneys, respiratory system,
- a sharp decrease in immunity (AIDS, autoimmune diseases),
- state of pregnancy (surgery is postponed to the postpartum period).
It is difficult to choose the conditions to operate on a patient with diabetes, due to fluctuations in glucose levels and the risk of infection. Patients in old age preferably conservative therapy. If it is decided to treat a person surgically, he is carefully prepared, pre-hospitalized in a hospital. It is difficult to determine in advance how long preparation will last, since each organism reacts differently.
Description of the technique
Hemorrhoidectomy - what is it? Hemorrhoidectomy operation is radical removal of hypertrophic tissues, based on the ligation of blood vessels supplying nodes.
In specialized proctology clinics, this type of operation is currently in first place in terms of frequency of distribution. This is due to the fact that currently practiced minimally invasive techniques are not always effective and have not been studied much.
Wherein the methodology of hemorrhoidectomy is owned by most surgeons - coloproctologists. Experienced doctors are of the opinion that it is hemorrhoidectomy that gives guarantees of getting rid of the manifestations of the disease for the longest possible period.
The hemorrhoidectomy technique was developed in 1937 and subsequently improved by many professional surgeons. During the period of development of the operation technique, several of its varieties appeared.
The initial open view of the operation was supplemented in 1959 with closed hemorrhoidectomy, allowing it to be performed on an outpatient basis.
Hemorrhoidectomy is an operation aimed at the complete removal of existing hemorrhoidal nodes. Surgical intervention is performed under local epidural anesthesia, in rare cases under general anesthesia.
Tissues are excised along with the perineal skin above them. During the operation, the vessels are ligated, and the mucous tissues are fixed to the subject.
The total duration, depending on the structure of the anal passage of the patient and the stage of the disease, is 20-60 minutes. During the operation, the patient is placed on his back with legs fixed on special supports.
Sometimes the patient is placed on his stomach and the pelvis is raised. In this position, the outflow of venous blood is improved.
The doctor conducts a devulsion (expansion) of the anus and introduces an anoscope into itgreased with glycerin. This opens access to hemorrhoidal nodes.
There is no universal way to excise nodes, and in each case, the surgeon chooses a particular instrument or a combination of them. Wounds after excision are sutured or left open. The procedure ends with the installation of a tampon and a vent tube in the rectum.
With minimally invasive procedures:
Classical surgical treatments for hemorrhoids
Experienced proctologist surgeons avoid "radical" treatment, since the cause of the pathology cannot be removed operatively. We can talk about the most gentle and reliable way to remove nodes and cavernous formations, restore the functions of the anal sphincter. For this, classical operations have been developed and are effectively applied that have earned the approval of several generations of practicing surgeons.
The difference lies in the technique of the operational approach, the use of equipment, techniques for excising nodes and mucous membranes, and the length of the rehabilitation period.
Indications and contraindications for surgery
Before the appointment of the operation, the attending physician assesses the benefit of the surgical intervention and the estimated risks from its implementation.
Surgery is recommended in the following cases:
- advanced disease (hemorrhoids of the 3rd and 4th degree),
- knot loss
- anemia caused by bleeding
- unsuccessful conservative treatment of hemorrhoids,
- education in nodes of blood clots.
The operation should be abandoned under the following conditions:
- elderly age and reduced immunity of the patient,
- the presence of malignant tumors,
- inflammatory processes in the intestines,
- the presence of concomitant diseases (Crohn's disease, HIV, cirrhosis, heart and pulmonary insufficiency).
The most common method is hemorrhoidectomy according to Milligan and Morgan. Almost 100 years ago, British surgeons proposed the removal of hemorrhoids with plastic surgery of the rectal mucosa.
The volume of operation consists in the complete resection (excision) of the cavernous tissue of the rectal veins after ligation of three large vessels. Intervention is carried out under general anesthesia necessarily in the conditions of hospitalization in a surgical or specialized department of the hospital. Surgeons use 3 techniques:
- In a closed way, after removal of the nodes, the mucosa is sutured with catgut sutures, which allows the channel walls to be fixed. Some doctors use it on an outpatient basis.
- An open option is possible only in a hospital. The wound is left without suturing for self-healing. It is used for cracks, paraproctitis. The nodes and surrounding mucosa are removed. To stop bleeding, electrocoagulation is used.
- The use of plastics is called submucosal hemorrhoidectomy. It is more complicated in execution, therefore, it is characterized by its duration, but recovery continues faster.
Approaches have the same positive and negative sides. Benefits include:
- the ability to remove external and internal nodes,
- achieving a long period of remission,
- rare complications.
- significant duration of the operation,
- the need for anesthesia for pain relief,
- the need for a long hospital treatment period with dressings, local anesthetics, and a strict diet during the rehabilitation period.
Types of hemorrhoidectomy
Depending on the surgical technique there are 5 types of hemorrhoidectomy:
- stapler (Longo method),
- Parks method
- Internal binding (Subbotin's method).
In the sections below, we will talk about each of the operations separately.
The method proposed by the Italian surgeon Longo is also called "hemorrhoidopexy". It differs from classical hemorrhoidectomy in the absence of such a surgeon's action as cutting nodes. The essence of the operation is a circular incision of the mucous membrane and its resection over the pain zone (dentate line) and attachment to it with the help of special clips of the knots legs.
As a result, when the wound heals, a decrease in blood flow to the cavernous formations is achieved, pulling the reduced nodules up, their drying and scar formation (scar on the mucosa). Longo's operation is tolerated painlessly by the patient or requires only local anesthesia. Lasts 15-20 minutes. Five days are enough for rehabilitation.
The disadvantage is the high cost of disposable medical instruments (an apparatus like a stapler increases the cost of treatment), the ability to operate only internal nodes.
Minimally invasive therapy: indications for intervention in hemorrhoids
The introduction and improvement of minimally invasive therapy methods has led to a decrease in the need for classical surgical treatment. Technically, the methods occupy a middle position between conservative and operational. They are carried out by proctologists who have been trained to work with modern high-tech equipment.
- outpatient care
- low injuries
- lack of blood loss,
- short rehabilitation period.
- the inability to delete all nodes in one session (usually limited to 2-3 nodes),
- guaranteed risk of relapse if the patient does not comply with the requirements of the doctor.
Methods are contraindicated in the following:
- intestinal infection,
- intense inflammation of the nodes,
- exacerbation of concomitant pathology.
After treatment, the question of the appropriateness of use is considered.
It is important to consider a categorical contraindication - a tumor process in any organ.
Hardware techniques have the best effect, allowing you to adjust the focus and penetration depth. The main disadvantage is the effective use only in stage I-II of hemorrhoids. Rarely used to temporarily relieve running forms. Usually well tolerated by patients, but in the absence of compliance with the doctor’s recommendations for proper nutrition, prophylactic use of venotonics, periodic exacerbations are possible.
Recommended preparation consisting of bowel cleansing, diet. General anesthesia is not required, local anesthesia with lidocaine ointment is sufficient.
The classic hemorrhoidectomy is Morgan-Milligan surgery. During the application of this technique, it has undergone changes.
The essence of open hemorrhoidectomy according to Morgan-Milligan is to use it to remove not only external but internal nodes.
A feature of the operation is the complete excision of the nodes and its removal together with the mucous membrane.
The nodes after the operation remain open, and after that their natural healing takes place.
The method is traumaticTherefore, the operation is performed under general anesthesia in a hospital setting. You can familiarize yourself with the Morgan-Milligan operation in more detail by watching the video below:
The operation of deserterization involves dressing by flashing the main supply arterial branches of the rectum. Through them, blood enters the hemorrhoids. Insufficient blood supply leads to wrinkling and reduction of nodes. Then they are filled with fibrous tissue. The place of exposure can be moderately sick only in the first days.
The use of a laser beam is based on the ability to accurately focus and various effects on the tissue of the node:
- the implementation of excision of the legs while cauterizing and stopping bleeding,
- coagulation (coagulation) of the protein part of the node wall - an artificial burn,
- vaporization (evaporation) - the nodes are dehydrated and dried.
The laser coagulation method is well combined with sclerotherapy of the external cones. The clinic of hemorrhoids disappears as the nodes dry, rejection with feces and the restoration of the normal anal canal. To coagulate the proteins of the muscle wall of the nodes, coagulators of a different mechanism of action are used. In addition to the laser, the radio wave and infrared method are used.
Infrared or photocoagulation is caused by a beam of light waves of a certain spectrum. Exposure to thermal energy in a few seconds allows you to painlessly wrinkle the tissues of the nodes. Allowed use during pregnancy. How laser radiation helps to sterilize the site of radiation, so infectious complications very rarely occur.
Usually, one bump is removed per session, repeated procedures are appointed after 10-14 days.
Stapler (Longo method)
The method was developed in the 90s of the last century. Unlike classic operation in this case, the mucosa of the rectum and the vessels carrying blood to the nodes intersect.
In Russia, operations using this technique began to be applied only 5 years ago. Hemorrhoidal nodes falling out of the anus are clamped with a special stapler, excess sections of the mucosa are cut off.
Prolapse of the skin of the anus is reduced by the introduction of a dilator. An anoscope is inserted through it to control the imposition of a purse string suture.
With the help of an anoscope, the prolapsed mucous tissue is pushed into the anus. Anoscope rotates 270 degrees and a seam is applied along its course.
A circular stapler is placed next to the seam and the closing assembly is cut off.The thread is pulled out and a stapler is inserted into the anal canal. The suture is tightened, while the fallen mucosa falls on a circular stapler, which heats up.
When heated, a second row of staples is applied. With a circular knife, excess tissue is cut off through the top of the anus.
The advantages of the method are relative painlessness. The postoperative period after hemorrhoidectomy is much easier and faster than with classical surgery, so the average length of hospital stay is shorter.
In the same time there are certain risks and possible complications after hemorrhoidectomy:
- damage to the tissues of the rectum,
- stretching the internal muscles of the anus,
- pelvic sepsis
- the method is not effective for large knots, as the tissues may not fit in the stapler,
- with such an operation, it is impossible to dissect the veins that are located on the surface,
- due to insufficient experience in conducting such operations, long-term consequences cannot be predicted.
The video below shows the operation of the Longo method:
The method is based on the ability of certain substances to cause obliteration (internal bonding) of nodes. An injection into the formation introduces sclerosant drugs. They seal the cavity and blood vessels, contribute to the drying out and further removal of the node during bowel movements.
It is important to conduct a preliminary skin allergy test. Since the method of sclerotherapy is relatively ineffective, it is used in combination with coagulating methods. As the main one, it is used only in 10% of patients.
This operational method is characterized by painlessness, low blood loss and the speed of patient rehabilitation. The whole procedure takes 15-20 minutes (with classical techniques, the operation takes up to 40 minutes).
The patient will have to spend up to 3 days in a hospital, and full working capacity returns after a week. But this method has several disadvantages:
- lack of the necessary result with running external hemorrhoids,
- high price: for each operation it is required to use a new circular stapler, which affects the cost of the operation.
Proctologists more often offer an alternative way to get rid of a painful problem: the Milligan-Morgan method.
In 1937, two leading proctologists of America Morgan and Milligan for the first time performed an operation to get rid of hemorrhoids, which is still considered the most effective.
Open hemorrhoidectomy. The classic surgical intervention in the treatment of hemorrhoids. The procedure received this name due to the fact that the site of excision of the nodes remains unshielded. Wounds are reanimated after 3-5 days. This time the patient spends in stationary conditions.
Closed hemorrhoidectomy. An improved method with complete closure of the suture was invented in 1959 by leading proctologists: Heaton and Ferguson.
It is interesting. In America, proctologists prefer a closed method of hemorrhoidectomy, almost no open surgery in the United States.
The advantage of this intervention is that the Heaton-Ferguson method can be performed on an outpatient basis and the patient needs less time to fully recover. The procedure is performed under general anesthesia (in some cases, the patient is offered epidural anesthesia).
Indications for removal of hemorrhoids
When planning surgical treatment, it is necessary to weigh the estimated benefits and risks of surgery, the indications for which are limited, although in proctology, hemorrhoidectomy is almost the first in frequency among all interventions.
Removal of hemorrhoidal nodes in elderly patients suffering from hypertension, diabetes, colitis and constipation, not only can be quite risky, but also not always justified.In most patients, rational conservative therapy, hygiene and diet give such a good result that the need for surgical intervention may disappear.
Indications for hemorrhoidectomy are:
- Stage 4 disease, hemorrhoids of the 3rd degree - with a significant increase in nodes.
- The loss of hemorrhoidal veins with each act of defecation.
- The development of anemia due to recurrent bleeding.
- Lack of result from conservative therapy.
- Thrombosis of hemorrhoids.
The patient’s general condition and the presence of a different pathology (anal fissure, fistula, polyps in the rectum), age of the patient, etc. are always taken into account. For example, surgery may be contraindicated for pregnant women, and older people may need to be thoroughly prepared.
In addition to indications, there are also surgical removal of hemorrhoidal nodes. contraindications, in particular, acute or exacerbation of chronic diseases of the large intestine, malignant tumors, severe decompensated pathology of internal organs, acute infectious diseases, blood clotting disorder. In these cases, the operation will have to wait.
The nuances of the operation
Proctologists prescribe hemorrhoidectomy in advanced forms of pathology: IV, III and II degree (with the formation of large nodes). But, before performing the operation, doctors take into account the following factors:
- Age. Surgical intervention is recommended for patients from 35-40 years old. At a younger age, hemorrhoidectomy does not guarantee a long-term effect, the risk of relapse is high.
- Existing diseases. The operation is contraindicated in people who are diagnosed with inflammatory bowel disease, immunodeficiency, Crohn's disease, oncology, AIDS.
Relative contraindications for hemorrhoidectomy include pregnancy and inflammation in the anus. They appear in case of discharge from the anus. To carry out the operation, anti-inflammatory therapy is first performed.
Preparation for hemorrhoidectomy
Any type of hemorrhoidectomy does not apply to abdominal operations, and often only local anesthesia is sufficient, however, the preoperative preparation of the patient does not lose its relevance from this. It is important to prevent infectious complications, bleeding in the early postoperative period, as well as to prepare the rectum itself for surgery.
Before the planned treatment, the necessary minimum of examinations should be taken: general and biochemical blood tests, urinalysis, tests for syphilis, HIV, hepatitis, coagulogram. According to indications - ultrasound of the abdominal organs. Mandatory examination and digital examination of the rectum, anoscopy, in some cases, sigmoidoscopy.
Particular attention should be paid to the diet, which determines the course of the subsequent postoperative period. Before the planned operation, you should refuse food that causes gas formation and the formation of excess feces, and preference should be given to dairy products, eggs, white bread. In addition, you need to drink more fluids.
On the eve of the operation and on the day of the intervention, a cleansing enema is shown, which can be replaced with special drugs that cleanse the intestines (fortrans). At this point, if the patient was taking blood-thinning drugs, they should be canceled.
The classic operation to remove hemorrhoids is performed under general anesthesia, the patient lies on his back, and the lower limbs are fixed on special supports. Foreign surgeons often perform an operation with the patient on the abdomen, since it improves the outflow of venous blood from the enlarged plexuses, which facilitates the process of their removal.
In preparation for minimally invasive interventions, the same procedures are necessary as for radical hemorrhoidectomy, but hospitalization is usually not carried out, and the patient is treated on an outpatient basis and may go home the same day.
Types of hemorrhoidal vein removal surgery
To date, the most effective radical methods for removing hemorrhoids have been recognized as classic Milligan-Morgan hemorrhoidectomy and resection of the rectal mucosa by the Longo method. Each of them has both advantages and disadvantages, but the first type of intervention is more common, although Longo’s operation can compete with him.
The Milligan-Morgan operation has undergone many modifications and continues to improve. Its essence is the removal of both external and internal hemorrhoidal nodes after flashing the vascular pedicle. At the beginning of the operation, the surgeon excises the skin of the anal region and the mucosa of the rectum over the dilated venous plexuses, then bandages the veins and removes them. Finally, the intestinal wall is fixed to the underlying tissues, and the wounds in the organ wall can either be sutured or left open. The approach depends on the experience and preferences of the surgeon; this does not have a fundamental difference for the patient.
The stages of the operation include analgesia and expansion of the anal canal, treatment of the intestinal mucosa with disinfectants, and drying with a cotton swab. Hemorrhoidal veins are removed in a specific sequence. The surgeon, imagining the dial of the watch, first captures the “bumps” located at three o’clock, then at seven and eleven. Having seized the knot with a clamp, the doctor sutures his leg and cuts it off. It is advisable to use an electric knife, which leads to minimal trauma and does not contribute to bleeding. After removing the nodes, the wound is sutured and treated with an antiseptic.
After classical hemorrhoidectomy, some doctors plug the rectum, but this contributes to the appearance of pain and urinary retention, so most specialists do not perform plugging. To maintain sensitivity in the anus zone and to avoid narrowing of the anal canal, skin-mucous membranes are left in the wound area.
The Morgan-Milligan operation is rather traumatic and requires general anesthesia, which means that preparation for it must be thorough and serious. Its advantage is considered the ability to excise not only internal but also external varicose nodes.
Another option for surgical treatment of hemorrhoids is intervention by the Italian surgeon Longo, who proposed to cross the rectal mucosa and blood vessels that carry blood to the hemorrhoidal nodes, circularly, eliminating the loss of veins. Longo's operation can be an alternative to classical hemorrhoidectomy and is successfully used in the West, but in Russia it began to be performed only about five years ago.
Longo's operation is more gentle than classical hemorrhoidectomy, since a small section of the mucous membrane is resected, and the nodes are not excised, but rather are pulled up and fixed. The flow of blood to the veins decreases, and they are gradually replaced by connective tissue. For suturing the mucous membrane at the resection site, titanium staples are used, which are applied using special staplers.
Longo surgery takes about 15 minutes, and local anesthesia is enough for it. Low invasiveness, but an excellent therapeutic effect, low probability of complications and relapses make it preferable in elderly patients, people with severe concomitant pathology.
Despite the undoubted advantages, the removal of hemorrhoidal nodes by the Longo method has some disadvantages, among which - the impossibility of excising externally located dilated veins, the need to monitor the patient, at least for a week after the operation. In addition, due to the relatively short period of application of this operation, it is still impossible to judge the long-term effects of treatment.
In addition to the described types of hemorrhoidectomy, in the arsenal of modern doctors there are also minimally invasive methods of combating the disease, which can be used both with internal hemorrhoids and with external formation of nodes:
- Laser treatment
- Radio wave treatment,
- Sclerosis and thrombectomy.
Excision of hemorrhoids using a laser very effective. The advantages of the method are the speed of the procedure, quick recovery, low pain. For laser treatment, local anesthesia is used, and after a few hours the patient can go home.
Radio wave therapy implies excision of nodes by means of a radio knife (Surgitron apparatus). Under local anesthesia, the doctor removes varicose veins. The undoubted advantage of this method of treatment is the almost complete absence of contraindications. The procedure is carried out quickly, it does not damage the surrounding tissues of the intestine and anus, which means that the likelihood of scarring and bleeding is reduced to zero.
Deserterization - A new method of combating hemorrhoids, which is to "turn off" the flow of blood through the arteries of the rectum. At the same time, the dilated venous plexuses collapse, decrease in volume and are replaced with connective tissue over time. The patient needs only a few days to recover, and the procedure itself is painless.
Ligation - The most popular gentle way to combat hemorrhoids, when using a special apparatus latex rings are placed on varicose nodes. After about a week, hemorrhoidal "bumps" are rejected along with such a ring, without causing significant inconvenience to the patient. Ligation performed according to indications allows avoiding hemorrhoidectomy in the vast majority of patients.
Sclerosis - A widely used method of combating varicose veins of any location, the rectum is no exception. A special substance is introduced into the hemorrhoidal nodes, causing them to "stick together" and sclerosis.
Often, the disease proceeds with hemorrhoidal vein thrombosis, which causes severe pain and requires mandatory treatment. One of the options for minimally invasive surgery in such cases is thrombectomy, when blood bundles are removed from the veins with a laser or a radio knife. The procedure is performed under local anesthesia on an outpatient basis. In addition, in this way, nodes of external hemorrhoids can be removed at any stage of the disease if they cause discomfort to the patient, but there are no indications for their radical excision.
Minimally invasive approaches to the treatment of hemorrhoids are used in 80% of patients in Europe and the USA, while in Russia three quarters of patients undergo radical surgery. Minimally invasive procedures are performed in the early stages of the disease, and node thrombosis, the formation of an anal fissure, acute and chronic inflammatory processes in the rectum and perineum can become a contraindication to them.
An operation in which only hemorrhoids are excised, the mucosa is not affected. it the most gentle operation, with low blood loss and the absence of pain in the postoperative period.
Manipulations are performed with a laser or an electroscalpel. During laser hemorrhoidectomy, blood vessels are cauterized during excision of the nodes, so blood is practically not released.
Preparation for surgery
At stage III and IV, with the ineffectiveness of medications, surgical intervention (operation) is used. Depending on the stage of the disease, semiotics, the presence or absence of prolapse, proctology uses the following types of invasive intervention (operations):
- Operation Longo,
- Ferguson hemorrhoidectomy,
- Fansler-Arnold hemorrhoidectomy,
- Open hemorrhoidectomy,
- Deserterization of hemorrhoids
- Laser hemorrhoidectomy,
- Parks hemorrhoidectomy,
- Transanal hemorrhoidal dearterialization.
In about half the cases, doctors choose the simple and cost-effective Milligan-Morgan procedure (the Ferguson method is used instead in the USA). In second place is submucosal hemorrhoidectomy.
All other surgical operations are still relatively young and for this reason are not often used. In Russia, they are not automatically subsidized or paid for by means of compulsory medical insurance. Only a few proctologists have the necessary knowledge to perform these procedures.
Preparation for all surgical interventions is the same: the patient is required to come on an empty stomach (daily fasting, withdrawal from tobacco, alcohol and other psychotropic substances) on the day of surgery. Previously, colon cleansing was performed with an enema.
Directly before the procedure, metal objects: piercings, loose braces or jewelry are removed. The nurse then carefully shaves the anal area to ensure a clean surgical field. If this is inconvenient for the patient, he can take this step on his own.
Depending on the particular procedure, various complications may result. However, doctors highlight a number of risks that are considered process independent. This is the risk of thrombosis that remains after any operation. As a precaution, the patient is put on compression stockings and injected with heparin.
Occasionally, as a result of the intervention, scars remain or bleeding, damage to the sphincter and nerves appear. In very rare cases, the patient develops an allergy to surgical material.
Bleeding after surgery
Transient numbness in the anal region is somewhat more common. In women, the vaginal muscles and vaginal walls may be affected, as they are located near the intestines. However, it is worth adding that such complications are extremely rare and more often the result of unskilled intervention.
Relatively often, operations in the anal area lead to the so-called distress syndrome. Patients are unable to retain stool in the rectum (fecal incontinence). However, this disorder spontaneously disappears in the first few weeks after surgery.
Relatively common complication is the relapse of hemorrhoids after surgery. Therefore, the highest risk of treatment is that hemorrhoids occur again after a few years or months. The likelihood of relapse varies depending on the method used, but averages 15%.
The Milligan-Morgan procedure, developed in 1935, is the most commonly used type of hemorrhoidectomy for the treatment of third and fourth degree hemorrhoids. The procedure forms the basis of Ferguson's general operation in the United States and is regarded as a relatively simple surgical technique.
After the preparation of the patient - anesthesia and disinfection of the anal area - a hemotypic solution is first introduced under the hemorrhoidal mucosa. The surgeon then uses forceps to pull the excess tissue out. Closing the hemorrhoidal artery stops the flow of blood to the hemorrhoidal nodes, allowing them to be removed with a scalpel.
It is important to ensure that the sensitive muscles of the anus are not damaged.Gradually, all hyperplasia is removed. As with the Ferguson procedure, a scalpel or laser is used to work. A feature of the Milligan-Morgan operation is that the wounds received do not heal completely: triangular openings appear, therefore this procedure is also called an “open” hemorrhoidectomy.
This inevitably leads to the fact that the healing process takes much longer than with closed procedures. This operation is much more painful for the patient than Ferguson's operation. The advantage of open wound operations is that wound secretion easily leaks and does not accumulate behind the suture.
After the procedure, a number of complications may occur: bleeding, swelling. First of all, they can be expected immediately after the operation. Urinary incontinence due to trauma to the anus or anoderm occurs almost exclusively after improper surgery. Since artificial sutures do not stretch, stenoses usually do not occur.
Patients undergo a long rehabilitation period of 8 weeks. Some people use laxatives to influence the consistency of their products. Proctologists do not recommend the use of laxatives for a long time. Instead of laxative medicines, you need to take healthy fiber-rich foods.
Important! Unlike other hemorrhoidectomies, it is not recommended to use the hip baths after the Milligan-Morgan procedure. Do not wear tight-fitting panties or pants made of dense synthetic fibers - this can lead to the formation of pus. Unfortunately, hemorrhoidal complaints return in about 15% of cases.
Hemorrhoid surgery: surgical methods, price and reviews
The doctor may prescribe the patient an operational method of treatment of the disease caused by chronic rectal varicose veins, if drug therapy and physiotherapy proved to be ineffective. In addition, they resort to surgery with an exacerbation of the inflammatory process, accompanied by intense pain. In this case, the specialist first achieves the transition of the disease into a state of remission, and only after that the hemorrhoids are removed.
Complications of the operation
The sooner hemorrhoids are detected, the greater the likelihood of a full recovery. If hemorrhoids are suspected, it is better to see a doctor sooner rather than later. Many patients who were not treated on time suffer from hemorrhoidal disease all their lives.
Hemorrhoids are divided into 4 stages. The necessary treatment depends on the severity of the disease:
- The first stage is the transition to a diet with sufficient fiber, moderate exercise, hot baths, elimination of constipation and drug addiction,
- The second stage is treatment with a special ointment and suppositories, which leads to a decrease in the size of hemorrhoids and subsequent tissue necrosis,
- The third stage - the same as the second stage of treatment is applied. In exceptional cases, surgery is prescribed,
- The fourth stage - surgical intervention cannot be avoided if pain and suffering become unbearable. With this treatment, the protruding hemorrhoids (lump) are removed with a scalpel or a special device under spinal anesthesia. After surgery, the patient may experience difficulty with bowel movements and pain in the anus.
Hemorrhoids are controlled in the early stages by many different home remedies. A mixture of chamomile and clover (50/50), used in the form of suppositories or ointments, can be used for the symptomatic treatment of hemorrhoids. St. John's wort, chestnut flowers, mulcein and milk thistle benefit.
Of the funds listed, you can brew tea. It is recommended to drink 200-250 milliliters of infusion twice a day, preferably in the morning and evening. Along with this, it is recommended to drink plenty of water, and follow a healthy diet, avoid a lot of sweets.
It is important to maintain proper anal hygiene and avoid strong straining during bowel movements. It is recommended to use multilayer soft toilet paper.
Do not treat the anus and folds with wet wipes. Their use causes itching and additional problems with hemorrhoids.
Instead of wipes, it is recommended to use warm water, especially for women before childbirth or patients with heavy bleeding.
Closed type hemorrhoidectomy
Closed hemorrhoidectomy in accordance with Ferguson is a surgical method to eliminate hemorrhoids 3 and 4 degrees.
Ferguson hemorrhoidectomy is a modification of the Milligan-Morgan method, which is mainly used in the United States.
This type of hemorrhoidectomy is performed under general anesthesia (anesthesia) or epidural (spinal anesthesia). Spinal anesthesia is performed only on the recommendation of a doctor.
Closed back pain anesthesia
At the beginning of this operation, the anus is first disinfected and slightly stretched by the fingers. Then the doctor inserts an anal retractor (synonyms: anal dilator, dilator) into the rectum. Visible hemorrhoids are carefully pulled out of the anus with special tools. The doctor bandages the hemorrhoidal artery.
Subsequently, the surgeon removes excess tissue from the intestines. To do this, use a scalpel or electronic device (high frequency electric current).
The advantage of electric cauterization is that wounds close immediately when hyperplasia is removed. In this way, bleeding is prevented.
On the other hand, working with a scalpel helps you determine exactly how much tissue is actually removed.
In some cases, both tools are used: hemorrhoids are removed with a scalpel, and the lower layer of the mucosa is subsequently removed with cauterization. The edges of the wound are finally closed with a longitudinal suture, this is the main difference in Milligan-Morgan hemorrhoidectomy, in which the wounds remain open.
Closed surgery has several advantages: it speeds up wound healing and minimizes pain. However, closure of an artificial wound causes more severe scarring of the tissue. Because of this, in the worst case, stenosis occurs (hardening by scarring), which, in turn, can cause a narrowing of the rectum.
In addition to hardening scar tissue during Ferguson surgery, there remains a risk of blood buildup behind the sutures. This is especially common when working with a scalpel. In this area, even a violation of wound healing is possible.
The rectum is regularly exposed to pressure that cannot be avoided. As a rare complication, persistent anorectal incontinence after surgery develops as a result of possible subsequent damage.
But it can also be the result of rectal prolapse.
Healing of the rectum after this operation takes from several days to several weeks. In the first days after the procedure, a diet is recommended.
Subsequently, it is recommended to pay attention to a fiber-rich diet. If the sutures have healed, the patient is allowed to use warm baths with chamomile or sage.
Unfortunately, the relapse rate after a successful operation, despite preventive measures, is 20%.
Types of operations for hemorrhoids
Surgical removal of hemorrhoidal nodes is necessary for people who have been trying for a long time to get rid of the disease with the help of conservative therapeutic methods, but it does not work out for them. At the same time, excision of cones is the only effective method that can cure pathology. There are various ways to remove hemorrhoids, including minimally invasive ones, which can be used both with external and internal formation of nodes.
Surgical treatment of hemorrhoids is justified in the late stages of the development of the disease (with 3 or 4 severity), when all other therapeutic methods have been tried. Indications for the operation are:
- disease progression, inefficiency of conservative treatment,
- with each process of bowel movement, the nodes filled with blood fall out,
- the development of complications of the disease, the appearance of fistulas with abscesses in the rectum, inflammation of the bumps and bleeding.
Parks hemorrhoidectomy, developed in 1956, is often called "submucosal" hemorrhoidectomy. The procedure mainly affects the tissue under the rectal mucosa. The method is used to treat complicated hemorrhoids. Only under very adverse conditions, for example, in the case of anal prolapse, hemorrhoids are treated with this operation in the third stage.
Submucous hemorrhoid surgery
The stated purpose of the operation is the complete preservation of the anal mucosa. For this purpose, hemorrhoidal arteries are first ligated. Subsequently, an incision is made through each hyperplastic node. The cuts roughly coincide with the letter Y. When the cutting edges are folded back, a triangular hole is created through which the surgeon removes hemorrhoidal tissue.
Subsequently, the mucous membranes recline, and the edges of the wound are closed with a T-shaped suture. This approach is often criticized because sutures cause pain and sometimes provoke stenosis. In rare cases, fistulas and abscesses form due to surgery.
The benefits of the Parks operation are that if successful, wounds heal quickly. The patient experiences less pain after the procedure.
In connection with the preservation of the anodic coarse-grained region, the sphincter is completely preserved after hemorrhoidectomy.
The likelihood of discomfort or other symptoms in the postoperative period (rehabilitation) during this operation is quite low. The recovery period is up to 2 weeks.
Rehabilitation after surgery
Irreversible effects rarely occur after Parks surgery. For this reason, the Parks method is most often used for the surgical removal of hemorrhoids.
Important! However, since this is a very complex procedure that requires surgical experience, not all surgeons can use this technique.
Laser hemorrhoid removal
The method involves cauterization of tissues with high-frequency infrared radiation. Laser coagulation of hemorrhoids provides sealing of the vascular walls, so there is no risk of bleeding. If the doctor operates on venous inflammation of external localization, the procedure is very simple - laser beams cut off the nodule and immediately burn the wound, while eliminating the risk of infection.
Vaporization (treatment of hemorrhoids with a laser) is a relatively simple technique, which is carried out using high-tech devices, and having a minimal risk of developing negative consequences. However, laser surgery is not always good, since enlarged nodes cannot be cauterized in full. Due to the partial removal of cones, the likelihood of a relapse of the disease remains high.
Milligan Morgan hemorrhoidectomy: surgery technique, postoperative period, diet, recovery, video
Modern medicine for the treatment of hemorrhoids of all stages and types offers all kinds of conservative, minimally invasive methods of treatment. But hemorrhoidectomy or surgical removal of hemorrhoidal nodes remains by far the most popular and sometimes the most effective way to combat hemorrhoids.
Hemorrhoidectomy remains by far the most popular and most effective way to combat hemorrhoids.
Coloproctologists call this surgery the gold standard. The pioneers of this classic operation were surgeons Milligan and Morgan.
Over eighty years from the day of the first operation, its methods changed, surgical instruments improved. But hemorrhoidectomy according to Milligan Morgan remained a classic.
This is the last and only way to get rid of a serious illness when other methods of treatment are ineffective.
Methods for the surgical treatment of hemorrhoids
The essence of surgical intervention for hemorrhoids is the resection of hemorrhoidal formations of varicose veins that fall into the lumen of the rectum.
The classic Milligan-Morgan method is called open hemorrhoidectomy.
1. The framing sections around the hemorrhoid cones and altered tissues of the dilated veins are secreted to healthy tissues by ligation, then the affected areas are removed.
Leave not cross-linked, provided there are good restorative properties of the rectal mucosa. A tight gauze swab with a special solution is placed on the operated site.
The classic Milligan-Morgan method is called open hemorrhoidectomy. The method of this type of surgical treatment is simple to perform (no suturing). An open type of surgical treatment is characterized by a long healing process with possible bleeding.
2. The edges of the sections are stapled or stapled. This type of surgical treatment is called closed hemorrhoidectomy, or the Ferguson method in honor of the doctor who first performed hemorrhoids surgery with sutures.
This method of surgery to remove hemorrhoids appeared in the late fifties. The method of operation is considered simple and reliable.
It is successfully used in the third or fourth stages, when in the chronic course of the disease it is difficult to determine the boundary between the internal and external hemorrhoidal nodes. There is a risk of dysuric processes (problems with urination) and pain after surgery.
3. The method of hemorrhoidopexy in combination with the classic option of removing hemorrhoids is a completely new approach in proctology.
The principle of operation is to remove only the defective part of the submucosal rectum, as a result of which the hemorrhoidal nodes are tightened. As a result, a sharp reduction in the volume of the node due to a decrease in blood circulation in the cavernous vein.
A medical device is inserted into the lumen of the anus through a circular device. The device automatically cuts and stitches the changed parts of the mucosa. Sophisticated technique.
The method involves a quick recovery, the absence of a prolonged pain syndrome, the elimination of urination disorders.
Methods of anesthesia
Surgical treatment of hemorrhoidal nodes is not included in the category of abdominal operations. But operations can be carried out under general anesthesia or under spinal anesthesia, which provides complete anesthesia of the pelvic and anus regions.
- Spinal (coccygeal) anesthesia is very difficult to carry out with a diagnosis of osteochondrosis, injuries in the spine or pelvis. In this case, the anesthetist chooses the type of anesthesia on his own.
- The classic method of surgery is under general anesthesia. The patient lies on his back, legs are on fixing devices. In the West, there is a practice of conducting such operations in the position of the patient on the stomach. The process of removing cavernous protrusions is facilitated by the good outflow of venous blood in this position of the patient.
The classic method of surgery is under general anesthesia.
Technique for the operation to remove hemorrhoids
The preparatory stage before removing the hemorrhoids consists of several steps:
- Preliminary passes the test.
- Immediately the day before the operation or on the day of the intervention, bowel cleansing procedures are prescribed.
- On this day you should not eat or drink. Bowel release is through enemas and / or Fortrans.
- Exemption from the hairline of the area of the operated site.
Before the operation, the anal ring and the rectum are treated with Betadine.
The operation process is a sequence of several steps.
- Treatment of the anal ring and the rectum with an antiseptic solution, Betadine or Iodonate.
- Anus anesthesia with 0.25% novocaine solution.
- Entering into the anus of the dilator (rectal mirror) to stretch the anus ring for maximum visualization of hemorrhoidal nodes.
- Introducing anoscope to access the bumps.
- Gripping the node with a surgical clamp and pulling it out.
- Localization of the node can be carried out using a scalpel, coagulator (electric knife) or laser, depending on the chosen method of conducting the operation. The advantage of the coagulator is obvious: it cauterizes small vessels, and blood loss is significantly reduced.
- Stitching the nodule leg with a special thread - catgut, which resolves within a month.
All formations are removed in strict sequence according to the visual layout of the dial. The nodes are localized first at three o'clock, then seven-hour, etc.
Depending on the choice of the method and the doctor’s experience, the areas of cut off structures are stitched or remain open. Of course, stitched incisions have a faster recovery period.
The anus after the end of the operation is treated with turundum soaked in Levomekol.
The anus is treated with turunda soaked in ichthyol ointment or Levomekol.
Hemorrhoidectomy has one unpleasant feature - the postoperative period is quite long. Recovery can take 3-5 weeks, depending on the complexity of the operation.
Milligan-Morgan hemorrhoidectomy is considered difficult and traumatic for the operated person. The patient is tormented by pain. The first days after surgery, he is prescribed to take analgesics, laxatives, a strict liquid and soft diet.
Doctor's advice! Diet is an important component of the postoperative period. The success of recovery after surgery depends on how well it is composed.
The rehabilitation period of hemorrhoidopexy is not very long. Hospitalization takes 1-2 days.
The rehabilitation period includes conservative treatment. The patient is prescribed drugs such as:
- methyluracil ointment and candles for healing,
- drugs that stimulate the fusion and healing of the walls of blood vessels,
- antimicrobial and antiviral drugs to prevent infection,
- drugs that relieve inflammation and tonic veins,
- drugs to improve blood flow.
Complications after removal of chronic hemorrhoids
- Unfortunately, after removal of hemorrhoidal nodes, there can be negative consequences.
- The degree of risk of complications depends on the stage of chronic hemorrhoids, the age of the patient, the immune system and the psychological mood of the patient.
- Pain effect from surgical intervention. There are many nerve endings in the pelvic area. As a rule, after anesthesia, the patient experiences severe pain.
- Violation of the outflow of urine in men during the day after surgery. The outflow of urine is carried out using a catheter.
There may be several reasons:
- Poor quality cauterization of blood vessels during the operation.
- Injury of the rectal mucosa by feces.
Constipation after surgery may be of psychological origin. The patient is simply afraid to push.
The patient is examined to determine the cause of bleeding. With severe bleeding, it may be necessary to re-burn bleeding vessels.
- The formation of postoperative fistulas.Fistulas appear as a result of improper suturing. Such an inflammatory process can occur several months after the operation. There is a chance of infectious inflammation. First, conservative treatment is prescribed. With negative results, an operation is performed to remove fistulas.
- Constipation can be psychological in origin. The patient is simply afraid to push. The patient is prescribed sedatives.
- The cause of narrowing of the rectal canal may be improper suturing. In this case, the problem is resolved using expanders.
- Suppuration of wounds.
During the operation, pathogenic microbes from the intestine can get in, causing inflammation. In the inflammatory process, surgery is performed using antimicrobial agents.
At the forum, former patients talk about their misfortunes and discomfort associated with hemorrhoids, about painful rehabilitation, difficult recovery. But the postoperative period passes, and the patient returns to normal. Words of gratitude to patients are not uncommon on the forums.
“Happy is he who does not know what hemorrhoids are,” is the phrase of a patient who has suffered excruciating pains with hemorrhoids and surgery to remove it.
Milligan-Morgan hemorrhoidectomy for hemorrhoids
Milligan - Morgan hemorrhoidectomy is performed in cases of neglect of the disease, as well as with low efficiency of therapy with conservative methods. This operational technique was named after the surgeons who developed and first successfully applied it in practice. Since then, this surgical method has been used in the most complex and advanced cases of hemorrhoids.
Surgery is performed only in a hospital, since such an operation is an open type. The patient is hospitalized on the eve of the operation.
There are a number of patient conditions in which the Milligan-Morgan operation is not performed. Such contraindications are:
- any gestational age
- states of immune deficiency, both congenital and acquired. In such cases, big problems are possible in the healing of postoperative wounds. Also likely to increase autoimmune aggression,
- a number of chronic diseases of the organs and systems of the patient. Surgical intervention in this case is also dangerous by exacerbation of sluggish pathology, which is a danger to the health and life of the patient,
- acute inflammatory processes in the body. Surgery in this condition can lead to generalization of inflammation and even the development of sepsis,
- oncological diseases,
- Crohn's disease, affecting any of the sections of the gastrointestinal tract, in the acute stage. As a rule, hemorrhoids in Crohn's disease are tried to be treated with conservative methods, since surgical treatment is fraught with complications and aggravation of the underlying disease. However, in extreme cases, hemorrhoidectomy is allowed only in the phase of prolonged remission of the underlying disease.
Certain restrictions on indications for surgical treatment according to the method of Milligan - Morgan impose the age of the patient. It is undesirable to carry out surgery for persons under 35 years of age, since a relapse of the disease is almost always observed. The same complication occurs in elderly patients.
It is most rational to conduct surgical treatment of hemorrhoids according to this technique for people from 40 to 60 years old.
Also, unconditional contraindications for surgical intervention are acute failure of the heart, liver, cerebral circulation, and kidneys.
Advantages and disadvantages of surgery
Like any other surgical intervention, Milligan-Morgan surgery has its advantages and disadvantages.
The advantages of this method include:
- the ability to get rid of hemorrhoids in the most advanced cases, when other techniques are powerless,
- during the first 10-12 years, a complete absence of relapse,
- after 10 years after surgery, the return of the disease is possible only in 25% of cases.
The disadvantage is severe pain, lasting from one to three days after surgery.
To relieve pain and thereby improve the general condition of the patient, you can prescribe painkillers.
The disadvantages include a relatively long rehabilitation period after surgery. The time required to recover the body after surgery depends on a modification of the technique used by the surgeon. Healing occurs most quickly with closed hemorrhoidectomy.
If the surgery was performed by the classic open method, then the length of stay in the hospital increases to a week or more. Complete healing in this case will take a longer time.
The most complicated is the technique of submucosal hemorrhoidectomy, which requires the patient to be constantly monitored even after discharge from the hospital.
How is the operation
Surgical intervention can be carried out both under general anesthesia and under local anesthesia, in which only an area of the surgical field is chipped with anesthetics. With general anesthesia, drugs for anesthesia are administered intravenously.
The position of the operated patient during the operation is on the back, while the legs are bent in a bent position and are fixed on a special support. The surgical field is treated with a disinfectant solution.
The operation technique consists of several stages:
- With the help of an anoscope (rectal mirror with backlight), the surgeon examines the nodes to be removed.
- Hemorrhoidal cones are fixed by clamps and brought out. As a rule, nodes are located at three, five, and eleven o'clock on a symbolic dial. To prevent bleeding from filling the surgical field, first of all, the node located on the number 3 of the conditional dial is removed. Then a resection of the cone located at 7 o'clock is carried out, and the node localized at 11 o’clock of the symbolic dial is last removed.
- For resection of each node, its vascular pedicle is first pinched. After this, the vessel is stitched with a ligature. At the same time, a special seam (“figure eight”) is imposed for reliable fixation.
- The assembly is removed with a laser or electric knife. This tool allows you to coagulate blood vessels and minimize blood loss during surgery. The ligature on the seam tightly and securely tightened.
- Then radial sutures are applied with small mucocutaneous flaps between them. This will prevent post-traumatic narrowing of the anus.
In the classical technique of Milligan-Morgan surgery, the external sutures are not superimposed, and the surgical wound remains open until healing by primary intention.
- At the end of the operation, the sutures are treated with antiseptic agents and closed with a sterile cloth. Turunda, impregnated with a drug with antimicrobial and wound healing effects, is introduced into the anus for several hours.
Possible complications after surgery
After hemorrhoidectomy, like any other operation, it is rare, but complications can develop:
- bleeding - the cause becomes damage with solid feces of fresh sutures. To avoid this, the patient must adhere to a diet that prevents constipation and promotes the formation of soft feces until recovery.
- infection of the wound - to prevent infection in the sutures, it is necessary to follow all the recommendations that the surgeon gives at discharge. This includes hygiene rules in the field of surgery, as well as the use of medicinal ointments and suppositories,
- urinary retention - more often occurs in men in the first day after surgery. During the day passes independently without treatment. Urine in such cases is excreted using a catheter,
- failure of the anal sphincter - occurs extremely rarely with muscle damage during surgery,
- narrowing of the anus - eliminated by the use of dilators. In severe cases, plastic is performed,
- fistula formation is also a very rare complication that develops as a result of infection of the sutures. Compliance with the hygienic prescriptions of the doctor will prevent this unpleasant complication.
Hemorrhoidectomy. Maryana Abricova in the program Doctor I at the TVC.
Relapses after resection of hemorrhoids within 10 years after surgery occur only in ¼ of patients. Proper nutrition, an active lifestyle and rejection of bad habits will help to avoid the recurrence of the disease.
Surgical treatment of hemorrhoids according to the method of Milligan Morgan
Milligan Morgan hemorrhoidectomy
Solving the problem of hemorrhoids with medical treatment or nutrition correction is possible only at the very early stages. In severe cases and significant discomfort for the patient, doctors resort to hemorrhoidectomy. The disadvantage of this operation is that after it there is a high probability of blood loss and a long rehabilitation period. The delicate location of the problem complicates wound healing and hygiene.
A simpler and less traumatic method is hemorrhoid surgery according to the method of Milligan Morgan. It consists in the removal of hemorrhoidal nodes and mucous membranes.
Types of Surgical Interventions
Depending on the complexity of the operation and the depth of removal of the affected tissue, minimally invasive and classic options for intervention in hemorrhoids are distinguished.
Minimally invasive operations are developing rapidly in connection with the advent of new equipment and technologies, the emergence of modern sclerosing substances. They are often performed on an outpatient basis, that is, after such an intervention, the patient is allowed to go home.
The main types of minimally invasive operations for hemorrhoids:
- infrared photocoagulation,
- latex ring ligation,
- ultrasound ligation (dopplerometry),
- cryodestruction of nodes
- embolization of the branches of the upper rectal artery.
In developed countries, more than 80% of patients with hemorrhoids are treated using minimally invasive methods.
Not all patients can be recommended such interventions. So, they are not carried out with thrombosis of the nodes, paraproctitis (inflammation of the fatty tissue around the rectum), anal fissures, acute hemorrhoids, the fourth stage of the disease.
In the third and fourth stages of the disease, when infringement of the prolapsed nodes occurs, as well as with severe bleeding, radical operations are performed (various modifications of hemorrhoidectomy), often using laser, ultrasound and other modern techniques.
The correct combination of minimally invasive methods, drug treatment and surgical operations allows you to get rid of hemorrhoids up to 90% of all patients, regardless of the stage of the disease.
Minimally invasive interventions for hemorrhoids
If the patient has stage 1 or 2 of the disease (the nodes either do not fall out or are repaired on their own), and at the same time he is concerned about bleeding, the best treatment options are infrared photocoagulation and sclerotherapy. To accelerate tissue repair, it is useful to supplement these effects with the effect of a therapeutic laser. In the third stage of the disease, when the fallen nodes can be repaired, the preferred method of treatment is ligation with latex rings.
Infrared photocoagulation is a cauterization of the node legs with a beam of light having a high temperature. For its implementation, the Russian apparatus Svet-1 or the American equipment Redfield is used.The light source is a halogen lamp. The flow of particles is focused and through the fiber enters the anoscope. Anoscope is brought closer to the leg of the node and tissue is coagulated in several places. This stops the bleeding from the vessel. In more severe cases, after stopping the bleeding, more radical methods need to be used, since photocoagulation cannot save the patient from falling out nodes. At the first stage of the process, the photocoagulation efficiency reaches 70 - 80%.
Sclerotherapy is carried out using phlebosclerosing drugs. These include thrombovar, fibrovane, ethoxysclerol. After these substances get into the hemorrhoid, denaturation (folding) of the proteins of the inner surface of the vessel occurs, its lumen is blocked and it completely falls off. The inflammatory process does not develop.
Sclerosing drugs can be administered no more than two nodes at a time. If necessary, treatment of other nodes is carried out after 2 weeks. The duration of one procedure is 10 minutes. In the first and second stages of the disease, the effect is achieved in 85 patients out of 100.
In the second and third stages of the disease, accompanied by prolapse of the nodes, ligation with a latex ring is very effective. It is carried out using German equipment from Karl Storz. With the help of an anoscope, a latex thread or ligature is formed on the inner node, forming a ring, pinching its leg. Two weeks later, the node dies, and in its place remains a small stump. You can carry out up to 5 such interventions with an interval of two weeks. After such treatment, all signs of the disease in the second and third stages disappear in 90% of patients.
Very interesting technique of ligation of blood vessels under the control of ultrasound. An anoscope equipped with an ultrasound probe and a special needle is needed to carry it out. Using ultrasound, under the mucous membrane, the branches of the artery that feed the hemorrhoidal nodes are found, and they are precisely stitched with a needle and a special thread. Ultrasound examination also controls the correctness of the “constriction” of the vessel by thread.
Ligation of blood vessels leads to the collapse of the nodes. At the same time, you can bandage up to 6 such arteries, if necessary, the intervention is repeated after two weeks. The technique is effective in 90% of patients with stage 2 - 3 disease. However, it can also be used in the fourth stage, especially in preparation for hemorrhoidectomy, the presence of an anal fissure, or rectal fistula.
Cryodestruction of nodes - their destruction with the help of liquid nitrogen. Intervention is effective in the early stages of the disease. The technique did not find distribution because of the inability to regulate the depth of tissue freezing and a long recovery period.
With hemorrhoids with prolonged bleeding, not amenable to other methods of treatment, catheterization of the upper rectal artery is possible. A large number of Teflon balls with a diameter of up to 0.6 mm are introduced into it. They fall into the small branches of this artery that feed the hemorrhoidal nodes. As a result, the blood flow in them stops.
Thus, minimally invasive interventions are the optimal method for the treatment of chronic hemorrhoids of stages 1-3. They are performed on modern equipment by qualified coloproctologists. It is clear that such an operation will be expensive.
Who is appointed to remove the method of Milligan Morgan
Milligan Morgan’s hemorrhoidectomy operation is a salvation for patients with severe manifestations of hemorrhoids. It is not prescribed to patients in the first stage. Most often, appointments are made to patients with the third and fourth degrees of hemorrhoids, which are characterized by severe symptoms and a high degree of severity. As a rule, at these stages, drug treatment is already ineffective.
Contraindications for surgery:
- HIV positive status.
- Crohn's disease.
- Malignant tumors.
More than 250 types of surgical operations for hemorrhoids have been proposed. Today, the most common is the operation of Milligan and Morgan, developed back in the 30s of the last century, as well as its modifications.
When ointments, suppositories, creams and minimally invasive techniques do not help, resort to surgical treatment
During Milligan-Morgan surgery, three groups of cavernous bodies forming hemorrhoidal nodes are removed. At the same time, the area of the skin and mucous membrane around the anal canal above the hemorrhoidal nodes is removed. To reduce tissue injury and thoroughly stop bleeding, lasers and electrocoagulators are used.
With open hemorrhoidectomy, sutures are not applied to the wound. This type is performed with complication of hemorrhoids with an anal fissure or paraproctitis. With closed hemorrhoidectomy, the wound is sutured with a catgut. There is also a submucosal hemorrhoidectomy resembling plastic surgery. The rehabilitation period after hemorrhoidectomy takes up to a month.
After removal of nodes in 40% of patients, severe pain is formed, in 20% - urination disorders. An ultrasonic scalpel is used to reduce the frequency of these complications.
In some cases, it is possible to conduct a circular incision of the mucosa and hemorrhoidal vessels, remove all pathological formations, and then stitch the mucous membrane.
Promising is the Longo operation. With it, a circular incision of the mucous membrane above the dentate line is also carried out. Hemorrhoidal nodes are not removed, and when suturing the mucosa, it is as if pulled up. As a result, they are worse supplied with blood and become empty. At the same time, the operation time is only 30 minutes, and the length of stay in the hospital is 3 days.
For a quicker operation, Longo proposed a kind of stapler with disposable titanium brackets, which allows you to effortlessly suture the mucous membrane of the rectum. This device was developed by Ethikon Endosurgery. Interventions with its use pass quickly, without complications, but their cost is much higher than the price of classical hemorrhoidectomy.
Thus, in order to avoid traumatic and expensive operations for hemorrhoids, you need to consult a doctor at the first symptoms. If medications are ineffective, you should agree to surgery. The sooner it is done, the better the long-term effect will be.
Which doctor to contact
With hemorrhoids, you need to contact a proctologist. If this is not possible, a surgeon can help. The therapist or family doctor will help prepare for the operation, prescribe medications. A nutritionist can prescribe proper nutrition to avoid exacerbations of hemorrhoids. A specialist in physiotherapy exercises will select a set of exercises aimed against this disease.
Recovery and regeneration of wounds depends on the chosen technique of surgery. Open hemorrhoidectomy requires about a month of recovery. Full rehabilitation may occur after 6 weeks. Closed hemorrhoidectomy according to Milligan Morgan promotes faster healing. The recovery period here will be up to a month.
The first two days after surgery are the most responsible and difficult for the patient. The wound hurts on its own, and can also be very injured during bowel movements.
Therefore, during this period, the patient eats almost nothing so that the stool does not form. When the wound stops bleeding and slightly heals, the patient is allowed to take liquid food.
Soft feces are formed from it, which most carefully pass through the intestines.
Postoperative pain can be eliminated with local anesthetics, and to accelerate healing, the patient is prescribed baths with chamomile solution.Healing is also promoted by suppositories and ointments containing methyluracil.
Recovery from hemorrhoidectomy implies the patient’s most sparing lifestyle, both in terms of physical activity and nutrition.
The method of Milligan Morgan allows you to very effectively get rid of running hemorrhoids. Repeated pathology can be repeated only after a few years. A healthy lifestyle and proper nutrition minimize relapse to a minimum.
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Further worth reading: Desarterization of hemorrhoids
Milligan Morgan hemorrhoidectomy operation: the essence of the method and reviews
Hemorrhoidectomy remains the most popular surgical operation to remove hemorrhoids. Modern changes in the technique of performing the operation have made it less traumatic.
Igor Andreevich, Ufa: “Good morning, yesterday the surgeon recommended a hemorrhoidectomy operation to save me from hemorrhoids. I am now 50 years old, the disease has been tormenting me for seven years now. I do not know anything about this method, ointments and suppositories no longer help. You can tell and give recommendations on this operation. Thanks!"
Among many diseases, hemorrhoids are “famous” for their neglected forms. Although proctologists recommend screening for the first alarming symptoms, a feeling of false shame prevents many people from going to the doctor on time. As a result, the pathology passes into neglected forms, the treatment of which requires surgical intervention.
Milligan – Morgan Operation
What is hemorrhoidectomy surgery? A hemorrhoidal disease is a pathological overflow of blood in the cavernous cavities, which together with the blood vessels form hemorrhoidal nodes. Radical surgical excision is required to remove them.
|Recommended for||Effective at 3-4 stages of hemorrhoids.|
|The essence of the Milligan-Morgan method||3 main collectors of cavernous tissue of the submucosal layer of the distal part of the rectum are excised with stitching of the vascular pedicle. With the subsequent removal of the nodes and the tissues covering them.|
|Kinds||Open and closed.|
|Modern change||Hemorrhoidectomy with an ultrasonic scalpel.|
Of course, over the past three quarters of a century, the original method has undergone changes. Surgeons operate with more advanced tools. Recently, some clinics in Russia even use hardware methods. In this case, the operation in essence remains a classic hemorrhoidectomy, but it passes faster and almost bloodless.
Preparation for the procedure
Hemorrhoidectomy does not apply to abdominal interventions. But preoperative preparation for hemorrhoidectomy is an important step to a quick subsequent recovery. What does it include:
Analyzes. Before the patient is immediately prepared for surgery, he will have to undergo a number of tests:
- blood (biochemical and general),
- blood for RW (detection of syphilis), HIV and hepatitis,
- on a coagulogram (determination of the level of blood coagulability).
According to the testimony, an ultrasound of the peritoneal organs is performed. Without fail, the patient undergoes anoscopy and a digital examination of the rectum. Sometimes sigmoidoscopy is also prescribed (examination of the lower intestine).
Diet. The preoperative diet is very important for the operation, because it plays the decisive role in the success of the recovery period. Before hemorrhoidectomy, the patient should refuse food that provokes flatulence and excessive formation of feces. It:
- beer and kvass
- black bread,
- milk (fresh)
- tomatoes, sorrel, onions,
- Exotic fruits,
- carbonated drinks,
- beef and lamb meat,
- pears, grapes, apples, gooseberries.
Preference in the menu is given to white bread, fermented milk products, eggs.It is recommended to consume more fluids.
On the eve of the operation. On the day “X”, the patient undergo cleansing enema. This procedure can be replaced by the use of special agents that deeply cleanse the intestines (Lavacol, Fortrans, Dufalac, Bisacodyl, Guttalax).
Attention: postoperative period
The first 24 hours after the operation, the patient is on a starvation diet. After a day, you can already eat, but the diet continues to be strict. Nutrition after hemorrhoidectomy consists of products that form soft feces (so as not to injure the healing mucosa).
These are lean beef and chicken, green salad, buckwheat and millet, wholemeal bread, beets, cauliflower, pumpkin. Eating is carried out fractionally, in small portions (150-200 g, 5-6 times a day).
How long recovery after hemorrhoidectomy will last depends on the type of operation:
- with open intervention - about 5 weeks,
- closed procedure requires 3-4 weeks.
The first days after surgery can cause pain. To stop the pain symptoms, doctors prescribe painkillers. It is recommended to carry out external baths from a decoction of chamomile and a weak solution of potassium permanganate.
When can I sit after hemorrhoidectomy? Sitting after excision of hemorrhoids is allowed from 5-6 days using a soft pillow. Within a month, the patient is not allowed to lift weights of more than 3 kg, for six months you will have to forget about heavy physical exertion and long walking / running.
Medicinal restorative drugs
In the postoperative period, the main focus is on wound healing. In order to prevent infection and accelerate the rehabilitation process, it is necessary:
- After each use of the toilet, wash yourself with a shower.
- After ablution, apply gauze soaked in Levomekol ointment to the wound area.
- Levomekol is used up to 2.5-3 weeks. Then the agent is replaced with agents that accelerate the regeneration of the mucosa and relieve itching after hemorrhoidectomy: Actovegin, Solcoseryl or Methyluracil.
- When removing internal nodes, rectal suppositories are prescribed. Suppositories after hemorrhoidectomy are selected with analgesic, restorative and anti-inflammatory effect: Relief, Natalsid, Hepatrombin G.
All medicinal measures aimed at wound healing are carried out for at least 30-35 days. At this time, damaged tissue will heal and repair. After examination by a doctor (with successful rehabilitation after hemorrhoidectomy), treatment is canceled.
How to perform hemorrhoidectomy
For the operation, the patient lies on his back in a chair similar to gynecological. Feet are placed on special stands. The anesthesiologist administers anesthesia, and the surgeon proceeds to surgical treatment. After removal of the hemorrhoidal nodes, stitches are placed, and the patient is taken away to the intensive care unit for awakening.
The duration of the operation depends on the stage of hemorrhoids, the condition of the nodes, as well as the type of method used.
Complications after hemorrhoidectomy develop infrequently. The main unpleasant consequences include the following:
- Bleeding. They happen due to a violation of hemostasis during surgery or damage to the healing area. Stop bleeding with an adrenaline swab. If a large vessel is damaged, it is bandaged.
- Stool / urine retention. To eliminate constipation after hemorrhoidectomy, laxatives and painkillers are used. In some cases, catheterization is used.
- Fecal / urinary incontinence. It is observed due to weakening of muscle ligaments in the operated area.
- Anal fissure. Appears after regular irritation of the wound with hard feces and gases after hemorrhoidectomy. They get rid of the problem by applying nitroglycerin ointment or perform an additional operation.
- Fistula. Such a complication is diagnosed 2-3 months after surgery. The reason for this is flaws during the operation, when muscle tissue of the intestine is captured when the hemorrhoid is removed.
- Infectious complications. Develop due to non-compliance with the rules of antiseptics during and after surgery.
Hemorrhoids are able to return. Relapse of the pathology is diagnosed in 3-4% of cases. A new problem is eliminated quickly - with the help of ligation (overlapping latex rings on blood vessels).
The postoperative period usually proceeds quite safely, but the need for defecation and ensuring the painlessness of this process can bring significant inconvenience. On the first day after the intervention, the appearance of stool is extremely undesirable, as it can cause severe pain and trauma to the postoperative wound, and in order to avoid this, a complete refusal of food is shown while maintaining a good drinking regimen.
From the second day, food is gradually introduced that does not contribute to intestinal irritation and the formation of a dense stool: light soups, cereals, dairy products. Be sure to drink plenty. In the first few days, many patients experience severe pain, for the elimination of which analgesics are prescribed. In order to accelerate the healing of the rectum, baths are carried out with a weak solution of potassium permanganate, a decoction of chamomile flowers. Drug treatment consists in the use of ointments and suppositories with methyluracil, which improves regeneration processes.
To prevent a possible urinary retention, they do not plug the rectum after the intervention, and the patient is recommended to use a sufficient amount of fluid. This complication is especially common among men and often requires the introduction of a urinary catheter to empty the bladder. Spasm of the sphincter of the rectum helps to remove the cream with nitroglycerin.
The patient must necessarily perform all necessary hygienic procedures, which the clinic staff will tell him about, and not ignore dressings and examinations. The diet after surgery should contain enough fiber to lighten the stool. You need to empty your intestines as soon as such a desire arises, but you should not linger in the restroom for too long, push or strain. If necessary, laxatives may be prescribed.
No matter how hard the surgeons try, it is not always possible to avoid the adverse effects of the operation. Among them, the most likely:
- Bleeding, which may be associated with insufficiently complete suturing of blood vessels, slipping ligatures,
- Anal canal stenosis that occurs in the late postoperative period, special expanders or even plastic surgeries are used to combat it
- Infectious and inflammatory processes, suppuration of the wound in case of non-compliance with the rules of asepsis during treatment,
- Relapse, the likelihood of which persists with any type of surgical treatment.
Hospitalization for radical treatment takes about 7-10 days, after which they remove the sutures, examine the rectum and, if all is well, let go home. One and three weeks after hemorrhoidectomy, a digital examination of the intestine is mandatory to exclude the formation of narrowing of the lumen of the organ and to monitor the treatment results.
Recovery after surgery takes about 2 weeks, but rehabilitation after removal of hemorrhoids is not limited to the time spent in the hospital. To consolidate the positive effect of treatment and prevention of relapse, the risk of which remains regardless of the stage of the disease and type of operation, the patient will have to constantly monitor the condition of the rectum, following some rules:
- Do not lift weights
- It is necessary to exclude physical activity with abdominal tension,
- If possible, avoid prolonged sitting or standing,
- Normalize diet
- Provide adequate physical activity.
Nutrition and movement- the first thing that even those patients who could not refuse a cup of strong coffee or a bar of chocolate would have to put up with. Spicy dishes, an abundance of spices, alcohol, chocolate, marinades and smoked meats, coffee and carbonated drinks should be excluded from the diet. Any of these products can lead to exacerbation of hemorrhoids. In addition to products that provoke the disease, you need to remove from use those that contribute to constipation (flour and sweets, in the first place).
If due to the nature of professional activity it is not possible to avoid prolonged sitting, then whenever possible you should take small breaks, get up and walk. Walking is a great way to prevent relapse.
The cost of surgical treatment of hemorrhoids depends on the method and scope of the operation. Removing one node costs from 7000 rubles, reaching 15-16 thousand in individual clinics, ligation - 6000, sclerotherapy - 5000 rubles. Perhaps free treatment, but in this case, the patient may be faced with the need to wait for their turn. Patients who are shown urgent treatment for massive bleeding or thrombosis of nodes, it is carried out free of charge in a surgical hospital.
Patient reviews depend on the quality of the operation, whether it be a radical treatment or minimally invasive. Of course, rapid improvement and early recovery with gentle techniques is the best experience. In many respects, the opinion of patients who underwent hemorrhoidectomy is determined by the qualifications and skills of the surgeon, on which possible complications in the postoperative period depend. If the surgeon performed a qualitative removal of hemorrhoids, then he will rightly be called a doctor from God, and unpleasant emotions in the early days associated with pain and difficulty with defecation will quickly be replaced by gratitude for getting rid of the disease.
Ligatures in the form of latex rings are applied to the node leg with a special apparatus. The effect of clamping the loop causes the cessation of blood flow in the tissues, necrosis and rejection.
Distinguish between mechanical and vacuum (piston) ligation. The first method is convenient if the node leg is clearly visible. The second - allows you to draw a knot into the cylinder of the device and reset the ligature to its base. After the procedure, patients feel fullness, pain for 2-3 days. Therefore, the rings are superimposed on 1-2 nodes. Jumping off the ligature is considered a complication.
Cryodestruction uses tissue freezing to die. Often combined with vascular ligation. Inert gases (argon, helium, nitrogen) serve as a refrigerant. Liquid nitrogen creates cooling to -196 ° C. Special cryoprobe touch the wall of the site.
The method is applicable even against the background of inflammation of hemorrhoids, but is not indicated for other pelvic diseases in men and women. It gives a good effect in elderly patients with impaired sphincter tightness. Stimulates local immunity, “rejuvenates” the tissue of the rectum.
It is used in the surgical department according to emergency indications for infringement of the external hemorrhoid cones. Under local anesthesia, a linear incision of the node (5 mm) is performed. A blood clot follows from it along with blood. It is rarely removed with a clamp. The wound heals in 5-6 days. The pains are immediately removed, and the node decreases in size.
The patient after thrombectomy requires observation, a change in ointment dressings, so it is better to be treated for several days in a hospital. A follow-up examination of the doctor is carried out after 2 weeks.
The approximate cost of surgical treatment of hemorrhoids
Cure hemorrhoids will not work for free. The cost of drugs (for example, venotonic) per course is quite comparable with some minimally invasive methods.If the patient decides to undergo surgery in a private clinic, then you need to expect that surgery according to Milligan-Morgan will cost 15,000 p., Longo - from 40,000 to 100,000 p.
Minimally invasive methods differ in price.
|Method name||The cost of removing one node in rubles|
|Moscow clinics||Regional Clinics|
|Laser therapy||12 000-18 000||6 000-8 000|
|Infrared coagulation||6 000-8 000||3 000-7 000|
|Sclerotherapy||8 000-9 000||3 000-6 000|
|Ligation||5 000-6 500||3 500-4 500|
|Cryodestruction||6 000||3 000|
|Thrombectomy||5 000||3 500|
Surgical methods are necessary to quickly solve the problem of hemorrhoids, but it should be remembered that without patient attitude to your health and with the most expensive treatment, relapse will occur.
Alexander Petrov, surgeon: “Hemorrhoids are a chronic ailment that affects many people on the planet. When conservative methods of treatment do not allow the doctor to hope for a positive outcome, the only way to solve the problem is surgery.
Surgical treatment of hemorrhoids is represented by different methods of surgical intervention. The main objective of such methods is the excision of tricky bodies located in the submucosal layer. The most popular, according to proctologists, is a hemorrhoidectomy according to Milligan-Morgan.
The operation involves excision of hemorrhoidal nodes, flashing and removal of cavernous bodies of the submucous layer of the rectum.
Classical hemorrhoidectomy has one drawback. After removal of nodes on the wall of the anal canal, wounds are formed that can bleed and cause pain.
In addition, infection can get into superficial wounds, which is fraught with serious complications.
In this regard, many surgeons after excision of the internal and external hemorrhoidal nodes partially suture the edges of the wounds, and their secondary tension is performed. ”
In many cases, Milligan – Morgan surgery is the only available option for getting rid of hemorrhoids. A thorough preliminary examination, preparation and the right attitude help to transfer this operation well. Allows you to safely survive the rehabilitation period and continue an active lifestyle.
CONTRAINDICATIONS ARE AVAILABLE
CONSULTING YOUR DOCTOR NEEDED
The method involves exposure to damaged tissue at very low temperatures. During the procedure, the blood supply to the cone is stopped, so that it dies and is rejected. Cauterization of hemorrhoids is carried out by krizonid in stationary or outpatient conditions, while hospitalization after removal is not required. Since low temperatures cause vasoconstriction, there is no bleeding during procedures. In addition, the cold eliminates muscle spasm in the operated area and improves tissue regeneration.
How to prepare for hemorrhoid surgery
Your doctor-proctologist will tell you about the preparatory measures. Preparation for hemorrhoid surgery is important, because the quality of surgical treatment depends on it. In addition, ignoring the preparatory phase increases the risk of complications after removal of the cone. In the preoperative period, important attention should be paid to the patient’s nutrition, since diarrhea or constipation will greatly complicate the procedure and aggravate the course of the disease. Diet means giving up heavy food a few days before surgery. From the diet are excluded:
- White cabbage,
- black bread
- carbonated drinks / water,
- smoked products.
Doctors advise giving liquid cereals, soups, lean meat, poultry, dairy products, and fish before removing hemorrhoids. In addition, the drinking regimen is increasing (the required volume is 2 liters per day. On the eve of the operation, the patient needs:
- finish the last meal no later than 12 hours before the removal of hemorrhoids,
- spend a cleansing enema in the evening,
- carry out hygiene procedures before the procedure.
Rehabilitation after hemorrhoid surgery
The recovery period after removal of the nodes by excision takes about a month and a half, with a closed operation, it lasts up to 4 weeks. A prerequisite after surgery is the patient's bed rest (the duration recommended by doctors for this stage is 2 weeks). Postoperative hemorrhoid surgery implies the following:
- light physical exercises are allowed only for 5-7 days after removing the cone (you can walk and do simple exercises),
- You can resume playing sports no earlier than 3 months after the operation,
- if a person has sedentary work, it is necessary to use a special medical pillow, which is placed on a chair,
- during recovery, you can not visit the bath / sauna.
To prevent relapse and quick recovery after surgery, the patient must follow a light diet. Nutrition rules to be observed:
- the diet should include trace elements and vitamins,
- food should be well chopped, light,
- better to eat a little, but often (5-6 times a day),
- digestive problems should be avoided,
- approximately 80% of the human diet after surgery should be plant foods,
- products can be steamed, baked, stewed or boiled,
- water should be drunk in unlimited quantities, drinking the first glass on an empty stomach.
The price of hemorrhoid surgery
Like any other surgical intervention, the cost of the operation to remove hemorrhoids depends on the chosen technique and the status of the clinic where the person turned. Hemorrhagic nodes can be removed for free by contacting a medical institution at the place of residence, however, you do not have to choose a method for removing bumps. Only paid clinics give a person the right to choose a treatment method, and each of them has an excellent price. The table below shows how much the laser hemorrhoid surgery and other methods of treating the disease cost in Moscow.
Removal of hemorrhoids
Hemorrhoidectomy is an operation to remove hemorrhoids. Such an intervention is carried out with internal hemorrhoids of stages 3 and 4, in the presence of pronounced combined hemorrhoidal nodes, which are difficult to set or not set at all. Surgical removal of hemorrhoids is performed if conservative therapy is ineffective and minimally invasive techniques are not suitable. Experienced surgeon-coloproctologists of GMS Hospital in Moscow perform excision quickly, painlessly and in the most sparing mode for the patient.
More about the operation
Removing hemorrhoids is a radical way to treat hemorrhoids. There are various options for such an intervention, but the essence of the technique is the same - excision of pathologically altered tissues. Hemorrhoidectomy is the "gold standard" in the treatment of hemorrhoids. Ultrasonic scalpel, electric and radio wave surgery, modern staplers made it possible to reduce the invasiveness of the operation, resulting in early recovery and minimal postoperative discomfort. In our clinic, such a surgical intervention is also performed using a laser, which can simultaneously remove, cut and solder blood vessels, avoiding rectal bleeding. The laser coagulation method makes the procedure completely bloodless, and the recovery of the patient is easy.
Classical hemorrhoidectomy is represented by the following methods:
- suturing the wound - Ferguson-Hilton operation,
- without suturing wounds of the rectal canal - Milligan-Morgan operation,
- submucosal excision of hemorrhoidal nodes - Parks operation,
- transanal resection of the rectal mucosa - Longo operation.
With such interventions, wound healing, rehabilitation, and rehabilitation take 4–5 weeks. At the same time, the absolute radicalism of the intervention remains.
In Moscow, GMS Hospital surgeons not only provide counseling services, but also perform minimally invasive surgeries, including ultrasound hemorrhoidectomy, which received the largest number of positive reviews from specialized doctors and patients.
We also offer laser removal of hemorrhoids. There are 2 types of such operations:
- Treatment of hemorrhoids of the 1-2 degree, when the blood vessels that feed the node are cauterized with a laser.
- With a disease of 3-4 degrees. The laser is introduced into the node itself and it is cauterized from the inside.
The method of surgical intervention is chosen after examination by a proctologist, determining the stage and severity of the disease. You can make an appointment by phone or online.
Types of surgery to remove hemorrhoids (hemorrhoids) (with prices and reviews)
Hemorrhoids in the late stages of the disease respond poorly to medical correction. Therefore, often to active people, especially of working age, hemorrhoids removal surgery is recommended. How is the preparation for surgery going, what types of surgical treatment exist, we will discuss below about the features of the course of the postoperative period (we will also dwell on what price and reviews on surgical intervention).
When the threat looms
Like any surgical intervention, surgical treatment of hemorrhoids is carried out according to strict indications. The most common reasons for referring to surgery are:
- Frequent hemorrhoidal hemorrhages or rare, but profuse, leading to significant blood loss and chronic anemia.
- The danger of a blood clot during prolapse of significantly enlarged nodes of internal hemorrhoids. The formation of a thrombus of hemorrhoidal veins per se is not as dangerous as its complications. The resulting blood clot can come off and begin to circulate in the systemic circulation. A blood clot settles in an inappropriate vessel for its size and causes acute circulatory failure.
- A significant increase in external hemorrhoidal veins.
- High risk of inflammation. The anal area is not the cleanest part of the body. A large number of various microorganisms are constantly present in it. The special secret developed by the skin, the impossibility of adequate hygiene due to the soreness of the affected area create excellent prerequisites for the multiplication of microbes and the development of inflammation.
- The pronounced symptoms of hemorrhoids: pain, discomfort, intolerable itching.
- Prolapse of the rectum.
- Other complications.
In some situations, the operation to remove hemorrhoidal veins is easier to tolerate than constant torment with an ailment.
Types of Intervention
Removal of hemorrhoidal nodes is possible in several ways. Methods
- Longo's operation for hemorrhoids. They do it under local anesthesia and it lasts about 15 minutes. Suitable for the treatment of internal hemorrhoids of varying severity. For external (external) hemorrhoids, other treatment methods will have to be used. Operation Longo is considered one of the most effective methods. On the network you can find a video showing the progress of the operation.
The essence of the operation is to pull up the enlarged nodes, which leads to a gradual desolation of the veins, after which they are replaced by connective tissue fibers. Stages:
- Stretching the edges of the anus for insertion of an expansion device.
- Introduction through anoscope extender with obturator.
- Imposing a loose purse string suture.
- Introduction of a circular stapler.
- The intersection of hemorrhoidal vessels with a circular knife of a stapler, the bonding of the edges of wounds.
- Revision of the site and, if necessary, the application of fastening stitches with absorbable threads.
- Removing appliances.The introduction into the rectum of a gauze strip with a medicine and a vent tube.
Some methods of surgical intervention leave traces, and after the operation a long rehabilitation is required. Longo intervention leaves no scars and does not require a long recovery. The disadvantage may be the cost of treatment, which the clinic where the surgery is performed sets for the operation.
- Operation Milligan-Morgan. Fairly painful procedure. During the intervention, not only the enlarged hemorrhoids of the internal or external (external) hemorrhoids are removed, but also the area of the mucosa. The disadvantages of the method are:
- Profuse blood loss.
- The duration of the operation.
- Complex and long recovery period.
Of the advantages distinguish how much the operation costs. The cost of intervention is an order of magnitude lower compared to other options. An introductory introductory video is found on the net.
- Parks operation. A variation of the previous operation, but less traumatic. Only enlarged hemorrhoids are subject to removal. Benefits that hemorrhoids removal from Parks provides:
- The absence of severe pain.
- The ability to quickly restore self-defecation.
- Ligation of veins with special rings. Provides minimally invasive methods. The essence of the method: elastic, hypoallergenic latex rings (photos and video devices are on the Internet), the doctor ligates hemorrhoids, thereby stopping blood flow in them. Vienna starts and after 10-14 days the plot is rejected. Stages of carrying out:
- An anoscope is inserted into the anus.
- Using a mechanical ligator equipped with a clamp, the assembly is retracted into an elastic ring.
- After ligation with latex rings, the devices are removed.
Ligation has many advantages: the method does not require pain relief and hospitalization. The intervention lasts 10-15 minutes. There is no rejection clinic, that is, no negative symptoms are observed in humans.
The disadvantages of the procedure are: the probability of re-formation of hemorrhoids and the inability to treat external hemorrhoids. Feature of the operation: other methods of surgical treatment make it possible to remove several enlarged nodes at once. During ligation, the ring is applied to only one area. How much does the operation cost, we will indicate below.
- Sclerotherapy. Provides minimally invasive methods. The essence of the intervention: a substance is introduced into the lumen of the dilated vein, which causes inflammation in the vessel wall and the vein sticks together. The corresponding video can be found on the Internet.
The procedure is possible with a 1-2 degree of hemorrhoids. With the 3rd treatment result is doubtful, and with the 4th degree sclerotherapy is used exclusively as preparation for surgery.
How much does sclerotherapy cost, we will describe below.
The correct behavior in the postoperative period helps to significantly reduce the number of complications, which is confirmed by reviews of surgeons. Rehabilitation takes place in several stages:
- Early. Includes a number of measures to prevent bleeding, inflammation. Some patients have a vent tube and tampons with antiseptics injected into the rectum. With severe pain, pain medications are prescribed. Everyone is shown a diet with the exception of solid foods.
- Late. Provides for diet, the exclusion of physical overload.
Patients are advised to eliminate risk factors that contribute to the re-formation of hemorrhoids.
Removal of hemorrhoids: surgery
When revealing hemorrhoid cones in a patient, most specialists try to resort to traditional methods of treatment. If they did not bring relief, and the situation worsens, the only way out is the operation to remove hemorrhoids.Before performing surgery, it is necessary to eliminate inflammation and stabilize the patient's condition. The operation is prescribed for prolapse of nodes and bleeding that cause iron deficiency anemia.
Indications for surgery
Surgical intervention is required when a patient suffering from hemorrhoids has serious complications. Other indications for surgery:
- prolapse of hemorrhoid cones after an act of defecation,
- thrombosis of hemorrhoids,
- lack of effect after conservative treatment,
- anal fissure,
- polyps in the anal canal.
The operations that are performed with hemorrhoids are not suitable for all patients. In the presence of contraindications conservative or minimally invasive therapy is used. Removal of hemorrhoids by surgery is not carried out with:
- the presence of any infectious processes in the body,
- exacerbation of chronic diseases,
- lactation period
- Crohn's disease
- HIV infection.
Possible complications after surgery
Before prescribing surgery as a treatment for hemorrhoids, the doctor carefully analyzes the risks that may arise as a result of the procedure. Despite the fact that complications are quite rare, the patient is warned about the likelihood of the following consequences:
- severe pain syndrome
- violation of urination (the first 24 hours after surgery to remove hemorrhoids),
- gas and stool incontinence caused by weakening of the anal sphincter,
- infectious and inflammatory process in the operated area,
- heavy bleeding
- narrowing of the anal canal, which makes the bowel movement difficult,
- severe psychological condition.
Preparing to remove humorrhoids
Before performing the operation, it is necessary to comply with a number of doctor's prescriptions. As with all other proctological manipulations, the main preparation in this case is a thorough bowel cleansing. Other activities include:
- Passing a full medical examination in a hospital or clinic. It includes blood tests, urine tests and electrocardiography. They are necessary in order for the surgical treatment of hemorrhoids to be as successful as possible.
- Low fiber diet Excluded products that cause increased gas formation. These include cabbage, brown bread, legumes, fresh vegetables and fruits.
- Cleansing enema. Rinsing must be done until the water is clear.
- Restriction on food from the evening of the previous day to the intervention.
- Taking sedatives.
It is worth noting that cleansing measures aimed at normalizing the work of the intestine should be carried out not only on the eve of the operation, but also a few weeks before it. This will help eliminate constipation, which provoke an exacerbation of hemorrhoids. If this is not done in advance, then after the operation to remove hemorrhoids is completed, the patient may experience complications. Inflammation in the anus is also necessary to remove. To eliminate irritations, small ulcers and puffiness, medicinal and folk remedies are used. To reduce pain, the doctor often prescribes analgesics or the use of nitroglycerin ointment in the field of surgical intervention.
Types of hemorrhoid surgery
In modern medical practice, various minimally invasive practices have become widespread. "Sparing" types of operations for the treatment of hemorrhoids:
- Sclerotherapy. In this case, a substance is introduced into the node that helps to connect the venous walls
- The use of laser and radio wave therapy.
- Cryodestruction. The knot is frozen with liquid nitrogen.
- The use of infrared rays.
- Ligation.This technique is a bandaging of the hemorrhoid with latex rings, after which it disappears.
Treatment in the late stages of the disease
Minimally invasive operations are performed on an outpatient basis. Local anesthesia is used for pain relief. The use of such minimally invasive techniques is permissible only if the disease is at an early stage. The more serious types of surgery aimed at removing hemorrhoids are the following methods:
- Operation Milligan-Morgan. In this case, hemorrhoid cones, including the mucous membrane, are completely removed. It is considered the most traumatic method. It takes about three weeks to recover.
- Operation Parks. The venous node is excised without touching the mucosa. The recovery period is less long and less painful.
- Longo surgery. The equipment is inserted through the rectum, where the portion of the artery that feeds the node is pinched. The whole procedure takes no more than 20 minutes. Blood loss is minimal. Recovery occurs within five days. After this type of surgery, there are no traces on the surface of the skin.
The price of a hemorrhoid surgery in our center
The cost of the procedure can be found in the price list section on the MHC network of the Open Clinic website. The price of hemorrhoid surgery in our center depends on the qualifications of the specialist, the quality of the equipment used and additional services. The clinic has an inpatient department, where each patient undergoing a recovery period will be provided with thorough medical care.
Entry to the medical center: +7 (495) 241-66-34
Internal binding (Subbotin method)
Minimally invasive surgery performed under local anesthesia. A clamp and a scalpel are inserted into the anus.
The mucous membrane around the base of the node is bandaged with a special ring. After a while, the bloodless node dies and falls out on its own.
Below are photos both before and after hemorrhoidectomy:
The rehabilitation period after hemorrhoidectomy lasts from 4 to 6 weeks, depending on the type of surgical intervention, the age of the patient and the state of his body. Performance is restored after 3-4 weeks, but pain can last much longer.
Therefore, in the first month after surgery, patients are prescribed painkillers to restore their general condition after hemorrhoidectomy.
When can I sit after hemorrhoidectomy? You can sit after removing the nodes no earlier than the fourth day.
If severe pains are felt, and blood discharge is observed after hemorrhoidectomy, it is better to wait another three to four days so that the wounds heal properly.
To reduce the load on the anus, special devices in the form of a donut are useddesigned for seating. In the first two weeks it is necessary to move as little as possible, to exclude any physical activity.
The main problem in the postoperative period is severe pain. They are removed with nitroglycerin ointment.
To speed up the healing process after hemorrhoidectomy, baths with chamomile or potassium permanganate are used. Effective use of suppositories with methyluracil, which accelerate tissue regeneration.
An important point after the operation is hygiene. The anus should be thoroughly washed and treated with an antiseptic after defecation, so that the inflammatory process does not develop when it gets into the wound of an infection.
Within 1-2 months after surgery, the patient will have to follow a special diet after hemorrhoidectomy:
- It is necessary to eat fractionally, 5-6 times a day. A serving of food should be no more than 200 grams.
- The menu is selected from easily digestible products so that the chair is formed as soft as possible. The basis of the diet should be steamed vegetables, soups, kefir with bifidobacteria.
- Completely exclude products that promote gas formation.
- Liquids must be consumed at least 6-7 glasses a day. It is necessary to exclude coffee and tea from the diet, give preference to simple, still water. Fruit and vegetable juices have a beneficial effect on the intestines.
- Sweets and pastries, salted, smoked and fried foods are prohibited.
It is strictly forbidden to drink alcohol after hemorrhoidectomy in the first two months. It is worth giving up not only vodka, but also beer.
Postoperative complications and their prevention
The following complications are most common:
- Urinary retention. The problem is solved by the introduction of a catheter in the first day after surgery.
- Delayed feces. Constipation after hemorrhoidectomy is a rather psychological problem, associated with a fear of pain during bowel movements. In this case, a laxative is prescribed.
- The development of fistulas and fissures in the anus. It occurs due to injuries in feces. Cracks are healed with nitroglycerin ointment. Fistulas require excision.
- Prolapse of the gut. This complication requires immediate surgical intervention, otherwise tissue necrosis may occur, which will lead to a complete loss of organ functions.
- Narrowing the anus. The problem is solved by the introduction of dilators or plastic surgery.
- Fecal incontinence. It occurs due to a violation of the ligaments in the anus.
Hemorrhoidectomy is a radical way to remove nodes. Correctly performed operation eliminates the problem for a long time. In principle, hemorrhoid cones removed by surgery cannot, in principle, develop again.
But this does not mean that once cured of hemorrhoids, a person will not meet with him again. In the presence of provoking factors, new nodes form in the rectum, and they will again have to be removed.
The appearance of relapses after hemorrhoidectomy is possible under the following conditions:
- Violation of diet: overeating, rare meals. Such a diet leads to digestion, provokes constipation, therefore, rectal tension increases during bowel movements.
- Eating spicy and smoked foods, which contributes to an active rush of blood into the pelvic organs.
- Weight lifting.
- Long time sitting.
Possible infections and inflammations
To avoid recurrence of hemorrhoids and to consolidate the results of the operation, it is necessary to adhere to the following recommendations:
- Do not lift heavy objects.
- Exclude physical stress with press tension.
- Try to spend less time sitting and standing. If you spend time sitting by the nature of the activity, you need to get up and walk around as often as possible so that the blood in the pelvic organs does not stagnate.
- Exclude spicy dishes, marinades, smoked meats from the diet.
- It is not recommended to drink alcohol not only after surgery, but also in the presence of hemorrhoidal nodes.
Alcohol reduces blood coagulation and can contribute to bleeding. The decay products of alcohol have a toxic effect on the intestines, the mucous membrane of the rectum when it is removed from the body will inevitably suffer.
Minimally invasive methods
These are the latest techniques to combat the disease in a "gentle" way. There are such varieties:
- IR coagulation
The selected methods of getting rid of the disease are carried out without general anesthesia. After completion of the intervention, the patient can immediately go home. Qualified doctors advise these techniques in the initial stages of the development of the disease.In more serious cases, surgical treatment of hemorrhoids is recommended.
Types of hemorrhoidectomy
Surgical treatment of hemorrhoids is an extensive radical method for eliminating nodes, performed under general anesthesia.
There are many of its varieties, each of which will dwell in more detail:
- open removal
- Milligan-Morgan method,
- Longo way.
An open hemorrhoid surgery is performed when the patient has noticed various complications. To avoid heavy bleeding, use a special scalpel to stop the blood in the damaged areas. The blood flow to the node is closed, which leads to its decrease.
Closed removal method is considered traditional. After the operation to remove hemorrhoids takes place, catgut fixation of the mucous tissue is done. Rehabilitation after the intervention is quite long, throughout this time, doctors recommend taking medications for pain relief.
Milligan-Morgan surgery is one of the oldest methods of getting rid of hemorrhoids. Indications: large nodes, the possibility of severe bleeding.
The procedure is quite lengthy, so the patient is under anesthesia for a considerable time, and then is rehabilitated for a long time in hospital treatment. The cause of the disease is eliminated (venous formations and affected areas of the mucosa are excised), but there is the possibility of the reappearance of hemorrhoids.
Longo's method is suitable for operating internal hemorrhoids. The essence of the intervention is that the artery, which provides blood supply to the inflamed nodes, is pulled, imposing a special seam on it.
The main advantages of this method: it is carried out in a dispensary under local anesthesia, the duration is no more than 30 minutes. The patient may be hospitalized for a day, or not at all. A person is fully restored in time from 3 to 5 days.
Why can not milk, and dairy products - can?
This question is asked by many patients. The thing is that the bacteria that are and are constantly acting in milk are already inactive in the products of the fermented milk group. They stopped fermentation, creating many useful substances. They are also useful for digestion.
Among protein products, it is advised to add chicken, veal and fish to the diet. Doing this is worth about a week after the operation. The most useful vegetables are pumpkin, beets, lettuce and carrots. Of fruits during this period, bananas and kiwi are recommended.
In addition, you need to drink plenty of fluids. Best if it is water (still) or herbal tea.
Rehabilitation after surgery for hemorrhoids is a difficult period in which you need to adhere to all the rules and recommendations of a doctor as accurately as possible. The speed of recovery and your further health depend on this.
Surgical treatment of hemorrhoids
The occurrence of hemorrhoids provokes many factors, for example, heavy physical exertion, an unbalanced diet, the consumption of alcohol-containing drinks, etc.
There are many methods of getting rid of the disease. These include surgical treatment of hemorrhoids. According to many patients, the treatment of hemorrhoids without surgery is a more attractive option, but in some cases the operation is necessary.
When is surgery required?
Surgical treatment of hemorrhoids is necessary in these cases:
- Drug inefficiency and disease progression.
- The loss of hemorrhoidal nodes in the allocation of feces.
- Other diseases of the rectum.
- Anemia provoked by constant bleeding during bowel movements.
Prices for both operations directly depend not only on the pricing policy of the clinic, but also on the region. The approximate cost is indicated in the table:
|Moscow||from 36,000 rubles||from 25000 rubles|
|St. Petersburg||from 35000 rubles||from 22000 rubles|
|Kazan||from 32000 rubles||from 20,000 rubles|
Minimally invasive surgery
Surgical treatment of external hemorrhoids and internal is not always necessary. As an alternative, a specialist can offer:
- Disintegration. Arteries that saturate the node with blood are pulled, after which it goes outside without causing inconvenience.
- Laser surgical treatment of hemorrhoids. The nodes are affected by a special laser.
- Cryodestruction. After the manipulation, the node treated with liquid nitrogen comes out.
- Vacuum ligation. Knots are pulled by vacuum.
- Sclerosis. The node is saturated with a substance that is detrimental to it. The procedure for introducing the composition through the needle has both bad and good reviews.
Careful preparation for surgical treatment is one of the keys to a successful operation. Before exposure to specialists, you need to take these measures:
- The examination recommended by the proctologist.
- Diet. It means giving up fiber-containing foods. This is especially true for legumes.
- Hunger. Have dinner at seventeen to eighteen in the evening and do not eat food on this and the next day (day of operation).
- The use of sedative medications. Reception should be carried out in the evening and in the morning.
- Enema or use of the drug "Fortrans". If you are intolerant of the medicine, you need to do an enema to clean water.
In which cases is surgical treatment of hemorrhoids recommended?
At the moment, there are many ways to get rid of hemorrhoidal disease. This is a conservative therapy, which includes systemic and local drugs, minimally invasive methods that allow you to quickly and painlessly remove nodes. All of them are effective, but can only help in the initial stages of the disease.
In more severe cases, only a radical hemorrhoid surgery can solve the problem. There are two types of surgical interventions that are fundamentally different from each other.
What you need to know for people who need surgical treatment for hemorrhoids
Surgery for hemorrhoids is carried out in almost all hospitals, but it is better to do it in a special proctology clinic. Indeed, only an experienced surgeon who knows his job will be able to correctly carry out surgical intervention. Typically, specialists operate on patients with chronic hemorrhoids when the disease is in remission and there are no acute manifestations.
With exacerbations, the operation is more difficult, while the results of the intervention itself are not always satisfactory, in addition, the risk of postoperative complications significantly increases. In this regard, hemorrhoids during exacerbation with thrombosis and infringement, as a rule, do not operate.
First, the inflammatory process is removed by therapeutic methods and only then surgical treatment of hemorrhoids is carried out. As a result of surgical intervention, dysfunction of the rectum and sphincter should not occur.
In such cases, the anal canal may be so narrowed that it will complicate bowel movements or, conversely, will not be able to hold feces.
Before surgery, the doctor must evaluate the nature of the course of the disease, especially the patient’s anatomy and select the most suitable option for the intervention.
As already explained above, surgery for hemorrhoids is prescribed at the third and fourth stages of the development of the disease, when the nodular formations are already uncontrollable on their own inside, when the bleeding is heavy and difficult to stop, when the pain reaches a critical point.
There are two types of surgical intervention:
- Longo surgery.
Treatment of hemorrhoids using the Longo method
Surgical treatment of hemorrhoids by the Longo method involves excising a section of the mucosa and pulling up the nodular formations.Nodules themselves are not cut.
The tool for such surgery is something like a stapler. This device sews the ends of the mucous membrane with brackets of titanium. Nodular formations do not receive sufficient nutrition in the form of blood, since it already enters too little.
They dry out, forming small scars. Surgery lasts twenty minutes.
The benefits of this method of treating a disease
- The inside of the colon is not damaged. The opening of the anus is restored and takes its former form.
- The recovery period does not last long, proceeds without special complications and severe pain. In the clinic, the patient spends a couple of days.
- Leaving the clinic, the patient can immediately return to his normal lifestyle. He can return to work after five days. The return of the disease is almost not observed.
- Surgical intervention is carried out under the influence of local freezing. There are no restrictions for this operation.
The knowledge needed by a patient who has decided on surgery
- Have a consultation with a doctor. Make sure that all other methods, except for surgical intervention, will be useless. Learn more about the doctor who will conduct the operation, his qualifications. Read reviews about him. Chat with your roommates. Do not forget that the law allows you to change the doctor if you have any doubts.
- Talk with your doctor about all the details of the surgery awaiting you. The doctor will tell you why surgery is necessary, what the risk of complications may be, and will predict what awaits the patient in the postoperative period. Do not be shy, ask, remove doubts and anxieties, consider the upcoming operation.
- Surgical intervention is carried out in any hospital, however, it is better to be operated on by a doctor - proctologist in a special clinic. The proctologist is like a jeweler in his work, and the operation to remove hemorrhoids needs skillful hands. If the patient has an acute manifestation of the disease, it is better to wait this time. It is more reliable to operate at the moment of a lull of a disease.
- At the acute stage, the surgical intervention is more complicated, the risk of postoperative complications is great, the results are not always encouraging. Therefore, an experienced specialist will not undertake surgery at the stage of exacerbation of hemorrhoids. It is necessary before the operation to remove inflammation with medical methods.
- As a result of the operation, all previously working functions should remain in the same working condition. So, for example, if after the intervention, the rectum cannot hold the feces, or, conversely, cannot release it, why such an operation was needed. Therefore, so that there are no such complications, the doctor tries to keep the mucous membrane intact. Prior to the operation, the doctor must study the patient’s body, its structural features, the nature of the course of the disease and choose the most optimal option for surgical intervention.