How to do surgery for hemorrhoids. Types of operations to remove hemorrhoids: hemorrhoidectomy, hemorrhoidopexy, ligation, laser coagulation, sclerotherapy, etc. How long after the operation is it better to get pregnant

Hemorrhoids is a disease of the rectum that occurs due to the expansion of the veins. As a result, blood clots accumulate in the tissues of the rectum and hemorrhoids appear.

Before becoming chronic, hemorrhoids go through 4 stages of development. If at the initial stage this disease can be cured without surgical intervention, then in the last stages this problem can be solved only with the help of an operation to remove hemorrhoids.

The operation to remove hemorrhoids is currently carried out mainly in the final stages of the process, in the event that all other methods of treatment have been recognized by the attending physician as ineffective. In addition, surgical intervention is recommended for thrombosis of hemorrhoids.

An indication for surgery to remove hemorrhoids may be the presence of prolapsed nodes, which is accompanied by heavy hemorrhoidal bleeding.

Currently one of the most effective means treatment of hemorrhoids is the surgical removal of hemorrhoids, which should be carried out outside the stage of exacerbation of the disease. The main contraindication for this procedure are pronounced inflammatory processes in the rectum.

Modern operations aimed at removing hemorrhoids are carried out in several ways. Previously, the rehabilitation period after surgery to remove hemorrhoids was quite long, while the operation itself was extremely painful. Thanks to modern methods surgical treatment of hemorrhoids, as well as advanced tools, the operation to remove hemorrhoids in most cases can be carried out safely, quickly and almost painlessly.

There are a number of indications for which surgery to remove hemorrhoids is a necessary treatment measure.

In the event that rectal prolapse, accompanied by profuse bleeding, is diagnosed in young man, it is recommended to immediately perform an operation, since blood loss can cause anemia.

If a middle-aged person suffers from hemorrhoids, surgery is also recommended in most cases. however, the patient must first undergo a complete medical examination. In addition, invasive procedures are indicated. Thanks to these procedures, some patients will be able to get rid of prolapse of the rectum and heavy bleeding. In this case, the need for an operation to remove hemorrhoids is eliminated.

Elderly people suffering from rectal prolapse are shown mainly medicinal methods of treatment, such as tablets, suppositories and ointments. Not the last place in the treatment of this category of people is occupied by folk remedies for hemorrhoids. Surgical intervention for this category of patients is recommended only in exceptional cases, with a severe degree of development of this disease.

Since the removal of hemorrhoids is a real operation, which is performed under anesthesia, this procedure may be contraindicated in patients with severe comorbidity.

Also contraindications for an operation to remove hemorrhoids are:

• heart failure;
• various oncological diseases;
• diabetes mellitus (due to poor wound healing);
• intestinal diseases associated with the presence of ulcers or acute inflammatory processes;
• immunodeficiency states.

It is worth noting

One of the relative contraindications to surgery is pregnancy. Remote on late term Pregnancy hemorrhoids are often prone to recurrence, while without surgery they can disappear after childbirth on their own.

Methods of surgical intervention: minimally invasive, surgical, laser, Longo operation. The cost of surgery to remove hemorrhoids.

Surgical removal of hemorrhoids is performed in almost 50% of cases of hemorrhoids - this can be explained by the fact that patients often go to the doctor when conservative methods of treatment are no longer effective. There are the following methods of surgical intervention: minimally invasive, surgical removal of hemorrhoids, laser removal of hemorrhoids.

Minimally invasive methods

A feature of minimally invasive methods is that the specialist does not use a scalpel to remove hemorrhoids - instead, several punctures are made in the internal tissues, through which all the necessary manipulations are performed. The indisputable advantage of this method is the absence of any contraindications, as well as a relatively short rehabilitation period.

The most common minimally invasive methods for removing hemorrhoids can be considered: sclerotherapy, ligation using latex rings, mono- or bipolar coagulation, laser coagulation, photocoagulation using infrared radiation, and cryodestruction.

Removing hemorrhoids surgically involves:

• Ordinary surgery to remove hemorrhoids
• Removing drop-down nodes using radio waves
• Hemorrhoidectomy
• An operation aimed at removing hemorrhoids using the Longo method

One of the most common surgical operations to remove hemorrhoids is the Longo operation for hemorrhoids.

How to remove hemorrhoids using the Longo method:

• At a distance of 1 centimeter from the edges of the anus, special clamps are applied to the skin, which are then stretched to the sides.
• A dilator is inserted into the anal canal, which is fixed to the skin of the perianal region with four sutures. The ends of the threads are tied with knots. After that, an anoscope with an obturator is inserted into the expander.
• A purse-string suture is applied to the mucous membrane of the rectum, to the area located 4-5 centimeters above the dentate line. At the same time, during the execution of seams, the anoscope cannot be turned in the expander - for each new stitch it is pulled out and reinserted. due to which the mucous membrane is not twisted, and the seam is symmetrical.
• The threads are not tightened immediately, since it is first necessary to check the correctness of the suture.
• A hemorrhoidal circular stapler is inserted into the lumen of the rectum - the head of the device is directed above the purse-string suture, and the stapler itself should be in the maximum open position.
• The purse-string suture is carefully tightened, the threads forming it are tied in one knot, after which the ends of the threads are brought out through the side holes of the stapler, tied and held.
• The stapler is advanced inward, its handle is turned clockwise, while the device closes, a fragment of the intestinal mucosa and hemorrhoidal vessels cross circular knife, and the ends of the wound are neatly fastened.
• The stapler is removed. In this case, the removed piece of the intestinal mucosa must be examined to make sure that the procedure is performed correctly.
• If bleeding persists, additional stitches are performed with absorbable surgical suture.
• After removing the anoscope from the intestine, a gauze strip impregnated with drugs and a gas outlet tube are placed on the affected area for a day.

If we talk about how much the operation to remove hemorrhoids costs, then according to the Longo method, the cost of the operation is approximately 35 to 40 thousand rubles.

Advantages of Longo's operation for hemorrhoids:

• The duration of the procedure is only about 15-20 minutes.
• The absence of an extensive wound in the patient after the procedure.
• A short rehabilitation period - a person can return to normal life almost immediately.

However, there are also disadvantages of Longo's operation for hemorrhoids:

• Using the Longo method, external hemorrhoids cannot be removed.
• This type of medical service is expensive.

Removal of hemorrhoids with a laser.

The main advantage of this method is the absence of a pronounced pain syndrome. During the procedure, the patient practically does not feel pain, which makes it possible to refuse the appointment of painkillers. In addition, unlike other methods of surgical intervention, after this procedure, you can immediately walk.

Another advantage of the laser method of treatment is the fact that when using this method, there is practically no traumatization of the anus and rectal membrane.

Removal of hemorrhoids with a laser is used both in the initial stages of the disease, with internal nodes, and in the presence of external bumps. The technique of this manipulation is simple: with the help of a laser, the internal nodes are burned from the inside, connective tissue develops in them, and there is a natural decrease in the size of the nodes. In the case of external hemorrhoids, the nodes are cut off with a laser beam. In this case, the tissues are instantly soldered without bleeding.

In the photo you can see the results of laser hemorrhoid removal:

A - hemorrhoids before laser removal;

B - area of ​​hemorrhoids after the laser removal procedure.

The method of removing hemorrhoids with a laser has the following advantages:

• Removal of hemorrhoids with a laser is relatively painless - during this procedure, the patient feels only a slight warmth. Patients with a low pain threshold may be asked to undergo laser removal under local anesthesia.
• The duration of the procedure for removing hemorrhoids with a laser is only 10-15 minutes, which allows it to be performed on an outpatient basis.
• For carrying out this procedure, there is no need for any preliminary preparation.
• Almost immediately after the procedure, the patient can go home, and the very next day he can return to normal work activities.
• Thanks to. that the laser beam instantly cauterizes bleeding vessels, there is no blood loss when removing hemorrhoids with a laser.
• After this procedure, no scars remain.
• The procedure for laser removal of hemorrhoids can be carried out in the presence of inflammatory processes, fistulas and cracks.

However, there are also some disadvantages:

• Large hemorrhoids are not completely removed, which can lead to relapses of the disease in the next 5 years.
• Surgery to remove hemorrhoids with a laser is a rather expensive procedure.

Often, after surgical removal of hemorrhoids, the question arises - what to do to avoid recurrence? What should be paid attention to during the postoperative period?

In this case, it is necessary to perform a number of medical procedures aimed at accelerating the regenerative processes and preventing various complications. Quite often, for this purpose, take special baths based on chamomile or potassium permanganate. In the event that the recovery process is accompanied by severe pain, analgesics are indicated, suppositories and ointments are used for inflammatory processes and bleeding.

It is worth noting

Treatment of any disease can be effective only with an integrated approach, which includes significant changes in lifestyle in general. Otherwise, after a while, the disease may return again.

In addition, in the future it is necessary to follow the methods of prevention aimed at preventing the recurrence of the disease. In the absence of complications, it will be effective to perform special exercises for hemorrhoids.

All materials on the site are prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative and are not applicable without consulting the attending physician.

The operation to remove hemorrhoids is considered one of the most frequent in proctology. This is not surprising, because the disease itself is widespread among the adult population of most countries of the world. Patients with hemorrhoids try to avoid surgery by applying conservative methods of treatment. In many cases, this approach is fully justified, since any operation carries a certain risk, and even more so, interventions on the vessels.

However, it happens that conservative treatment, coupled with a diet and regimen, no longer brings relief, varicose nodes reach large sizes, fall out and thrombose, and the patient experiences excruciating pain and is forced to abandon his usual way of life.

When surgical treatment becomes the only way to get rid of hemorrhoids, a proctologist evaluates the patient's condition and chooses best way removing nodes. Below we will try to understand the indications and methods of operations to remove hemorrhoids.

Indications for removal of hemorrhoids

When planning surgical treatment, it is necessary to weigh the expected benefits and risks of surgery, the indications for which are limited, although in proctology, hemorrhoidectomy occupies almost the first place in terms of frequency among all interventions.

Removal of hemorrhoids in elderly patients suffering from hypertension, diabetes, colitis and constipation can not only be quite risky, but is 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:

• 4 stage of the disease; hemorrhoids of the 3rd degree - with a significant increase in nodes.
• Prolapse of hemorrhoidal veins with every act of defecation.
• Development of anemia due to recurrent bleeding.
• Lack of results from conservative therapy.
• Thrombosis of hemorrhoids.

The general condition of the patient and the presence of other pathologies (anal fissure, fistulas, polyps in the rectum), the age of the patient, etc. are always taken into account. For example, surgery may be contraindicated for pregnant women, and the elderly may require preliminary thorough preparation.

In addition to indications, there are also contraindications, in particular, acute or exacerbation of chronic diseases of the large intestine, malignant tumors, severe decompensated pathology internal organs, sharp infectious diseases, bleeding disorders. In these cases, the operation will have to wait.

Preparing for a 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, and also prepare the rectum itself for surgery.

Before the planned treatment should be necessary minimum examinations: general and biochemical blood tests, urinalysis, testing for syphilis, HIV, hepatitis, coagulogram. According to the indications - ultrasound of the organs abdominal cavity. 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 fermented milk 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 indicated, which can be replaced with special preparations that cleanse the intestines (fortrans). By this time, if the patient has taken blood-thinning drugs, they should be discontinued.

Classic hemorrhoid surgery is performed under general anesthesia, the patient lies on his back, and the lower limbs are fixed on special supports. Foreign surgeons often perform the operation with the patient in the prone position, since this improves the outflow of venous blood from the dilated 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 can go home the same day.

Types of operations to remove hemorrhoidal veins

To date, the most effective radical methods for removing hemorrhoids are recognized as the classic Milligan-Morgan hemorrhoidectomy and resection of the rectal mucosa using 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.

Hemorrhoidectomy

The Milligan-Morgan operation has undergone many modifications and continues to improve. Its essence is to remove both external and internal hemorrhoids after stitching the vascular pedicle. At the beginning of the operation, the surgeon excises the skin of the anal region and the rectal mucosa over the dilated venous plexuses, then ligates the veins and removes them. Finally, the inner wall of the intestine is fixed to the underlying tissues, and the wounds in the wall of the organ can either be sutured or left open. The approach depends on the experience and preferences of the surgeon, it does not make a fundamental difference for the patient.

The stages of the operation include anesthesia 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 certain sequence. The surgeon, mentally imagining the watch dial, first captures the "bumps" located at three o'clock, then at seven and eleven. Having seized the node with a clamp, the doctor stitches its 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.

Some doctors pack the rectum after a classic hemorrhoidectomy, but this contributes to pain and urinary retention, so most specialists do not pack the rectum. To maintain sensitivity in the anus and avoid narrowing of the anal canal, mucocutaneous bridges are left in the wound area.

The Morgan-Milligan operation is quite traumatic and requires general anesthesia, which means that the preparation for it must be thorough and serious. Its advantage is the possibility of excision of not only internal, but also external varicose veins.

Another option for surgical treatment of hemorrhoids is the intervention by the Italian surgeon Longo, who proposed to cross the rectal mucosa and vessels that carry blood to the hemorrhoids, circularly, eliminating vein prolapse. The Longo operation can be an alternative to classical hemorrhoidectomy and is successfully used in the West, but in Russia it was only started to be performed about five years ago.

Longo technique

Longo's operation is more gentle than the classic hemorrhoidectomy, since a small area of ​​the mucous membrane is resected, and the nodes are not excised, but, as it were, pulled up and fixed. The blood flow to the veins decreases, and they are gradually replaced by connective tissue. To suture the mucous membrane at the resection site, titanium staples are used, which are applied using special staplers.

The operation according to the Longo method takes about 15 minutes, and local anesthesia is sufficient for its implementation. Low trauma, but at the same time an excellent therapeutic effect, low likelihood of complications and relapses make it preferable in elderly patients, those with severe comorbidities.

Despite the undoubted advantages, the removal of hemorrhoids by the Longo method also has some disadvantages, including the impossibility of excision of externally located dilated veins, the need to monitor the patient for at least 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 consequences of the treatment.

In addition to the described types of hemorrhoidectomy, in the arsenal of modern doctors there are also minimally invasive ways to deal with the disease, which can be used both for internal hemorrhoids and for external formation of nodes:

• Treatment with a laser;
• radio wave treatment;
• Desarterization;
• Ligation;
• Sclerosis and thrombectomy.

Excision of hemorrhoids with a laser very efficient. 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 involves the excision of nodes by means of a radio knife (Surgitron apparatus). Under local anesthesia, the doctor performs the removal of varicose veins. The undoubted advantage of this method of treatment is the almost complete absence of contraindications. The procedure is carried out quickly, with it the surrounding tissues of the intestine and anus are not damaged, which means that the likelihood of scarring and bleeding is reduced to zero.

Desarterization – new method the fight against hemorrhoids, which consists in "turning off" the blood flow through the arteries of the rectum. Expanded venous plexuses at the same time subside, decrease in volume and are eventually replaced by connective tissue. The patient needs only a few days to recover, and the procedure itself is painless.

Ligation- the most popular sparing way to deal with 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, carried out according to indications, avoids hemorrhoidectomy in absolute majority sick.

ligation

Sclerosis- a widely used method of dealing with varicose veins of any localization, the rectum is no exception. A special substance is injected into the hemorrhoids, causing them to "glue" and sclerosis.

Often the disease occurs with thrombosis of the hemorrhoidal veins, which causes severe pain and requires mandatory treatment. One of the options for minimally invasive operations in such cases is thrombectomy, when blood clots are removed from the veins using a laser or radioknife. The procedure is performed under local anesthesia on an outpatient basis. In addition, in this way it is possible to remove the nodes of external hemorrhoids at any stage of the disease, if they cause discomfort to the patient, but there are no indications for their radical excision yet.

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 carried out in the early stages of the disease, and thrombosis of the nodes, the formation of an anal fissure, acute and chronic inflammatory processes in the rectum and perineum can become a contraindication to them.

After operation…

The postoperative period usually proceeds quite well, but the need to defecate and ensure the painlessness of this process can bring significant inconvenience. On the first day after the intervention, the appearance of stool is highly undesirable, as it can cause severe pain and injury to the postoperative wound, and in order to avoid this, a complete refusal to eat 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, sour-milk products. Be sure to drink plenty of water. 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 possible urinary retention, the rectum is not plugged after the intervention, and the patient is advised to consume a sufficient amount of liquid. This complication is especially common among men and often requires the insertion 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 the necessary hygiene procedures, which the clinic staff will tell him about, do not ignore dressings and examinations. The post-surgery diet should contain enough fiber to make stools easier. You need to empty your bowels immediately, as soon as such a desire arises, but you should not linger in the restroom for too long, pushing or straining. If necessary, laxatives may be prescribed.

No matter how hard the surgeons try, it is still not always possible to avoid the adverse consequences of the operation. Among them, the most likely are:

• Bleeding, which may be associated with insufficiently complete suturing of blood vessels, slipping of ligatures;
• Anal stenosis that occurs in the late postoperative period is treated with special dilators or even plastic surgery;
• Infectious and inflammatory processes, suppuration of the wound in case of non-compliance with the rules of asepsis during treatment;
• Recurrence, the likelihood of which persists with any type of surgical treatment.

Hospitalization for radical treatment takes about 7-10 days, after which the stitches are removed, the rectum is examined and, if all is well, they are allowed to go home. One and three weeks after hemorrhoidectomy, a digital examination of the intestine is mandatory to exclude the formation of a narrowing of the lumen of the organ and monitor the results of treatment.

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 persists regardless of the stage of the disease and the type of operation, the patient will have to constantly monitor the condition of the rectum, adhering to some rules:

• Do not lift weights;
• It is necessary to exclude physical activity with tension in the abdominal press;
• If possible, avoid prolonged sitting or standing positions;
• Normalize the diet;
• Ensure adequate physical activity.

Nutrition and movement - the first thing that even those patients who could not deny themselves a cup of strong coffee or a bar of chocolate will have to come to terms 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, if possible, you should take short breaks, get up and walk. Walking is an excellent means of preventing the recurrence of the disease.

The cost of surgical treatment of hemorrhoids depends on the method and volume of the operation. Removal of one node costs from 7,000 rubles, reaching 15-16 thousand in some clinics, ligation - 6,000, sclerotherapy - 5,000 rubles. It is possible and free treatment, but in this case, the patient may be faced with the need to wait in line. Patients who are indicated for urgent treatment for massive bleeding or thrombosis of the nodes, it is carried out free of charge in a surgical hospital.

Removal of the venous plexuses, what we call hemorrhoids, is a measure that is required when drug therapy is not effective. It turns out that indications for surgical treatment are not a rare practice: often, already for patients with the second stage of the disease, the doctor recommends a surgical solution to the problem. It does not yet follow from this that the patient, who first appeared at the doctor, goes straight to the operating table. There are minimally invasive techniques for removing hemorrhoids, and they are not as traumatic and complicated as a classic operation.

But the fact remains: if hemorrhoids fall out, the situation is no longer amenable to medical correction - excision of the hemorrhoid or alternative actions to remove it is required. The classic operation is carried out today not so often: on final stages diseases associated with complications of the pathological process.

When surgery is needed for hemorrhoids, the doctor decides. For a classic operation, serious indications are required, because this is a violation of the integrity of tissues and by no means a simple rehabilitation.

The doctor insists on a surgical solution for hemorrhoids when:

1. Cavernous formations () come out of the anus not only when the rectum is emptied, but also with any tension;
2. The patient complains of frequent and massive bleeding;
3. The sizes of the cones themselves are interpreted as large;
4. The patient has a physiological predisposition to thrombosis in the hemorrhoidal veins;
5. Pain, discomfort, bleeding and burning cross out the patient's usual regimen;
6. All applied conservative methods were powerless in the face of the problem of varicose veins of the rectal vessels.

The final word is up to the doctor: but without the consent of the patient, the patient will not be operated on. The doctor chooses in what period and how the surgical correction of vascular pathology will be carried out.

Surgery is not always possible. There are situations that in themselves will be a contraindication to such therapy. For example, classical hemorrhoidectomy is associated with excision of the skin, mucosa, and choroid. It's connected with possible complications Therefore, it is important for the doctor to calculate all potential risks.

For example, very rarely, hemorrhoidectomy is prescribed for elderly patients, since general anesthesia and a difficult rehabilitation period are excessive loads for them. Yes, and the existing chronic pathologies in every way impede the operation.

Very rarely, if we analyze the situation with examples, hemorrhoid surgery is recommended for patients with diagnosed diabetes mellitus. Chronic hypertension is another point that makes surgery an undesirable intervention.

Serious contraindications for surgery include:

• Fistulas developing in the lower rectum;
• Infection in the large intestine;
• Decompensated stage of chronic diseases;
• Pregnancy;
• Poor blood clotting;
• Genetic susceptibility to bleeding.

But, again, these cases will not be an unequivocal and permanent contraindication to surgery. You can wait for a favorable period when the operation will be real way out and the doctor will also take into account all the risks. It should be noted that minimally invasive technologies are more flexible in this sense: they do not have such a large list of contraindications.

How to Prepare for Hemorrhoid Surgery

One of the radical
methods of treatment of hemorrhoidal disease - operation hemorrhoidectomy. This is preceded by preparation: firstly, an instrumental examination, which will accurately determine the location of the nodes and their size. Anoscopy and sigmoidoscopy are usually performed. Secondly, on the eve of the operation, a person will have to pass a series of standard tests.

These appointments include:

1. UAC. Among the functions general analysis blood - identifying the duration of bleeding, as well as fixing the period of blood clotting and platelet count.
2. OAM (urine must be taken).
3. Biochemistry of blood. Needed to determine the level of glucose, as well as indicators of cholesterol, urea, etc.
4. Setting the blood group and Rh factor.
5. Blood test for syphilis, hepatitis and HIV.

Remember, a full-fledged operation is not just a preliminary examination, but also some procedural points. One of them is colon cleansing. This is usually done with an enema, but taking special laxatives can be an alternative.

A couple of days before the scheduled operation, you need to stop taking medications, among the actions of which is blood thinning. This, I would like to note, anticoagulants, antiplatelet agents, as well as some NSAIDs.

Do I need psychological preparation for surgery?

Fortunately, today many medical institutions employ full-time psychologists who communicate with patients on the eve of surgery.

This is a really good, proven practice. For many patients, surgery is not just stress, but an event that they are very afraid of. The psychologist does not just talk with such a patient, he can do exercises with him that help to relax, normalize breathing, and relieve tension.

If you feel that nervous trembling and intense fear appear even at the thought of how hemorrhoids are operated on, you need to seek help from a specialist. The more prepared you are both physically and psychologically for the operation, the more successful it will be.

Hemorrhoidectomy: how it works

This is a classic intervention for excision of cavernous bodies. Another name for the intervention is the Milligan-Morgan operation. This technique was developed a very long time ago, in 1937. Coloproctologists in the course of time changed the nuances of the operation, in particular, its end.

Today it is done in two ways:

• . This is the same, the primary version of the operation. Doctors remove not only the nodule itself, but also neighboring tissues. So, the doctor does not suture the edges of the wound, it is assumed that the tissues will heal naturally. The doctor wields either a scalpel knife or an electrocoagulator.

• Closed hemorrhoidectomy. It was developed in the early 50s of the last century, and this is already a Ferguson operation. The difference from the above method is the suturing of the wound after completion of the work. It is sometimes done on an outpatient basis.
• Submucosal hemorrhoidectomy. This method was proposed by the surgeon Parkes. This operation is not easy - the doctor removes only the node, leaving its base, while the mucosa itself is not injured. Such an action is more easily tolerated than the two above-mentioned options.

The doctor chooses the most preferred option, discussing the upcoming options with the patient. The specialist and the patient discuss the disadvantages of the operation, which, of course, exist.

This operation used to be common, but today only 15% of patients with hemorrhoids who need surgical correction undergo hemorrhoidectomy. Firstly, minimally invasive hemorrhoid removal techniques have appeared in the practice of coloproctologists, and secondly, the disadvantages of this operation are too significant.

The disadvantages of hemorrhoidectomy include:

1. The duration of the operation;
2. The need for general anesthesia;
3. Massive blood loss;
4. Pain syndrome;
5. The threat of complications;
6. Long rehabilitation.

But it happens that there is simply no other way out, and the patient has to decide on this operation. The doctor will explain how hemorrhoids are removed, what the patient expects after the operation, what are the risks of complications, etc.

How is the operation

The operation takes place in several stages. Shortly before surgery, the entire surgical field is shaved for the patient. An immutable moment is the disinfection of the anus and rectal canal.

The patient needs to lie down
on the back in comfortable armchair(proctological). But sometimes the operation is performed when the patient is in a prone position with a slightly raised pelvis. In this position, there is an outflow of blood from the cones, which facilitates the process of excision for the surgeon. The patient is then given anesthesia. Under what anesthesia the hemorrhoids are removed, the doctor decides - they often use general anesthesia for such a cardinal intervention.

The doctor inserts a dilator with a rectal mirror into the rectum - this is necessary for better visualization of the nodes and their availability. The doctor grabs the knot with a tool, pulls it out, and then the leg is stitched with catgut. The bump is excised with an electric coagulator (in order to avoid bleeding).

The final stage of the operation depends on its type. If you choose closed view hemorrhoidectomy, then the wound is sutured, and a swab with ointment is inserted into the anus for 4-5 hours.

Postoperative period: what awaits the patient

It is always true to say that the healing process is 50% dependent on the doctor and 50% on the patient himself. There is no need to shift the entire responsibility for undergoing recovery to physicians.

From the doctor it is necessary to perform the operation with high quality, strictly according to indications, to cope with all intraoperative nuances and competently explain to the patient what needs to be done next and how to control the wound healing process.

The patient needs discipline and trust in the doctor. It is necessary to put aside fear, fatigue, whims and other moments, which, of course, have a place to be. When the operation is completed, active work passes from the doctor to the patient himself. Now he needs as much as necessary to insert candles into the anus, do ointment rubbing, and follow a diet.

The patient may not expect sensation to change in the anal canal. He sometimes does not even understand whether he really wants to go to the toilet, or this is a deceptive feeling. Defecation can be multiple - up to 6 times a day. And this will take some time to get used to. Wounds will heal in about two months or less. But the most difficult days for the patient are one and a half to two weeks after the operation. It is really not easy, therefore, when deciding on an operation, you must understand that recovery is a difficult period for which you need to be prepared.

The doctor who will operate on you explains how the operation is done for hemorrhoids, and also talks in detail about the recovery period. Recommendations will be individual, but there are some general points.

The standard postoperative recovery scheme includes:

If after the operation, despite all the efforts of the patient, he is still tormented by constipation, the doctor will prescribe him special laxatives.

Can there be complications after hemorrhoidectomy?

Not always everything goes smoothly, and complications can really overshadow the recovery period.

Usually, doctors in every possible way prevent the course of events and do everything so that the negative scenario does not come true, but even the most experienced coloproctologist will not give a 100% guarantee of the success of the operation.

What complications are more common:

1. Bleeding - possibly due to deformation of the seams, poor cauterization of blood vessels.
2. Urine retention - more often fixed in men, they are unable to empty bladder, you have to use a catheter.
3. Psychogenic constipation - appears due to the fact that the patient is afraid of going to the toilet.
4. Narrowing of the rectal canal. This can be explained by the mistake of the surgeon - to expand the anal canal, the doctor uses special tools or recommends plastic surgery.
5. Prolapse of the lower segment of the rectal canal. If the coloproctologist accidentally damages the muscles and nerve endings, then the removal of the mucosa beyond the boundaries of the anus cannot be ruled out.
6. Fistulas. These are abnormal tubules that connect the rectal passage to nearby tissues.
7. pus formation. Inflammation and suppuration are not such a rare complication of the postoperative period. This is due to the accumulation of pathogenic bacteria in the operation area. Pustules will have to be opened, or the correction of this condition should be limited to antibiotic therapy.

But, once again it is worth noting that many complications can be prevented. The patient must be especially careful to follow the hygiene instructions after the operation.

Hemorrhoidopexy: how is this operation performed

This method was invented and patented by the Italian physician Antonio Longo about twenty-five years ago. Specifically, hemorrhoidopexy actively replaces the classic operation today, i.e. hemorrhoidectomy. This is explained by the less invasiveness of the Longo operation (otherwise called hemorrhoidopexy).

The essence of the operation is the excision of the mucosal zone of the rectal canal in a circular way, slightly above the hemorrhoids. The surgeon pulls the pathological formation up and fixes it there with titanium clips. During the intervention, the blood circulation of the cavernous body is disturbed, therefore after some time it becomes smaller, and then disappears completely.

Advantages of hemorrhoidopexy:

• Complete painlessness. There are no large number of nerve clusters in the operated areas. Local anesthesia is required only for the introduction of a special dilator.
• The operation can be performed even by the elderly. Hemorrhoidopexy is done to people with serious chronic ailments and to patients "in position".

• manipulation speed. A competent surgeon will carry out all the actions in 25 minutes.
• Hassle-free recovery. And this is true: the patient recovers quickly and relatively easily.

But, as expected, it was not without its downsides. For example, it is impossible to carry out hemorrhoidopexy with an external form of hemorrhoids. Finally, this is an expensive operation: doctors work with disposable instruments, which are quite expensive.

Alternative Therapy: Minimally Invasive Techniques

Gentle techniques are a great opportunity to solve the problem of hemorrhoids without serious trauma. Minimally invasive techniques are, in fact, "one day" operations with a quick recovery, with minimal risks of complications. But not at all stages, not in all cases, it is possible to solve the problem by these methods.

Among the popular minimally invasive techniques:

1. Ligation with latex rings - the coloproctologist puts a ring of ecological latex on the leg of the nodule, it stops the flow of blood;
2. Laser coagulation - the bump is negatively affected by directional radiation, then the tissues and blood vessels coagulate;
3. Desarterization - an apparatus is inserted into the anus canal, pulling the artery that feeds the hemorrhoid formation;
4. Sclerotherapy - an adhesive composition is introduced into the deformed vessels, which disrupts their work, feeding the nodes;
5. Infrared photocoagulation - suppress hemorrhoids infrared rays, fabrics are rolled up and baked;
6. Cryodestruction - manipulations are carried out using liquid nitrogen, it freezes and simply destroys the veins altered by varicose veins.

These techniques are effective, but they are rarely carried out for free. True, the minimum complex of negative aspects that accompanies them covers the need for costs.

The treatment of any disease by surgery requires the patient to make some changes in his lifestyle. A person must understand that the situation is critical, and the opportunity to improve the quality of life is work, and on his part too. Hygiene, nutrition, physical activity, a positive attitude, and finally, are very important.

Hemorrhoids are not only discomfort and pain, they often occur in severe forms with vascular thrombosis, bleeding and other malformations. To date, there are different ways getting rid of this disease. Surgical intervention is considered the most effective. However, it is not carried out in all cases.

When an operation is needed for hemorrhoids, and when it is possible to do without it, only a specialist decides, taking into account the characteristics of the course of the disease, its type, stage, etc.

When Can I Avoid Surgery?

1. compliance;
2. application medications ( , );
3. increased motor activity, special;
4. meticulous hygiene.

Conservative treatment gives a good effect only when the disease is in the initial stages (1 and 2), and then not always. Positive results are possible only with timely access to a doctor, compliance with all his recommendations regarding therapy.

But even this does not give a full guarantee that hemorrhoids will not reappear after a certain period. With regards to whether it is possible to cure hemorrhoids without surgery once and for all - most experts agree that this cannot be done. Of course, in the initial stages of the disease, it is possible to achieve a long-term or even lifelong remission, but the likelihood that it recurs still remains. Conservative methods allow only stopping, enlarged hemorrhoidal venous plexuses do not have a reverse development.

When surgery is needed

When conservative treatment of hemorrhoids does not give the desired effect and does not bring relief, while the disease is in remission, the question of whether to perform an operation may be raised.

In acute hemorrhoids, it is not recommended to hurry with the operation, since the risks associated with surgical treatment in this case increase significantly. The patient, first of all, needs to undergo a course of therapeutic measures. And after stabilization of the condition and elimination of replenishment, a decision is made on the advisability of surgical intervention.

Hemorrhoids of moderate severity are not an indication for surgery. It is usually used in the following cases:

• thrombosis and pinching of nodes;
• prolapse of hemorrhoids;
• rare heavy bleeding;
• scanty regular bleeding.

Methods of surgical treatment

At the moment there are various. The choice of one or another type depends on the nature of the disease, its stage, as well as the characteristics of the patient's body. Conventionally, all methods can be divided into radical and minimally invasive. The latter are sparing methods, they do not make incisions on the patient's body, they do not require general anesthesia, they are usually carried out on an outpatient basis, they have a short rehabilitation period, therefore they have mostly positive reviews. More often, minimally invasive methods are used in the initial stages of hemorrhoidal disease. The main ones include:

• - a special agent is injected into the node, after which the bleeding stops, and the node itself is overgrown with connective tissue.
• - a special latex ring is put on the knot leg, which squeezes it. As a result, the blood supply to the hemorrhoid stops and it gradually dies.
• - a piece of the artery that feeds the node, with the help of special equipment introduced through the rectum, is dissected and tied up. Due to this, tissue rejection occurs.
• - removal of hemorrhoids is carried out using low temperatures. Liquid nitrogen is supplied to the surgical field by a cryoprobe, after which, after a few weeks, drying and rejection of dead tissues occurs.
• and - the node is exposed to infrared radiation, due to which its tissues are coagulated. After the procedure, only a small scar remains.

Minimally invasive methods are not always possible. Contraindications to their conduct are paraproctitis, acute hemorrhoids. They may also be ineffective in the advanced stage of hemorrhoidal disease. In the later stages of the disease, radical surgical treatment is used. What operations are done for hemorrhoids in such cases? Usually this:

• . During this operation, a clamp is applied to the knot and cut off. Then, with catgut, the vascular bundle of the node is first stitched, then the postoperative wound. There are various modifications of this surgical technique. Its undoubted advantage is that it completely eliminates hemorrhoids and minimizes the likelihood of relapse. In addition, hemorrhoidectomy is one of the few techniques that allow you to fully remove external nodes. Its main disadvantages are a long and difficult period of rehabilitation, the need for general anesthesia, and the likelihood of numerous complications.
• . With this procedure, manipulations are not performed directly with hemorrhoids. During it, a part of the rectum is excised in a circle using a special device, after which titanium staples are applied to the resulting wound, so the remaining sections of the mucosa are sutured. After such manipulations, the inner wall of the intestine is stretched and the nodes are pressed against it, because of which the blood supply is disturbed in them. Then the nodes are gradually replaced by connective tissue. This method is used at 2-3 stages of the disease. Its advantage is painlessness, the possibility of removing multiple internal nodes, a short recovery period. The main disadvantage of the operation is the inability to remove external nodes.

Surgery to remove hemorrhoids

Types of operations in the treatment of hemorrhoids

With thrombosis of the hemorrhoid, in situations in which conservative therapy does not give a positive effect, the patient may be recommended. During such an operation, a blood clot is removed from a clogged vessel, after which blood flow is restored and the patient's well-being improves significantly. However, it is worth noting that

The operation to remove hemorrhoids refers to radical methods of treatment and is performed if conservative therapy has not been effective. Hemorrhoids occur most often in the male half of the population, and much less frequently in the female.

Indications for surgery

Hemorrhoids are accompanied by unpleasant symptoms, like burning in the anus, pain and itching. The disease begins due to varicose veins in the anus and can sometimes be accompanied by periodic bleeding. With a strong lesion of a certain part of the intestine, hemorrhoids are formed.

Removal of hemorrhoids is indicated in the following cases:

• profuse bleeding;
• prolapse of hemorrhoids;
• thrombosis;
• pinching;
• frequent inflammation of the veins.

The main indication for surgical treatment is various complications that can worsen the patient's quality of life. So, surgical treatment of hemorrhoids is necessarily carried out with prolapse of the rectum and bleeding, because this condition poses a particular danger to human health. Also, an indication for surgery is a sharp progression of hemorrhoids or a constant prolapse of hemorrhoids after an act of defecation.

What are the operations

Removal of hemorrhoids surgically can be performed in different ways:

1. sclerotherapy;
2. operation Longo;
3. cryotherapy;
4. hemorrhoidectomy;
5. deserterization.

A method such as sclerotherapy is carried out at the first stage of the disease or at the last stage to stop bleeding. It is considered minimally invasive and is performed using a special sclerosant substance, which is injected into the hemorrhoidal vein. After that, the vein sticks together and overgrows.

It has an effective effect only in the presence of hemorrhoids small size. The advantages of this type of treatment include the absence of pain during all manipulations and after, a quick rehabilitation period, and the absence of the need for anesthesia.

Thrombectomy, which can be performed with a laser or radio waves, will help remove the formed blood clots. In this way, it will also be easy to remove hemorrhoids. Laser removal of hemorrhoids almost rarely leads to complications and is considered one of the most effective ways treatment. Also, a general laser blood cleaning has a good result, under the influence of which it is possible to improve the general condition of the body and get rid of many problems.

For the treatment of hemorrhoids, ligation of the hemorrhoid is successfully performed. An operation is performed for intravenous hemorrhoids and consists in tying the hemorrhoid with a latex ring, as a result of which blood stops flowing to it. The technique helps to avoid more serious interventions in the body, such as hemorrhoidectomy.

Hemorrhoidectomy is one of the standard surgical treatments for hemorrhoids. The indication for surgery is hemorrhoids of the third and fourth degree. An area of ​​skin with a mucous membrane above the hemorrhoid is removed. In addition to surgical excision, cauterization may be used. Complications after such treatment are extremely rare, and the rehabilitation period passes quickly enough.

Cryotherapy takes place under local anesthesia and consists in freezing the hemorrhoids, after which they die. In time, such an operation to remove hemorrhoids takes no more than 5 minutes. In the place where the nodule was, a small wound is formed, which will have to be treated with special preparations.

Desarterization is the removal of hemorrhoids by ligation of the hemorrhoidal artery. An indication for such treatment may be internal hemorrhoids, the presence of hemorrhoids and other pathological processes. The advantages of desarterization include high efficiency, painlessness and a short rehabilitation period.

Advice: when choosing the type of surgical treatment for hemorrhoids, it is recommended to pay attention to operations with a minimal risk of complications, high efficiency and a short period for the recovery of the body.

Such an operation to remove hemorrhoids got its name in honor of Dr. Antonio Longo from Italy. It consists in removing a specific section of the mucous membrane above the hemorrhoid. The whole operation takes no more than 20 minutes.

Longo's operation for hemorrhoids helps to cure internal hemorrhoids on last stage and remove hemorrhoids. It is also considered the most effective among all other techniques and is performed under ultrasound guidance. This surgery requires local anesthesia.

Advantages of surgical treatment:

1. fast recovery;
2. excision of several nodes at once;
3. no postoperative wound.

The internal hemorrhoid is removed in a hospital using a special device that is inserted directly into the rectum. To do this, the anus is stretched with clamps, and then a dilator is inserted, which is sutured to the skin. After that, an anoscope is inserted, and the necessary manipulations are performed. At the very end, the surgeon fastens the edges of the wound with special titanium staples. Also, a piece of gauze with ointment and a gas outlet tube are inserted into the anus. Anesthesia can be general or local.

The disadvantages of the operation are that it cannot be used to treat external hemorrhoids. The cost of such a surgical intervention will be quite high.

How to prepare for surgery

Before performing any operation, the doctor will consult with the patient about his proper preparation. Therefore, risk factors for complications are first identified and possible contraindications which may affect the course of the operation. To do this, the patient must pass a blood test, urine test, etc.

Before surgery, be sure to clean the intestines with a laxative or enema. You should also stick to a special diet and exclude foods that irritate the intestines. You can relieve inflammation in the rectum with the help of traditional medicine and medicines.

rehabilitation period

The behavior of the patient in the first days after removal of the hemorrhoid should largely depend on the type of surgical manipulation. To prevent irritation and inflammation of the intestine will help properly selected diet after surgery to remove hemorrhoids. It is recommended not to overload the intestines and refrain from defecation for the first day.

It is necessary to consult with a proctologist about how to treat a postoperative wound. The first time can be disturbing strong pain in the anus.

Advice: in order to avoid serious consequences after the operation, it is necessary to carefully follow the doctor's instructions and not use any means without his prescription.

Complications after surgery

The most common complications include the following pathologies:

• bleeding;
• pain syndrome;
• narrowing of the anal canal;
• urinary retention;
• fistulas;
• purulent processes.

Bleeding may occur due to the divergence of the edges of the mucosa and the pressure of feces on the area of ​​​​the rectum that has undergone surgical intervention. Some patients after treatment of hemorrhoids cannot urinate on their own, as acute urinary retention occurs. Bladder catheterization helps restore urination.

Prolapse of the rectum can be attributed to the rather rare consequences of the treatment of hemorrhoids with the help of surgery. The cause of this pathology is injury to the nerve canals of the rectum during surgery.

A complication such as a fistula can occur several months after the operation. A channel is formed in the intestine, which connects to a neighboring hollow organ or skin. The only way to fix this problem is with a second surgery.

Quite frequent consequences of the operation to remove hemorrhoids include a purulent process, the cause of which is the ingress of harmful microbes into the wound. In this case, an abscess is opened or a course of antibiotics is prescribed.

Contraindications

It is forbidden to perform the operation in the presence of the following contraindications:

• malignant diseases;
• reduced immunity;
• diabetes;
• heart diseases;
• intestinal ulcer;
• pregnancy.

Surgical removal of hemorrhoids helps to effectively get rid of the problem in cases where no other methods help and medications. The type of operation is selected for each patient individually, taking into account his age, the severity of the disease and the results of the examination.

Correct behavior before surgery and in the postoperative period will help to avoid serious complications. The doctor will tell the patient about how to eat and what medications to take in order to reduce the load on the intestines.

The doctor must select for the patient suitable look treatment depending on the type of hemorrhoids (internal hemorrhoids, external) and prescribe surgical intervention if necessary. You will first have to undergo a medical examination and pass all the tests in order to exclude the presence of contraindications to the operation.

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Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for self-treatment. Be sure to consult a doctor!