How to have hemorrhoid surgery. Types of surgery to remove hemorrhoids: hemorrhoidectomy, hemorrhoidopexy, ligation, laser coagulation, sclerotherapy, etc. How long after surgery is it better to get pregnant

Hemorrhoids are diseases of the rectum caused by varicose 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 surgery, then at 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 were found to be ineffective by the attending physician. In addition, surgical intervention is recommended for hemorrhoidal thrombosis.

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

Currently, one of the most effective treatments for hemorrhoids is surgical removal of hemorrhoids, which should be carried out outside the stage of exacerbation of the disease. The main contraindication for this procedure is 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 of surgical treatment of hemorrhoids, as well as improved instruments, the operation to remove hemorrhoids in most cases can be carried out safely, quickly and practically painlessly.

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

In the event that a prolapse of the rectum, accompanied by profuse bleeding, is diagnosed in a young man, it is recommended that an operation be performed immediately, since blood loss can cause anemia.

If a middle-aged person suffers from hemorrhoids, surgical intervention 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 rectal prolapse and heavy bleeding. In this case, the need for an operation to remove hemorrhoids disappears.

Elderly people suffering from rectal prolapse are shown mainly drug treatments such as pills, suppositories and ointments. Not the last place in the treatment of this category of people is taken 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 that is performed using anesthesia, this procedure may be contraindicated in patients with severe concomitant pathology.

Also, contraindications for surgery to remove hemorrhoids are:

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

Its useful to note

One of the relative contraindications to surgery is pregnancy. Hemorrhoids removed in late pregnancy are often prone to recurrence, while without surgery, they can disappear on their own after childbirth.

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

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

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 are: sclerotherapy, ligation using latex rings, mono- or bipolar coagulation, laser coagulation, photocoagulation using infrared radiation, as well as cryodestruction.

Surgical removal of hemorrhoids means:

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

One of the most common surgical procedures to remove hemorrhoids is Longo's operation for hemorrhoids.

How to remove hemorrhoids according to 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 tightened in knots. After that, an anoscope with an obturator is inserted into the expander.
• A purse-string suture is applied to the rectal mucosa, on the area located 4-5 centimeters above the dentate line. At the same time, during the seams, the anoscope cannot be turned in the expander - for each new stitch, it is pulled out and reinserted. thanks to which the mucous membrane does not twist, and the seam is symmetrical.
• The threads are not tightened immediately, as you must first check the correct suture.
• A hemorrhoidal circular stapler is inserted into the rectal lumen - 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 moved inward, its handle is turned clockwise, while the device is closed, a fragment of the intestinal mucosa and hemorrhoidal vessels are crossed with a circular knife, and the ends of the wound are carefully 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 made from absorbable suture.
• After removing the anoscope from the intestine, a gauze strip and a gas outlet tube soaked in drugs are inserted into 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 about 35 to 40 thousand rubles.

Advantages of Longo 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.
• Short rehabilitation period - a person can return to normal life almost immediately.

However, there are also disadvantages of Longo surgery for hemorrhoids:

• External hemorrhoids cannot be removed with the Longo method.
• This type of medical services is notable for its high cost.

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 pain medications. In addition, unlike other methods of surgical intervention, after this procedure, you can immediately walk.

Another advantage of the laser treatment method is the fact that when using this method, there is practically no trauma to 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 cones. The technique of this manipulation is simple: with the help of a laser, the internal nodes are burned out from the inside, connective tissue develops in them, and a natural decrease in the size of the nodes occurs. In the case of external hemorrhoids, the nodes are cut off by a laser beam. In this case, the tissues are instantly soldered without bleeding.

The photo shows the results of laser hemorrhoid removal:

A - hemorrhoids before laser removal;

B - the area of \u200b\u200bhemorrhoids after the laser removal procedure.

The laser hemorrhoid removal technique has the following advantages:

• Removal of hemorrhoids with a laser is comparatively painless - during this procedure, the patient feels only a slight warmth. Patients with a low pain threshold may request 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 carried out on an outpatient basis.
• To carry out this procedure, there is no need for any preliminary preparation.
• Almost immediately after the procedure, the patient can go home, while the very next day he can return to normal work activities.
• Thanks to. that the laser beam instantly cauterizes the 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 some disadvantages:

• Large hemorrhoids are not completely removed, which can lead to relapses of the disease in the next 5 years.
• An operation 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 relapse? What should you pay attention to during the postoperative period?

In this case, it is necessary to perform a number of medical procedures aimed at accelerating regenerative processes and preventing various complications. Quite often, special baths based on chamomile or potassium permanganate are taken for this purpose. 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.

Its useful to note

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

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

All materials on the site have been prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative and inapplicable without consulting your doctor.

The operation to remove hemorrhoids is considered one of the most common 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 using conservative treatments. In many cases, this approach is quite 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 bring relief, varicose veins reach large sizes, fall out and thrombose, and the patient experiences excruciating pain and is forced to abandon his usual lifestyle.

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

Indications for the removal of hemorrhoids

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

Removal of hemorrhoids in elderly patients with hypertension, diabetes, colitis, and constipation can not only be quite risky, but it is not always justified. In most patients, rational conservative therapy, hygiene and diet are so good that the need for surgery may disappear.

The indications for hemorrhoidectomy are:

• 4 stage of the disease; hemorrhoids 3 degrees - with a significant increase in the nodes.
• Prolapse of hemorrhoidal veins with every act of defecation.
• Development of anemia due to recurrent bleeding.
• Lack of result 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 thorough preliminary preparation.

In addition to indications for surgical removal of hemorrhoids, there are also 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 disorders. In these cases, the operation will have to be postponed.

Preparation for hemorrhoidectomy

Any of the types of hemorrhoidectomy does not apply to abdominal operations, and often only local anesthesia is sufficient, however, the patient's preoperative preparation does not lose its relevance from this. It is important to prevent infectious complications, bleeding in the early postoperative period, as well as prepare the rectum itself for surgery.

Before the planned treatment, you should undergo the necessary minimum of examinations: general and biochemical blood tests, urinalysis, tests for syphilis, HIV, hepatitis, coagulogram. According to indications - ultrasound of the abdominal organs. Examination and digital examination of the rectum, anoscopy, and in some cases sigmoidoscopy are required.

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 consume 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 preparations that cleanse the intestines (Fortrans). At this point, if the patient took blood thinning drugs, they should be canceled.

The classic surgery 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 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.

When preparing for minimally invasive interventions, the same procedures are required as for radical hemorrhoidectomy, but hospitalization is usually not carried out, and the patient is treated on an outpatient basis and can go home on the same day.

Types of surgery to remove hemorrhoidal veins

To date, the most effective radical methods of removing hemorrhoids are recognized as classical hemorrhoidectomy according to Milligan-Morgan 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 it.

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 rectal mucosa over the enlarged venous plexuses, then ties 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; this does not make a fundamental difference for the patient.

The stages of the operation include anesthesia and dilation of the anal canal, disinfecting the intestinal mucosa and drying with a cotton swab. Hemorrhoidal veins are removed in sequence. The surgeon, mentally imagining the dial of the clock, first captures the “bumps” located at three o'clock, then at seven and eleven. Having grasped the knot 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 tampon the rectum after a classic hemorrhoidectomy, but this contributes to the appearance of pain and urinary retention, so most specialists do not perform tamponation. To maintain sensitivity in the anus and avoid narrowing of the anal canal, mucocutaneous bridges are left in the area of \u200b\u200bwounds.

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

longo technique

Longo's operation is more gentle than the classical hemorrhoidectomy, since a small area of \u200b\u200bthe mucous membrane is resected, and the nodes are not excised, but rather pulled up and fixed. The flow of blood to the veins is reduced and they are gradually replaced by connective tissue. To suture the mucous membrane at the site of resection, titanium staples are used, which are applied using special staplers.

The Longo procedure takes about 15 minutes and requires local anesthesia. Low trauma, but at the same time an excellent therapeutic effect, low probability of complications and relapses make it preferable in elderly patients, those with severe concomitant pathology.

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, 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 dealing with the disease, which can be used both for internal hemorrhoids and for external formation of nodes:

• Laser treatment;
• Radio wave treatment;
• Desarterization;
• Ligation;
• Sclerotherapy and thrombectomy.

Excision of hemorrhoids with laser very effective. The advantages of the method are considered to be the speed of the procedure, quick recovery, and low pain. For laser treatment, local anesthesia is used, and after a few hours the patient can go home.

Radio wave therapy involves excision of nodes with 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.

Desarterization - a new method of dealing with hemorrhoids, which consists in "turning off" the blood flow through the arteries of the rectum. Dilated venous plexuses collapse at the same time, decrease in volume and, over time, are 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 of dealing with hemorrhoids, when using a special apparatus, latex rings are placed on varicose veins. 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 the vast majority of patients.

ligation

Sclerotherapy- 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 "stick together" and sclerosis.

Often, the disease occurs with hemorrhoidal vein thrombosis, 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 with a laser or radio knife. The procedure is performed under local anesthesia on an outpatient basis. In addition, in this way, it is possible to remove nodes of external hemorrhoids at any stage of the disease, if they cause discomfort to the patient, but there is still no indication for radical excision.

Minimally invasive approaches in the treatment of hemorrhoids are used in 80% of patients in Europe and the United States, 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 be 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 a stool is extremely undesirable, since it can cause severe pain and trauma to the postoperative wound, and in order to avoid this, a complete refusal to eat is shown while maintaining a good drinking regime.

From the second day, food is gradually introduced that does not contribute to irritation of the intestines and the formation of dense stools: light soups, cereals, dairy products. Be sure to drink plenty of fluids. In the first few days, many patients experience severe pain, to eliminate 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. Medical treatment consists in the use of ointments and suppositories with methyluracil, which improves the 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. A spasm of the rectal sphincter helps to remove the nitroglycerin cream.

The patient must necessarily perform all the necessary hygienic procedures, which the clinic staff will tell him about, not ignore dressings and examinations. The postoperative diet should contain enough fiber to help ease bowel movements. You need to empty your bowels immediately, as soon as such a desire arises, but do not linger in the bathroom for too long, push or strain. Laxatives may be prescribed as needed.

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

• Bleeding, which may be associated with insufficiently complete suturing of blood vessels, slipping of ligatures;
• Stenosis of the anal canal that occurs in the late postoperative period, special dilators or even plastic surgery are used to combat it;
• Infectious and inflammatory processes, wound suppuration if the rules of asepsis are not followed 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 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 narrowing of the lumen of the organ and control 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 remains 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:

• You should not lift weights;
• It is necessary to exclude physical activity with tension of the abdominal press;
• If possible, avoid prolonged sitting or standing position;
• Normalize diet;
• Provide 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 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 foods can aggravate hemorrhoids. In addition to products provocateurs of the disease, it is necessary 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 impossible to avoid prolonged sitting, then if possible, you should take short breaks, get up and walk. Walking is an excellent means of preventing disease recurrence.

The cost of hemorrhoid surgery depends on the method and scope of the operation. Removal of one node costs from 7000 rubles, reaching 15-16 thousand in some clinics, ligation - 6000, sclerotherapy - 5000 rubles. Free treatment is also possible, but in this case the patient may have to wait for his 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.

Removal of the venous plexus, which we call hemorrhoids, is a measure that is required when drug therapy is not effective. It so happens that indications for surgical treatment are not a rare practice: often the doctor recommends a surgical solution to the problem for patients with the second stage of the disease. It does not yet follow from this that the patient who first appears at the doctor's office goes straight to the operating table. There are minimally invasive techniques for removing hemorrhoids, and they are not as traumatic and difficult as a classic operation.

But the fact remains: if the 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 classical operation is carried out today not so often: at the final stages of the disease, associated with complications of the pathological process.

When an operation 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 is 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 during emptying of the rectum, 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 cancel out the patient's usual regimen;
6. All conservative methods used were powerless over the problem of rectal varicose veins.

The final word is for 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.

Surgical is not always possible. There are situations that in themselves would be a contraindication to such therapy. For example, classical hemorrhoidectomy involves excision of the skin, mucosa, and choroid. This is due to 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 stress for them. And the existing chronic pathologies in every possible way impede the operation.

Very rarely, if you look at the situation with examples, surgery for hemorrhoids is recommended for patients with diagnosed diabetes mellitus. Chronic hypertension is another item that makes surgery an unwanted intervention.

Among the serious contraindications for surgery:

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

But, again, these cases will not be an unambiguous and permanent contraindication to surgery. You can wait for a favorable period when the operation will be a real solution 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 surgery to remove hemorrhoids

One of the radical
methods of treating hemorrhoidal disease - hemorrhoidectomy operation. This is preceded by preparation: first, an instrumental examination, which will accurately determine the localization of the nodes and their size. Anoscopy and romanoscopy are usually performed. Secondly, on the eve of the operation, a person has to pass a number of standard tests.

Among such appointments:

1. UAC. Among the functions of a general blood test is the identification of the duration of bleeding, as well as fixing the period of blood coagulation and platelet count.
2. OAM (urine must be passed).
3. Blood biochemistry. It is 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 operation is not just a preliminary examination, but also some procedural points. One of them is bowel cleansing. This is usually done with an enema, but the use of special laxatives can also 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, are anticoagulants, antiplatelet agents, as well as some NSAIDs.

Do I need psychological preparation for the operation

Fortunately, many medical institutions today have in-house 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 of which they are very afraid. The psychologist does not just talk with such a patient, he can do exercises with him that help to relax, normalize breathing, relieve tension.

If you feel that nervous tremors and strong fear appear even when you think about how to operate on hemorrhoids, you need to seek help from a specialist. The more you are ready both physically and psychologically for the operation, the more successful it will be.

Hemorrhoidectomy: how it goes

This is a classic procedure for excision of the corpora cavernosa. 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 primary version of the operation. Doctors remove not only the nodule itself, but also adjacent tissues. So, the doctor does not suture the edges of the wound, it is assumed that the tissues will heal naturally. The doctor uses either a scalpel knife or an electrocoagulator.

• Closed hemorrhoidectomy. It was developed in the early 50s of the last century, and this is an operation according to Ferguson. The difference from the above method is wound closure after completion of work. It is sometimes done on an outpatient basis.
• Submucosal hemorrhoidectomy. This method was suggested by the surgeon Parks. This operation is not easy - the doctor removes only the node, leaving its base, while the mucous membrane itself is not injured. This action is easier to bear than the two above-mentioned options.

The doctor chooses the most preferable option, discussing the upcoming opportunities with the patient. The specialist and the patient discuss the disadvantages of the operation, which, of course, are.

This operation used to be widespread, but today only 15% of patients with hemorrhoids requiring surgical correction undergo hemorrhoidectomy. Firstly, minimally invasive techniques for removing hemorrhoids 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. 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 awaits the patient after surgery, what are the risks of complications, etc.

How is the operation going

The operation takes place in a series of stages. Shortly before surgical procedures, the patient is shaved the entire operating field. An indisputable point is the disinfection of the anus and rectal canal.

The patient needs to lie down
on the back in a comfortable chair (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 bumps, which makes the excision process easier for the surgeon. The patient is then given anesthesia. Under what anesthesia the hemorrhoids are removed, the doctor decides - general anesthesia is often used with such a cardinal intervention.

The doctor inserts a dilator with a rectal speculum into the rectum - this is necessary for better visualization of the nodes and their accessibility. The medic grabs the knot with the instrument, pulls it out, and then the leg is stitched with catgut. The lump is excised with an electric coaglator (to avoid bleeding).

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

Postoperative period: what awaits the patient

It is always true that the healing process depends 50% on the doctor, and 50% on the patient himself. There is no need to shift all the responsibility for undergoing recovery to doctors.

The doctor needs to perform the operation with high quality, strictly according to the indications, cope with all the intraoperative nuances and competently explain to the patient what to do next and how to control the wound healing process.

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

The patient may not expect sensations to change in the anal canal. He sometimes does not even understand whether he really wants to go to the toilet, or if this is a deceptive feeling. Defecation can be repeated - up to 6 times a day. And this will take some getting used to. The 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 tells in detail about the recovery period. Recommendations will be individual, but there are some common points.

The standard postoperative recovery scheme implies:

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 complications arise after hemorrhoidectomy?

Things don't always go smoothly, and complications can really darken recovery.

Usually, doctors in every possible way warn the course of events and do everything to prevent the negative scenario from coming 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 burning of blood vessels.
2. Retention of urine - more often recorded in men, they are unable to empty the 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 surgeon's mistake - to expand the anal canal, the doctor uses special instruments 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 mucous membrane outside 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 such a condition should be limited to antibiotic therapy.

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

Hemorrhoidopexy: how is this operation going

This method was invented and patented by the Italian physician Antonio Longo about twenty-five years ago. Specifically, hemorrhoidopexy is actively replacing the classical operation today, i.e. hemorrhoidectomy. This is explained by the lesser traumatism of Longo operation (this is the other name for hemorrhoidopexy).

The essence of the operation is the excision of the area of \u200b\u200bthe mucous membrane of the rectal canal in a circular manner, slightly above the hemorrhoid cone. The surgeon pulls the pathological formation up, and fixes it there by titanium clips. During the intervention, the blood circulation of the corpus cavernosum is disturbed, therefore, after a while it becomes smaller, and then leaves completely.

Pros of hemorrhoidopexy:

• Complete painlessness. There are not many nerve clusters in the operated areas. Local anesthesia is required only to insert a special dilator.
• Even the elderly can be operated on. Hemorrhoidopexy is done to people with serious chronic ailments and patients "in position".

• The speed of manipulation. 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 you might expect, there were some drawbacks. For example, hemorrhoidopexy cannot be performed with external hemorrhoids. Finally, this is an expensive operation: doctors work with disposable instruments, which are quite expensive.

Alternative therapy: minimally invasive techniques

Sparing 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 risk of complications. But not at all stages, not in all cases it is possible to solve the problem with these methods.

Popular minimally invasive techniques include:

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

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

Treatment of any disease through surgery requires some changes in the patient's 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, finally, are very important.

Hemorrhoids are not only discomfort and pain, they often occur in severe forms with vascular thrombosis, bleeding, and other malts. Today, there are different ways to get 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 you can do without surgery

1. compliance;
2. the use of medications (,);
3. increased motor activity, special;
4. thorough hygiene.

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

But even this does not give a complete guarantee that hemorrhoids will not reappear after some period. With regard 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, you can achieve long-term or even lifelong remission, but the likelihood that it will recur is still there. Conservative methods only allow stopping, enlarged hemorrhoidal venous plexuses do not develop back.

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 undergo surgery may be raised.

In acute hemorrhoids, it is not recommended to rush to 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 replacement, a decision is made about the expediency of surgery.

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

• thrombosis and pinched nodes;
• prolapse of hemorrhoids;
• rare profuse bleeding;
• scanty regular bleeding.

Surgical treatment methods

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 relate to gentle techniques, 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. Most often, minimally invasive methods are used in the initial stages of hemorrhoidal disease. The main ones include:

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

It is not always possible to use minimally invasive methods. Contraindications to their conduct are paraproctitis, acute hemorrhoids. They can 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 performed for hemorrhoids in such cases? Usually this:

• ... During this operation, a clamp is placed on the assembly and cut off. Then the vascular bundle of the node is first stitched with catgut, 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 allows 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 braces are applied to the resulting wound, thus the remaining sections of the mucous membrane are sutured. After such manipulations, the inner wall of the intestine is stretched and the nodes are pressed against it, due to which the blood supply in them is disrupted. Then the nodes are gradually replaced with connective tissue. This method is used at 2-3 stages of the disease. Its advantage is painlessness, the ability to remove multiple internal nodes, and a short recovery period. The main disadvantage of the operation is the impossibility of removing the external nodes.

Hemorrhoid Removal Surgery

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 thrombus is removed from the clogged vessel, after which blood flow is restored and the patient's well-being is significantly improved. However, it should be noted that

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

Indications for surgery

Hemorrhoids are accompanied by such unpleasant symptoms as a burning sensation 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 severe damage to 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 all sorts of 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

Surgical removal of hemorrhoids can be performed in different ways:

1. sclerotherapy;
2. longo operation;
3. cryotherapy;
4. hemorrhoidectomy;
5. dearterization.

A method such as sclerotherapy is performed 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 is effective only in the presence of small hemorrhoids. The advantages of this type of treatment include the absence of pain during and after all manipulations, 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 rarely leads to complications and is considered one of the most effective treatments. General cleaning of blood with a laser also 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, hemorrhoidal ligation is successfully performed. An operation is performed for intravenous hemorrhoids and consists in ligating 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. Removal of the skin area with the mucous membrane over the hemorrhoid is performed. In addition to surgical excision, moxibustion can 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 hemorrhoids, after which they die off. 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 ligating the hemorrhoidal artery. An indication for such treatment can be internal hemorrhoids, the presence of hemorrhoids and other pathological processes. The advantages of dearterization 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 minimum 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 area of \u200b\u200bthe mucous membrane above the hemorrhoid. In time, the entire operation takes no more than 20 minutes.

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

The benefits of surgical treatment:

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

The internal hemorrhoid is removed in the hospital using a special apparatus, which 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, the anoscope is inserted and the necessary manipulations are performed. At the very end, the surgeon secures the wound edges with special titanium staples. Also, a gauze piece 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 surgery will be quite high.

How to prepare for surgery

Before carrying out any operation, the doctor will consult with the patient about his proper preparation. Therefore, risk factors for complications and possible contraindications that may affect the course of the operation are first identified. For this, the patient must pass a blood test, urinalysis, etc.

Before surgery, it is imperative to cleanse the intestines with a laxative or enema. It is also worth adhering to a special diet and excluding foods that irritate the intestines. It is possible to 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. A properly selected diet after hemorrhoid surgery will help prevent irritation and inflammation of the intestines. It is recommended not to overload the intestines and refrain from bowel movements for the first day.

It is necessary to consult a proctologist about how to treat a postoperative wound. At first, severe pain in the anal area may disturb.

Advice: to avoid serious consequences after surgery, you must carefully follow the doctor's instructions and do not use any means without his appointment.

Complications after surgery

The most common complications include the following pathologies:

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

Bleeding can occur due to the divergence of the edges of the mucous membrane and the pressure of feces on the area of \u200b\u200bthe rectum that has undergone surgery. Some patients after treatment of hemorrhoids cannot urinate on their own, as there is an acute urinary retention. Bladder catheterization helps to restore urination.

Rectal prolapse is a rather rare consequence of treating hemorrhoids with surgery. The reason for this pathology is trauma to the nerve canals of the rectum during surgery.

A complication such as a fistula can occur several months after the operation. A canal is formed in the intestine that connects to the adjacent hollow organ or skin. This problem can be eliminated only with the help of a second surgical operation.

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

Contraindications

It is forbidden to perform an operation if there are 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 and drugs help. 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 and during the postoperative period will help to avoid serious complications. The doctor will tell the patient how to eat and what medications to take in order to reduce the strain on the intestines.

The physician should select the appropriate type of treatment for the patient depending on the type of hemorrhoids (internal hemorrhoids, external) and prescribe surgery if necessary. You will first have to undergo a medical examination and pass all 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!