Types of hemorrhoid removal. Removal of hemorrhoids: invasive and minimally invasive methods. Can complications occur after hemorrhoidectomy?

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

The operation to remove hemorrhoids is considered one of the most common in proctology. This is not surprising, since 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 treatment methods. In many cases, this approach is completely justified, since any operation carries a certain risk, and even more so, interventions on blood vessels.

However, it happens that conservative treatment, coupled with 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 give up his usual lifestyle.

When the only way to get rid of hemorrhoids is surgical treatment, a proctologist assesses the patient’s condition and chooses the optimal method for removing the 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 an operation, the indications for which are limited, although in proctology, hemorrhoidectomy occupies almost the first place in 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 also not always justified. In most patients, rational conservative therapy, hygiene and diet give such good results that the need for surgical intervention may no longer be necessary.

Indications for hemorrhoidectomy are:

stage 4 of the disease; hemorrhoids of the 3rd degree - with a significant increase in nodes.
Prolapse of hemorrhoidal veins with each 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 pathology (anal fissure, fistulas, polyps in the rectum), the patient’s age, etc. are always taken into account. For example, surgery may be contraindicated for pregnant women, and careful preliminary preparation may be required for elderly people.

In addition to the 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 delayed.

Preparing for hemorrhoidectomy

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

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

Particular attention should be paid to diet, which determines the course of the subsequent postoperative period. Before the planned operation, you should avoid foods that cause gas formation and the formation of excess feces, and preference should be given to fermented milk products, eggs, and 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 drugs that cleanse the intestines (fortrans). At this point, if the patient was taking blood thinning drugs, they should be discontinued.

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 positioned on his stomach, since this improves the outflow of venous blood from the enlarged plexuses, which facilitates the process of their removal.

In preparation for minimally invasive interventions, the same procedures are necessary as for radical hemorrhoidectomy, but hospitalization is usually not performed, and the patient is treated as an outpatient and can go home the same day.

Types of operations to remove hemorrhoidal veins

Today, the most effective radical methods for removing hemorrhoids are 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 the Longo operation can compete with it.

Hemorrhoidectomy

The Milligan-Morgan operation has undergone many modifications and continues to be improved. Its essence is to remove both external and internal hemorrhoids after suturing the vascular pedicle. At the beginning of the operation, the surgeon excises the skin of the anal area and the rectal mucosa over the dilated venous plexuses, then ties the veins and removes them. Finally, the inner wall of the intestine is fixed to the underlying tissues, and 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 makes no fundamental difference for the patient.

The stages of the operation include anesthesia and dilation 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 a watch dial, first grabs the “bumps” located at three o’clock, then at seven and eleven. Having grabbed 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, after a classic hemorrhoidectomy, tamponate the rectum, but this contributes to pain and urinary retention, so most specialists do not perform tamponing. To maintain sensitivity in the anal area 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 preparation for it must be thorough and serious. Its advantage is considered to be the possibility of excision of not only internal, but also external varicose veins.

Another option for surgical treatment of hemorrhoids is the intervention using the method of the Italian surgeon Longo, who proposed to cross the rectal mucosa and the vessels carrying blood to the hemorrhoids in a circular manner, eliminating vein prolapse. The Longo operation can be an alternative to classical hemorrhoidectomy and is successfully used in the West, but in Russia it began to be performed only about five years ago.

Longo technique

Longo's operation is more gentle than classic hemorrhoidectomy, since a small area of the mucous membrane is resection, and the nodes are not excised, but rather pulled up and fixed. Blood flow to the veins decreases, and they are gradually replaced by connective tissue. For suturing the mucous membrane at the resection site, titanium staples are used, which are applied using special staplers.

The operation using the Longo method takes about 15 minutes, and local anesthesia is sufficient to perform it. Low morbidity, but at the same time excellent therapeutic effect, low likelihood of complications and relapses make it preferable in elderly patients and people with severe concomitant pathology.

Despite the undoubted advantages, removal of hemorrhoids using 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 surgery. In addition, due to the relatively short period of use of this operation, it is not yet possible to judge the long-term consequences of treatment.

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

Laser treatment;
Radio wave treatment;
Disarterization;
Ligation;
Sclerosis and thrombectomy.

Excision of hemorrhoids using 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 using a radio knife (Surgitron device). 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 combating hemorrhoids, which consists of “switching off” the blood flow through the arteries of the rectum. The dilated venous plexus collapses, decreases in volume and is eventually replaced by connective tissue. The patient only needs a few days to recover, and the procedure itself is painless.

Ligation– the most popular gentle way to combat hemorrhoids, when latex rings are placed on varicose veins using a special apparatus. After about a week, the hemorrhoidal “bumps” are rejected along with such a ring, without causing significant inconvenience to the patient. Ligation performed according to indications allows avoiding hemorrhoidectomy in the vast majority of patients.

ligation

Sclerosis- a widely used method of combating varicose veins of any location, 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 thrombosis of 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 radio knife. The procedure is performed under local anesthesia on an outpatient basis. In addition, in this way it is possible to remove external hemorrhoid nodes 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 contraindications to them may include thrombosis of nodes, the formation of an anal fissure, acute and chronic inflammatory processes in the rectum and perineum.

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 extremely undesirable, as it can cause severe pain and injury to the postoperative wound, and to avoid this, a complete refusal to eat while maintaining a good drinking regime is indicated.

From the second day, food is gradually introduced that does not contribute to intestinal irritation and the formation of dense stools: light soups, cereals, fermented milk 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 speed up the healing of the rectum, baths are carried out with a weak solution of potassium permanganate and a decoction of chamomile flowers. Drug treatment consists of using ointments and suppositories with methyluracil, which improves regeneration processes.

To prevent possible urinary retention, the rectum is not tamponed after the intervention, and the patient is advised to consume a sufficient amount of fluid. This complication is especially common among men and often requires the insertion of a urinary catheter to empty the bladder. Spasm of the rectal sphincter helps remove nitroglycerin cream.

The patient must necessarily follow all the necessary hygiene procedures, which the clinic staff will tell him about, and do not ignore dressings and examinations. The diet after surgery should contain enough fiber to make stool easier. You should have a bowel movement immediately when the urge arises, but you should not linger in the bathroom for too long, or strain or strain. If necessary, laxatives may be prescribed.

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

Bleeding, which may be associated with insufficiently complete suturing of vessels, slipping of ligatures;
Anal canal stenosis 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 observed during the treatment process;
Relapse, the likelihood of which remains with any type of surgical treatment.

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

Recovery after surgery takes about 2 weeks, but rehabilitation after hemorrhoid removal is not limited to the time spent in the hospital. To consolidate the positive effect of treatment and prevent 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 certain rules:

You should not lift heavy objects;
It is necessary to exclude physical activity with abdominal tension;
If possible, avoid prolonged sitting or standing;
Normalize your diet;
Provide adequate physical activity.

Nutrition and movement – the first thing that even those patients who could not resist a cup of strong coffee or a bar of chocolate will have to come to terms with . Spicy foods, an abundance of spices, alcohol, chocolate, marinades and smoked foods, coffee and carbonated drinks should be excluded from the diet. Any of these products can lead to exacerbation of hemorrhoids. In addition to foods that provoke the disease, you need to remove from consumption those that contribute to constipation (flour and sweets, first of all).

If, due to the nature of your 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 relapse of the disease.

The cost of surgical treatment of hemorrhoids depends on the method and extent 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. Free treatment is also possible, but in this case the patient may have to wait his turn. Patients who are indicated for urgent treatment for massive bleeding or thrombosis of nodes are provided free of charge in a surgical hospital.

Hemorrhoids are a disease of the veins and blood vessels located in the rectum and anus of a person. All people on the planet are susceptible to disease, but few seek medical help on time. As a result, the disease reaches its final stages, and conservative treatment is unable to solve the patient’s problem. Surgery is mandatory.

The third and fourth stages of the disease are direct indications for surgical removal of hemorrhoids. The patient's condition is serious. If conservative and minimally invasive treatment methods fail, the disease rapidly progresses and surgical intervention is required. Let us describe the reasons for the need.

Large nodes fall out of the rectal lumen;
Heavy bleeding;
The patient experiences unbearable pain when walking, in a resting position;
The functions of the rectal sphincter are weakened - uncontrolled excretion of feces;
Threat of thrombosis, pinching of hemorrhoids, formation of cracks in the rectum;
There is a high risk of developing an inflammatory process and infection.

For external hemorrhoids:

Severe swelling of the tissues around the anus;
The pain is strong;
Large hemorrhoids interfere with movement. It is impossible to fixate in a sitting position;
The tissue around the anal canal cracks;
The risk of thrombosis and pinching of the hemorrhoid increases;
Increased likelihood of developing skin diseases due to aggressive mucous secretions;
The threat of infection and inflammation of the subcutaneous fat tissue increases.

With combined hemorrhoids, symptoms characteristic of external and internal hemorrhoids occur.

A mandatory indication for surgery is rectal prolapse due to hemorrhoids, complications - paraproctitis and others.

Cases of contraindications for surgery

A number of contraindications for surgery for hemorrhoids:

Surgery for hemorrhoids is not performed in the acute stage of intestinal disease;
Surgery to remove hemorrhoids is not performed in case of poor blood clotting or diseases of the circulatory system;
Surgical treatment of hemorrhoids cannot be prescribed in cases of renal, hepatic and pulmonary failure;
It is unacceptable to perform surgery using general anesthesia for pathologies of the cardiovascular system and respiratory diseases;
Diabetes mellitus is a contraindication for surgery due to poor blood clotting;
Surgery to remove hemorrhoids is contraindicated if the patient has malignant tumors;
Surgery to remove hemorrhoids is not performed if the immune system is weakened.

They try to prescribe treatment for older people using conservative methods - after 50 years, tissues are difficult to restore. If surgery cannot be avoided, careful examination of the patient and preparation for surgery is recommended.

Preparing for surgery

The patient is carefully prepared for the upcoming surgical intervention.

What preparatory activities are carried out at the clinic?

Selection of a suitable treatment method. The doctor determines the method of surgical intervention depending on the severity of the disease, the location of the hemorrhoids, and the presence of complications. For this purpose, the patient is examined, his medical history is taken, and complaints are discussed.
Conducting a medical examination. In order to identify possible contraindications and risks, laboratory tests (blood and urine tests), electrocardiography, fluorography, digital examination of the rectum, anoscopy, colonoscopy, and ultrasound of the abdominal organs are performed.
Preparation for anesthesia. The anesthesiologist records information about the patient’s constant use of medications, the presence of allergic reactions to medications, and performs the necessary tests. Decides what anesthesia the operation will be performed under. Informs the patient about preparations the day before surgery - nutrition and drinking regimen, enema. Removable dentures should be removed from the oral cavity and jewelry should be removed.

How does a patient prepare for surgery?

The patient begins preparing for surgery a couple of weeks before the operation.

The diet is being followed. To prevent complications after surgery, the patient normalizes intestinal function and prevents constipation. Foods that cause bloating, diarrhea, constipation, and foods that irritate the stomach and intestines are excluded from the diet.
Before the operation, measures are taken to eliminate inflammation in the anal area. Swelling, inflammation or ulcers are minimized with medications.
Visit your dentist before surgery. Treat sick and loose teeth, as they will cause problems under general anesthesia.
In the evening before the operation, hygiene procedures are required. In the evening, take a shower and do a cleansing enema - the intestines are kept empty on the day of the operation.
Nutrition and drinking regime. The last meal before surgery should be taken at least 12 hours before. On the morning of the operation, in case of general anesthesia, you should not drink water.

Methods of surgical intervention

Depending on the location of hemorrhoidal cones, size, presence of bleeding, stage of the disease, methods are prescribed to rid the patient of hemorrhoids.

The primary goal of surgery is to remove inflamed hemorrhoids.

Radical and minimally invasive methods of surgical treatment are known. Removal of hemorrhoids by radical surgery is carried out at the third or fourth stages of the disease. Elimination of the affected areas occurs by cutting and excision.

Milligan-Morgan hemorrhoidectomy

A radical method for treating hemorrhoids. Treatment is carried out in two ways:

Open - when the surgical wound is not sutured, but heals on its own. The operation takes place in a hospital setting.
Closed - sutures are placed on the operated areas of the mucous membrane. The patient is operated on on an outpatient basis.

Open hemorrhoidectomy is used in cases complicated by fissures in the rectum or the development of paraproctitis. The procedure involves cutting or excision of the inflamed nodes and surrounding mucosa. Sometimes the Prax method is used, when the nodes themselves are cut out without the mucous membrane.

The advantages of the method include:

Surgery using the Milligan-Morgan method removes internal, ;
The operation gives results, the problem does not return for a long time;
Complications after surgery are rare.

The disadvantages include:

Surgical treatment takes several hours and is performed under general anesthesia;
Pain during the postoperative period;
Long-term period of healing and rehabilitation.

Hemorrhoidectomy using the Longo method

The transanal resection method used is the Longo method.

Surgical intervention consists of cutting off part of the mucous membranes of the rectum above the dentate line - above the hemorrhoidal cones. The nodes are not excised; they are pulled upward and sutured with medical staples. As a result of the cessation of blood flow, the cones “shrink out.” Subsequently, they are overgrown with connective tissue, and the intestine acquires a natural anatomical appearance.

Advantages of the method:

The patient is operated on using local anesthesia;
Blood loss during surgery is minimal;
The procedure lasts up to 15-20 minutes;
Painless course of the postoperative period;
The operation gives a stable result, complications occur infrequently.

Flaws:

The Longo method is only applicable to the treatment of internal hemorrhoids.
The operation is expensive.

Treatment of hemorrhoids with laser

If at stages 1-2 conservative treatment does not bring a noticeable effect, surgery is required; hemorrhoids are removed using minimally invasive methods.

Laser coagulation is an effective method for treating hemorrhoids. Effective for .

The technique is based on the use of the following properties of the laser beam:

Work in the infrared range;
Ultra-precise focusing;
Use of thermal radiation.

The internal nodes are cauterized with a laser beam, the external ones are cut off. During treatment, the doctor adjusts the depth and power of the beam.

The method is effective in the treatment of thrombosed hemorrhoids, in the presence of heavy bleeding from internal nodes and anal fissures. Laser coagulation is prescribed even for inflammation and fistula canals.

Advantages of the method:

Laser coagulation is used to remove hemorrhoids of any location;
Cracks, ulcers and inflammation are eliminated;
The procedure is highly precise and non-traumatic for surrounding tissues;
Laser coagulation is painless and bloodless;
The patient recovers quickly after such an operation;
Removal of large nodes at stages 3 and 4 of the disease using a combined technique.

A few disadvantages:

Cost of treatment;
Insufficient performance on .

The laser coagulation procedure requires preliminary preparation from the patient.

The operation to remove hemorrhoids involves the use of anesthesia, so there are clear contraindications to this type of treatment for external hemorrhoids:

the presence of severe concomitant pathologies of a general nature;
oncological diseases of varying localization and severity;
(due to poor wound healing);
intestinal pathologies that are associated with the formation of ulcers or acute inflammatory processes;
immunodeficiency states.

Note:Pregnancy is also a contraindication in this case, but is conditional. The fact is that removal of external hemorrhoids during pregnancy is usually accompanied by relapses, but during childbirth hemorrhoids may simply disappear.

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Types of operations for external hemorrhoids

Surgical treatment of external hemorrhoids is carried out in 50% of cases when patients consult a doctor, because they do this already in the last stages of the development of the disease. Modern surgery can offer various types of surgical treatment for the disease in question: minimally invasive, classical surgery and laser removal of hemorrhoids.

Minimally invasive methods

A feature of minimally invasive methods is that the surgeon does not use a scalpel during the operation. Instead, punctures are made in the internal tissues, through which the necessary manipulations are carried out. The main advantage of this method of treating external hemorrhoids is the absence of contraindications and a short rehabilitation period. Similar minimally invasive methods of treating external hemorrhoids include:

Sclerotherapy

It is used to treat stages 1-3 of external hemorrhoids and to stop bleeding. It involves the introduction of specific sclerosing drugs into the hemorrhoids, which cause the transformation of blood vessels into connective tissue. The bleeding stops quickly; over time, the hemorrhoidal node can significantly decrease in size.

Infrared coagulation

To carry out this treatment, doctors use a special device - a photocoagulator. Using an anoscope, the surgeon brings the tip of the device’s light guide directly to the “legs” of the external hemorrhoids. The heat flux that passes through the light guide acts on the principle of laser beams. It is worth knowing that it is impossible to remove a hemorrhoid using infrared coagulation; this minimally invasive method of treating the disease in question is most often used to stop bleeding.

Ligation with latex rings

The essence of this operation is to put special latex rings on the external nodes of hemorrhoids. During the procedure, the surgeon will use a mechanical and/or vacuum ligator. The hemorrhoid lump falls off along with the applied ring, and a stump of connective tissue remains at the site of rejection. This method relieves 90% of patients from external hemorrhoids, especially since it only takes 2 weeks to wait for the procedure to be completed (when the node disappears).

Cryotherapy

During this minimally invasive procedure, the hemorrhoids are frozen with liquid nitrogen. After thawing, the node dies, and the resulting wound is treated with special wound-healing drugs. The entire procedure for freezing hemorrhoids lasts a maximum of 4 minutes.

Classic surgical methods

In some cases, removal of external hemorrhoids requires the patient to remain in the hospital, carefully prepare for the operation and use general anesthesia. Surgical removal of hemorrhoids is also carried out using several methods:

conventional surgery to remove nodes;
removal of dropped nodes using radio waves;
hemorrhoidectomy;
disarterization.

All of the listed methods of surgical removal of external hemorrhoids have some advantages:

relapses are extremely rare;
after the operation there are no open wounds;
cases of infection and extensive bleeding are rare;
the rehabilitation period is reduced to 4-5 days.

Laser removal of hemorrhoids

The main advantage of this method of surgical treatment of external hemorrhoids is the absence of pain. During the procedure, the patient does not feel any discomfort or pain at all, which makes it possible to avoid prescribing painkillers. In addition, only after removal of hemorrhoids by laser is the patient immediately allowed to walk. It is worth noting another positive point - during laser removal of external hemorrhoids, the risk of trauma to the anus and surrounding tissues is minimized.

Removal of hemorrhoids with a laser is carried out both at the initial stage of the disease and with visible progression of the pathology. The external nodes are simply cut off with a laser beam, and the resulting wounds are immediately “soldered together,” which means a complete absence of bleeding.

Advantages of laser removal of hemorrhoids (external)

To understand why doctors prefer to remove external hemorrhoids with a laser, you need to familiarize yourself with the advantages of this treatment method:

Removal of external hemorrhoids is absolutely painless - the patient only feels heat waves. If a person’s pain threshold is low, then the operation can be performed under local anesthesia.
The procedure for removing external hemorrhoids is performed on an outpatient basis and lasts 10-15 minutes.
There is no need for any specific preparation before the operation.
Immediately after removal of the nodes with a laser, the patient can go home, and the very next day they can return to their usual lifestyle, including work.
Since the laser instantly cauterizes the wounds, there is almost no risk of bleeding.
External hemorrhoids can be removed with a laser in case of acute inflammatory processes, diagnosed fistulas, etc.

It is worth knowing about some of the disadvantages of this method of removing hemorrhoids. Firstly, nodes that are too large are not completely removed by a laser beam, so relapses of the disease may occur. Secondly, this procedure is quite expensive.

Possible complications after surgical treatment

The most unpleasant consequence of surgical treatment of external hemorrhoids is relapse of the disease. Agree, the appearance of new nodes and the need for a repeat operation is unlikely to please anyone. But besides this, there are a number of complications/undesirable consequences that accompany surgical treatment of external hemorrhoids:

Severe pain. They are caused by the presence of many nerve fibers in the anorectal region. You can get rid of pain only with painkillers (prescribed by your doctor).
Psychological barrier. Occurs if the patient experiences severe pain during surgery or visiting the toilet. He will hold back the urge to go to the toilet, which only makes the situation worse. This phenomenon can be dealt with by prescribing laxatives.
Urinary retention. This unpleasant syndrome lasts no more than a day after surgery to remove external hemorrhoids. If necessary, the doctor will catheterize the bladder.
New bleeding. The reason for this may be either an improperly cauterized vessel or injury to the rectal mucosa. The patient is prescribed a hemostatic sponge, or the vessel is sutured.

Surgical treatment of external hemorrhoids is a necessity that both doctors and patients often face. There is no need to be afraid of operations for external hemorrhoids - modern medicine performs them quickly, practically painlessly and with minimal risk of complications. But timely removal of external hemorrhoids will help avoid the serious consequences of the progression of this disease.

Tsygankova Yana Aleksandrovna, medical observer, therapist of the highest qualification category

Surgery to remove hemorrhoids is a radical treatment method and is performed if conservative therapy is not effective. Hemorrhoids occur most often in the male half of the population, and much less often in the female half.

Indications for surgery

Hemorrhoids are accompanied by such unpleasant symptoms as burning in the anus, pain and itching. The disease begins as a result of varicose veins in the anus and can sometimes be accompanied by periodic bleeding. When a certain area of the intestine is severely damaged, hemorrhoids form.

Removal of hemorrhoids is indicated in the following cases:

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

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

What types of operations are there?

Surgical removal of hemorrhoids can be performed in different ways:

sclerotherapy;
Longo operation;
cryotherapy;
hemorrhoidectomy;
disarterization.

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

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 recovery period, and no need for anesthesia.

Thrombectomy, which can be performed with a laser or radio waves, can help remove blood clots. 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 treatment methods. General blood cleansing 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.

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

Hemorrhoidectomy is a standard surgical treatment for hemorrhoids. The indication for surgery is third and fourth degree hemorrhoids. A section of skin with mucous membrane over the hemorrhoid is removed. In addition to surgical excision, cauterization can be used. Complications after such treatment are extremely rare, and the rehabilitation period passes quite quickly.

Cryotherapy is performed under local anesthesia and involves freezing the hemorrhoids, after which they die. In terms of time, such an operation to remove hemorrhoids takes no more than 5 minutes. A small wound is formed at the site where the nodule was, which will have to be treated with special preparations.

Desarterization is the removal of hemorrhoids by ligating the hemorrhoidal artery. Indications for such treatment may be internal hemorrhoids, the presence of hemorrhoids and other pathological processes. The advantages of disarterization 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 recovery of the body.

This operation to remove hemorrhoids was named after Dr. Antonio Longo from Italy. It involves removing a specific area of the mucous membrane above the hemorrhoid. The entire operation takes no more than 20 minutes.

Longo's operation for hemorrhoids helps to cure internal hemorrhoids at the last stage and remove hemorrhoids. It is also considered the most effective among all other techniques and is performed under ultrasound guidance. To perform this surgical procedure, local anesthesia is required.

Advantages of surgical treatment:

fast recovery;
excision of several nodes at once;
absence of a 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 this, the 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. A piece of gauze with ointment and a gas outlet tube are also 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 performing 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. To do this, the patient must undergo a blood test, urine test, etc.

Before surgery, it is imperative to cleanse the intestines with a laxative or enema. It is also worth following a special diet and eliminating foods that irritate the intestines. You can relieve inflammation in the rectum with the help of traditional medicine and medications.

Rehabilitation period

The patient’s behavior in the first days after removal of a hemorrhoid should largely depend on the type of surgical procedure. A properly selected diet after surgery to remove hemorrhoids will help prevent intestinal irritation and inflammation. It is recommended not to put too much strain on the intestines and refrain from bowel movements for the first day.

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

Advice: To avoid serious consequences after surgery, you must 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 for hemorrhoids, cannot urinate on their own, as acute urinary retention occurs. Bladder catheterization helps restore urination.

A rather rare consequence of treating hemorrhoids with surgery is rectal prolapse. 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 surgery. A channel is formed in the intestine, which connects to an adjacent hollow organ or skin. This problem can be eliminated only through repeated surgery.

A fairly common consequence of surgery to remove hemorrhoids is a purulent process, which is caused by the entry of harmful microbes into the wound. In this case, the abscess is opened or a course of antibiotics is prescribed.

Contraindications

It is prohibited to perform surgery 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 or medications help. The type of operation is selected for each patient individually, taking into account his age, severity of the disease and examination results.

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

The doctor must select the appropriate type of treatment for the patient 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 tests to exclude the presence of contraindications to the operation.

Video

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

Hemorrhoids are characterized by 4 stages of development, separating the acute form from an advanced chronic condition. If in the first stages of pathology formation conservative treatment allows solving the problem, then in the last stages hemorrhoids have to be eliminated radically.

Surgical intervention is mandatory for node thrombosis. Also, surgery is inevitable in the following situations:

Constantly dropping nodes;
Heavy hemorrhoidal bleeding;
Increasing anemia occurring against the background of abnormal bleeding;
Tendency to seasonal exacerbations of inflammatory processes in the rectal mucosa (including the nodes themselves).

Contraindications for surgery

The main contraindication to surgery to eliminate hemorrhoids is the presence of an inflammatory process (often with additional infection). Often, elderly patients whose medical history is burdened with pulmonary or cardiac pathologies, and the hemorrhoids themselves hardly become inflamed or bleed, are prescribed conservative methods.

This is explained by the fact that it is inappropriate to expose an organism that is not prone to anemia, but sensitive to various stress factors, to any danger. Contraindications include the following:

Acute heart failure;
Diabetes mellitus, complicated by poor healing of wounds (including surgical wounds);
Intestinal pathologies accompanied by total inflammatory processes and the formation of ulcers;
Immunodeficiency of various origins.

Also, surgery to remove hemorrhoids is not performed on pregnant women. This is largely due to the fact that some pathological protrusions disappear on their own immediately after childbirth.

Surgical procedures

Surgical intervention to get rid of hemorrhoids is performed in 60% of all cases. This pattern is explained quite simply: for any patient, such a problem is delicate and shameful, so many people start the disease and seek help only after hemorrhoids become impossible to ignore. Today, there are many ways to quickly solve the problem of hemorrhoids.

Milligan-Morgan technique

The operation is also called hemorrhoidectomy. This is the oldest method of surgical treatment, which in comparison with other techniques is considered to be the most traumatic.

The operation is advisable if the patient has very large nodes and the risk of heavy bleeding is maximum. The doctor removes venous conglomerates completely, even excising fragments of the mucous membrane.

It is worth mentioning the disadvantages of this operation:

The need to remain under general anesthesia for an extremely long time;
The risk of heavy bleeding during surgery;
In the early postoperative period, there is a risk of developing numerical complications;
Long postoperative recovery period.

Parkes technique

The operation is considered one of the variants of the Milligan-Morgan technique. With this type of intervention, it is easier for the patient to tolerate the procedure. The deformed tissues of the nodes are completely excised, but the mucous membrane is almost not affected.

Operation Longo

The most effective radical treatment for hemorrhoids today is considered to be surgery using the Longo method. A positive result can be obtained by disarterization of hemorrhoidal cones.

The doctor penetrates the patient’s rectum, under ultrasound control, dissects and tightens fragments of the arteries that feed the pathological formations. During the procedure, the patient is under local anesthesia. The duration of the entire operation does not exceed 20 minutes. In this case, manipulations are performed on an outpatient basis.

The main advantages of this operation:

Ability to remove multiple internal nodes;
During the procedure, the patient suffers almost no blood loss, which is especially important for patients with anemia;
Short recovery period after surgery;
Minimum period of hospitalization (maximum 1 day).

However, Longo's method of removing hemorrhoids has one feature. This procedure does not remove the external manifestations of the disease.

Minimally invasive interventions

To treat small nodes, minimally invasive techniques are used, which are carried out with utmost comfort for the patient and avoid most complications. Popular methods include infrared photocoagulation.

For grade 1 - 3 hemorrhoids, the doctor removes the node using the energy of an infrared ray, damaging the vascular pedicle of the hemorrhoidal protrusion. In this case, additional cauterization of some sections of the blood vessels approaching the node occurs.

No more than 3 nodes are processed in one session. Removal of formations is allowed in case of minor inflammatory processes of the intestines.

Scleroderma is a method of treating hemorrhoids of degrees 1, 2 and 3. Special substances with sclerosing properties are injected into the formation. The bumps sharply decrease in size, while the remaining tissue is replaced over time by connective tissue and no longer brings discomfort to the person.

Ligation

Ligation of hemorrhoids is a common method for removing stage 2 and 3 nodes. A special ring made of natural latex is placed over the bump. This element compresses the node, completely blocking the blood flow to the formation. The death of the cone occurs after 2 - 3 weeks.

In this case, the remains of the node are removed from the rectum directly during the process of natural bowel movement. After this, the person can be considered healthy. This is an excellent option, allowing radical intervention to be extremely patient-friendly.

Suture ligation is another minimally invasive procedure for removing hemorrhoids. In this case, they do not use latex rings, but suture material, which is used to bandage the cones. The method is considered technically simple, and patient reviews indicate that in the postoperative period there are no discomforts, unlike techniques with latex rings.

Complications

No matter how minimally invasive the intervention, complications can always arise, even after the most flawless surgical algorithm. However, problems in the early or late postoperative period still arise due to medical oversight.

The most common complications:

Suppuration;
Formation of a fistula or fistula;
Pathological narrowing of the anal canal;
Bleeding;
Urinary retention;
Rectal prolapse;
Psychological discomfort, a feeling of fear directly related to worries about one’s delicate problem;
Weakness of the anal sphincter.

Any of the problems that arise can be solved. It is necessary to understand that removal is only one of the stages of treatment. Rehabilitation takes about 3 - 4 weeks. During this time, the patient must not only recover, but also reconsider his lifestyle.

The person is told how to initially care for tissues whose areas have been removed, and what to do to prevent the re-formation of hemorrhoids. An active lifestyle, changing eating habits and paying attention to your health will help you avoid most problems.