How is the operation to remove hemorrhoids. What types of operations to remove hemorrhoids exist and how much do surgical interventions cost? Milligan-Morgan hemorrhoidectomy

Surgery is a radical method, which is prescribed as a last resort when conservative and minimally invasive treatment has not brought the desired result. How are hemorrhoids removed? In what cases is the operation prescribed and how is it performed?

Milligan-Morgan Method

The classic way to remove nodes surgically is the most traumatic method, which is used for highly enlarged bumps and the risk of extensive bleeding. Hemorrhoids are removed completely, along with the affected mucosa.

The operation is of 2 types: open (the wound is not sutured) and closed (the wound is sutured).

Surgical intervention is carried out in a hospital under general anesthesia. The patient is placed on a couch or seated in a special chair and the legs are fixed on the stands. Treat the surgical site with an antiseptic solution and perform the following actions:

• An anoscope is inserted into the anus to facilitate access to the nodules.
• Cones are seized alternately with a surgical clamp, pulled out and pinched the vessels that feed them.
• The base of the knot is sutured with a self-absorbable thread, applying a figure-eight suture (this prevents the ligature from slipping).
• With the help of an electric knife or a scalpel, a bump is excised. Electroknife is used more often, as it not only cuts, but also cauterizes blood vessels, preventing bleeding.
• Depending on the type of operation (open or closed), the wounds are sutured or left open. Between the sutured wounds, sections of the mucous membrane are left to prevent narrowing of the posterior canal.
• The sutures are treated with an antiseptic, a cotton swab soaked in a medicinal ointment is inserted into the anus, and the operated area is covered with a sterile napkin.

Parkes method

Less traumatic method of surgical intervention compared to the previous method. During the operation, the surgeon removes the nodular formation itself, while the mucosa remains intact. Surgical intervention allows the patient to do without a strong pain syndrome in the recovery period.

It is performed under general anesthesia or epidural anesthesia. The patient is placed on the operating table with legs apart and bent at the knees. Feet are fixed on special supports. The anorectal region and the rectal mucosa are treated with an antiseptic and dried. Next do:

• The mucosa over the enlarged bump is dissected in the longitudinal direction, the knot is captured with a surgical clamp and pulled out until the leg is released.
• Another clamp is applied to the vascular pedicle and stitched with catgut (special thread), but not tightened. Such manipulations are necessary to prevent the ligature from slipping off the stump (the place of rejection of the hemorrhoidal formation) of the bump.
• The wound is sutured, and above the stump of the nodular formation, 2 mucosal lobes are formed, which are sutured in the radial direction.
• A tampon impregnated with an antiseptic and wound healing agent is inserted into the anal passage for 6-8 hours.

An effective and sparing method of surgical treatment of internal hemorrhoids. During the operation, the surgeon resects a small area of ​​the mucous membrane, while the nodes are not excised, but pulled up and fixed. The blood flow to the veins gradually decreases, and they are overgrown with connective tissue.

It is carried out in a hospital under local anesthesia. The patient is placed in the required position and manipulations begin:

The surgeon expands the anal passage with special clamps and inserts an anoscope into the rectum. Slightly above the dentate line, a purse-string suture is applied and the threads are pulled together.

After that, a circular stapler is inserted into the operated area, with the help of which part of the affected tissues is excised, and the edges of the wound are fastened with special staples.

After excision, the doctor examines the staples and checks the correctness of the operation. In the presence of bleeding, additional sutures are applied with a self-absorbable thread.

At the end of the procedure, a gauze swab soaked in ointment and a gas outlet tube are inserted into the patient's anal passage for 24 hours.

Indications

• - hemorrhoids;
• prolapse of hemorrhoidal cones during bowel movements;
• vein thrombosis;
• development of anemia due to frequent bleeding.

Contraindications

• Diabetes;
• hypertension;
• exacerbation of chronic intestinal pathologies;
• blood clotting disorder;
• malignant neoplasms;
• severe decompensated diseases of internal organs;
• acute infectious processes.

How to prepare

Before the planned surgical intervention, the patient is recommended to undergo an examination to identify hidden pathologies of internal organs and infectious and inflammatory processes:

• general urine and blood tests;
• blood sugar test;
• electrocardiography;
• chest x-ray;
• sigmoidoscopy or colonoscopy;
• digital examination of the rectum.

Pay special attention. During preparation, it is forbidden to use foods that provoke excessive formation of feces and gas formation. Easily digestible food is preferred: fermented milk products, eggs, low-fat varieties of poultry, fish, vegetable soups.

Preparation of the patient on the eve and on the day of surgery to remove hemorrhoids includes:

• the last meal should be at least 12 hours before the operation;
• before the intervention, the patient is given a cleansing enema, which can be replaced with laxatives (Fortrans or Microlax).

Diet

On the first day after surgery, bowel movements should be avoided, so the patient is recommended a starvation diet. In the future, such a diet is selected so that the feces are formed in small volumes and are soft. The use of a large amount of liquid is shown.

The diet for the first 7-10 days after surgery should consist of:

• semi-liquid cereals (buckwheat, oatmeal) cooked in water;
• vegetable soups;
• boiled or grated lean meat and poultry (steam cutlets or meatballs are allowed);
• low-fat dairy products.

In the future, the menu can be varied:

• lean fish (pollock, hake);
• lean meat (veal, rabbit meat);
• poultry meat (chicken, turkey);
• fruits (bananas, baked apples);
• high-fiber vegetables (zucchini, cauliflower, lettuce, beets, pumpkin);
• eggs in the form of omelettes;

From drinks it is better to give preference to herbal teas, homemade compotes, fruit drinks.

Allowed foods should be steamed, boiled or stewed. You need to eat 5-6 times a day, in small portions and at regular intervals.

During the recovery period, it is necessary to abandon products that will contribute to flatulence, constipation:

• fruits (citrus fruits, raspberries, gooseberries, fresh apples, grapes);
• vegetables (onion, garlic, radish, radish, cabbage, turnip);
• mushrooms;
• legumes;
• rice and semolina porridge;
• alcohol, carbonated and caffeinated drinks;
• fatty meat and poultry (pork, duck, goose, lamb);
• sweets, muffins, white bread;
• pasta;
• smoked meats, spicy and spicy food, marinades, pickles, canned food, fast food.

rehabilitation period

After the operation, the patient remains under the supervision of a doctor in a hospital for about 10-12 days. In this case, the rehabilitation period depends on the chosen method of intervention. For a complete recovery after a closed hemorrhoidectomy, 3-4 weeks are required, with an open one - 1.5-2 months, according to the Parks and Longo method - 14-15 days.

In order to consolidate the therapeutic effect and prevent relapse, the patient is advised to follow the following rules:

• to speed up the recovery processes, treat postoperative wounds with special ointments based on methyluracil;
• exclude physical activity with tension of the anterior abdominal wall;
• do not lift weights;
• Healthy food;
• avoid prolonged sitting;
• lead an active lifestyle, take walks.

Complications

The most common complication after radical removal of cones is bleeding due to early falling off of the crust on the vessel after its coagulation or poor hemostasis.

Other adverse effects may also occur:

• suppuration of the seams;
• fistulas;
• recurrence of hemorrhoids;
• anal sphincter weakness and rectal prolapse;
• narrowing of the anal passage.

Most of these consequences require repeated surgical intervention.

Effects

The most common consequences of surgical removal of hemorrhoids include:

• pain syndrome;
• puffiness;
• problems with bowel movements and urination.

These effects are a variation of the norm and will pass if the doctor's recommendations are followed a few days after the operation.

See inaccuracies, incomplete or incorrect information? Do you know how to make an article better?

Would you like to suggest photos for publication on a topic?

Please help us make the site better! Leave a message and your contacts in the comments - we will contact you and together we will make the publication better!

Surgical treatments for hemorrhoids are usually carried out in the last stages of the disease, when conservative therapy does not give positive results, or during exacerbation, which is accompanied by unbearable pain.

Removal of nodes allows you to forget about unpleasant symptoms forever, especially since surgeons offer not only traditional operations, but also minimally invasive treatment techniques. What are the features, pros and cons of various types of surgical intervention, we will tell further.

Indications for carrying out

It is formed as a result of the expansion of venous accumulations. Violation of blood flow in the anus leads to the appearance of blood clots, swelling of the walls of the veins and their damage by feces.

There are 4 degrees of severity of proctological disease. And if at the very beginning the disease is well treated with the help of systemic and local drugs, then at the last stage, surgical removal of hemorrhoids becomes mandatory.

There are several indications in which the surgical removal of hemorrhoids is considered an important and necessary measure for the treatment of an unpleasant disease. Among them:

• prolapse of internal nodules after defecation and even during light physical exertion;
• pinching of cones and thrombosis of venous accumulations;
• frequent or heavy bleeding from the rectum.

Thus, surgical treatment of hemorrhoids is indicated in the presence of various complications and negative consequences that seriously worsen the patient's condition and even threaten his life.

For example, it is necessary when inflamed cones exit the anus and the flow of blood, since such phenomena are dangerous for humans.

In addition, specialists prescribe surgery for a combination of enlarged hemorrhoids with other proctological diseases of the rectum, for example, anal bleeding fissures, polyps, pararectal abscess.

Methods for removing hemorrhoids are divided into minimally invasive and operational. The first techniques are characterized by less blood loss, associated pain syndrome and a shorter recovery period.

Minimally invasive techniques

Recently, removal has been practiced more and more often.

In addition to the fact that penetration into the rectal cavity and its trauma is minimal, the following features can be distinguished among the advantages of minimally invasive methods:

• insignificant damage to the tissues that surround the inflamed hemorrhoids;
• short duration of the intervention itself (about 20-30 minutes);
• the procedure is almost always performed not under general anesthesia, but under local anesthesia;
• patients practically do not feel pain and return home within a few hours after the manipulation;
• after the intervention, the risk of scarring and deformation of the tissues and mucous membranes of the rectum is minimal;
• the techniques have practically no restrictions, which is why they are prescribed for age patients and people with serious concomitant diseases;
• low-traumatic techniques can be used at almost all stages of hemorrhoids.

To date, there are several types of such sparing surgical interventions, each of which deserves a separate discussion.

Desarterization

This is the removal of internal hemorrhoids, during which the surgeon ligates the arterial vessels that deliver blood to the overgrown hemorrhoids. Since they now have no nutrition and blood supply, the bumps begin to die off, and soon disappear altogether.

Itself looks like this - an anoscope equipped with a sensor is inserted into the anus of the patient.

With its help, the exact location of the arteries leading to the nodule is clarified. Through a special window, the vessels are tied with threads.

Desarterization is carried out at all stages of the disease, however, patients with the second or third degree of inflammation of the hemorrhoidal cones see the most tangible effect.

Cryodestruction

The essence of this technique is to freeze enlarged venous plexuses with the help of liquid nitrogen, which cools parts of the body to almost -200 C. After such an impact, the node freezes, and after a while it completely disappears.

Liquid nitrogen affects only damaged areas, since healthy areas through the arteries create a thermal "border" that prevents the penetration of cold into nearby tissues.

Dead cells leave the rectum in about a week.

Cryodestruction is painless, without scarring and bleeding.

In addition, low temperatures activate the immune system, improve microcirculation, enhance metabolic and recovery processes.

Sclerosis

This procedure involves the elimination of hemorrhoids with the help of special medications that cause the venous and arterial vessels to stick together in the hemorrhoids.

The drug is injected into the area that supplies blood to the inflamed venous congestion. As a result of the injection, the nodule ceases to receive nutrition and soon decreases in size.

The procedure is done painlessly and very quickly, the therapeutic effect is detected after the first injection of the sclerotic solution. However, the technique is not suitable for the treatment of external hemorrhoids, in addition, a relapse is possible, since the cause of the disease is not eliminated.

Laser coagulation

This gentle surgery is used to treat both external and external hemorrhoids. The laser, acting on the venous congestion with heat, causes coagulation, or folding of protein substances. Arteries and veins are soldered, so that bleeding is excluded.

Removal of external and internal hemorrhoids occurs in different ways. In the first case, the skin is excised with a laser; with internal hemorrhoids, the device burns out the nodule from the inside.

After this minimally invasive surgical treatment of hemorrhoids, the feeding of the cones stops, they die off and after 14 days they come out with the feces. Most often used in stages 2 and 3 of the disease.

Ligation with latex rings

Similar. The procedure itself involves clamping the "legs" of hemorrhoids, as a result of which they cease to be supplied with blood, dry up and then completely die off.

Latex rings do not contain any harmful elements, so these devices do not lead to allergies. Elastic rings are thrown over the base of the hemorrhoidal bump and squeeze it. After 2 weeks, the dead nodule comes out along with the feces.

Only nodules located in the rectum are removed by this method. For the treatment of external hemorrhoids, ligation is not suitable. The main drawback is that the patient experiences a sensation of a foreign body in the anus, however, this feeling is short-lived.

infrared coagulation

You can also remove overgrown venous accumulations with the help of infrared rays.

After some time, hemorrhoidal cones die off.

Depending on the severity of the proctological disease and the severity of clinical symptoms, up to 6 procedures may be required. The method demonstrates particular effectiveness in the first stage of the disease.

If the intervention is successful, the damaged nodes fall out, and the bleeding stops.

However, recurrence of hemorrhoids is quite often observed.

Cons of minimally invasive techniques

Low-traumatic methods for removing enlarged hemorrhoids are characterized by a minimal number of undesirable consequences, but they still exist.

• Pain syndrome. Unpleasant sensations after the procedures are possible, since the mucous membrane of the anus is extremely sensitive to all influences. Most often, pain occurs during ligation (especially if the rings are incorrectly applied or there is a capture of nearby tissues) or infrared coagulation.
• Bleeding. A similar complication is possible in almost every procedure. A pleasant exception is the removal of nodules with a laser (arteries and veins are cauterized) or cold (vessels are frozen). Moderate bleeding occurs when dead nodules come out of the rectum.
• Thrombosis of external nodules. This possibility is not excluded in the combined form of the disease, when internal nodules are ligated, and clots form in external ones. If the nodule is not completely removed during coagulation with infrared rays, then the probability of the formation of a blood clot is quite high.

Minimally invasive methods for removing developed hemorrhoids also have certain disadvantages, for example:

• the frequent return of clinical symptoms, since it is not the cause of hemorrhoids that is eliminated, but its result (a pleasant exception is desarterization);
• rather high cost of procedures;
• extremely high requirements for the skills of a surgeon (highly qualified specialists are not found in all medical institutions).

Not always the low-traumatic methods listed above lead to the desired result. In this case, a traditional operation is prescribed to remove hemorrhoids.

Surgery

Surgical removal of hemorrhoids involves the use of two main types of intervention - hemorrhoidectomy and. Most often they are used in the most severe forms of the disease or in the event of complications.

Hemorrhoidectomy

Another variant of the name of the procedure is . Such an event is designed to remove external enlarged venous accumulations and get rid of internal nodules with the help of excision.

The operation to remove hemorrhoids can be performed in two ways - closed or open. The first method is more preferable, as it has the following advantages:

• after the knot is removed, the wound is sutured (during an open operation, the wound remains open), which is why the consequences pass faster;
• operate under normal clinical conditions under local anesthesia, and in the case of open intervention, the operated person is in the hospital, and the procedure is performed under epidural or general anesthesia;
• an operated person is able to recover in about half a month, and with open hemorrhoid surgery, recovery can take 5 or 6 weeks.

Hemorrhoidectomy has one big plus - most patients say goodbye to the disease forever or forget about it for decades.

However, surgical removal of hemorrhoids has certain disadvantages:

• the operating period does not last so long, but the patient "falls out" of life for several weeks - does not work, does not move;
• operated on hemorrhoids does not involve treatment, but this is with minimally invasive methods, during surgical interventions, analgesics are likely to be taken, since a strong pain syndrome is expressed;
• there are serious limitations:
  • cancerous tumors;
  • Crohn's syndrome;
  • bearing a child;
  • inflammation of the anal area.

Longo method

With the diagnosis of "hemorrhoids", the surgical removal of nodules is carried out according to the Longo method, which is also called hemorrhoidopexy in another way. This intervention is carried out only with hemorrhoids localized inside the rectum. Removal of external hemorrhoids in this way is impossible.

How is the operation of excision of hemorrhoids according to the Longo technique performed? The doctor needs to excise the area of ​​​​the anus mucosa around the circumference. Simultaneously with the tissues, the areas protruding into the intestinal lumen are also pulled up.

This method differs in that the inflamed nodules themselves do not need to be operated on and cut out. During manipulation, hemorrhoidal cones rise to the intestinal surface, as a result of which their blood supply is disrupted. After a while they die off.

Surgery has advantages and disadvantages. The advantages include:

• a rather short recovery period - the patient is in the ward for only two or three days, and the recovery itself lasts a week;
• pain syndrome is observed only in 15% of patients, but it is very moderate and lasts only 24 hours;
• surgery can be done at any stage of hemorrhoids;
• the procedure is characterized by a minimum number of restrictions.

The disadvantages of hemorrhoidopexy include:

• application only to nodules located inside the rectum;
• relatively high cost of the operation.

After the diagnosis of "hemorrhoids" is made, the question of how to remove enlarged venous accumulations arises in each patient. The choice depends on many indicators, but first the patient should prepare the intestines for the procedure.

Cleansing the rectum with laxatives or enemas is carried out immediately before the operation, as well as within 2-3 weeks before it. In addition, doctors recommend observing a special diet that normalizes the functioning of the gastrointestinal tract.

Possible negative consequences of the operation

Surgery for hemorrhoids is often accompanied by the occurrence of various complications. The reason for the high probability of undesirable consequences lies in the traumatism of manipulations and the presence of bacterial components.

As a result, the following complications are likely to develop:

• the formation of pus is the most common consequence that occurs when pathogenic bacteria penetrate into open wounds. In such a situation, the patient is prescribed antibacterial and anti-inflammatory drugs. If an abscess is formed, it should be opened and cleaned;
• pararectal fistula is a serious complication of surgical intervention, which can occur even after 3-4 months. This formation is a tubule that arises in the wall of the anus and connects it with a gap on the surface of the body or with a nearby organ;
• narrowing of the anus - possibly with incorrectly applied sutures. To expand the anal canal, it is necessary to introduce special tools. In a particularly difficult situation, the narrowing will be removed with a new surgical intervention;
• bleeding - loss of a large volume of blood may occur due to poorly performed cauterization of arteries and veins or injury to nearby mucosal areas during stitching of wounds;
• stressful state - negative feelings associated with the very fact of the operation, often affect the mood of the patient. Particularly impressionable patients develop the so-called psychological constipation, in which a person is afraid to defecate. In such a situation, laxatives and sedatives will help;
• weakness of the anal valve is an infrequent consequence that occurs in case of injury to the nerve endings located in the anus. Most often, the work of the sphincter is restored with the help of a medicine; in difficult situations, surgery is required.
How best to get rid of hemorrhoids, the attending physician should determine, based on the stage of the disease, the presence of concomitant ailments.

In addition, any therapy involves an integrated approach, so the patient needs to make significant changes in their own lifestyle. In this case, it will be possible to forget about negative symptoms forever.

Varicose veins of the rectum today can be cured using a variety of methods. But at severe stages of the pathological process, the operation to remove hemorrhoids is considered the most preferable and effective.

To date, minimally invasive techniques are most often used, which have proven to be well tolerated, a short rehabilitation period, a minimum number of contraindications and undesirable consequences.

In the most severe cases, radical methods of treatment (for example, hemorrhoidectomy) are used, which are usually tolerated by patients rather difficultly and are characterized by a long recovery period. However, such operations allow you to forget about hemorrhoids forever.

When is hemorrhoid removal indicated?

Since the classic operation to remove enlarged hemorrhoids involves a certain violation of the integrity of the tissues of the organisms, there should be serious indications for its appointment.

A radical solution to the problem is possible in the following situations:

• there is a constant exit of cavernous formations from the rectal canal, not only during defecation, but also in the case of any physical effort;
• the patient is disturbed by frequent or massive from the rectal canal, which threatens with anemia;
• significant sizes of hemorrhoid cones of various localization are noted (minimally invasive methods are also prescribed in the initial stages, if large cavernous bodies are diagnosed);
• the patient has a tendency to;
• a person is not able to lead a normal life, because pain, itching and bleeding make it difficult to solve many household problems and prevent the performance of work tasks;
• conservative methods of treatment have shown inefficiency, on the contrary, the patient's condition is only getting worse.

Of course, in each case, the decision to conduct a surgical intervention is decided by the doctor, taking into account all the nuances. The ideal option is to do without using only medications.

Obstacles to the operation

Despite the fact that hemorrhoidectomy is not an abdominal operation, such a surgical intervention is associated with excision of the skin, mucous and vascular structures, which does not exclude the occurrence of various complications. That is why the doctor calculates all possible risks.

It is extremely rare to prescribe an operation to remove hemorrhoids to elderly patients due to the difficult recovery period, the use of general anesthesia. In addition, age-related patients usually have a significant number of concomitant chronic diseases.

For example, with extreme caution, radical operations to remove hemorrhoids are prescribed for people with diabetes mellitus, chronic hypertension, or simultaneous inflammation of the small and large intestines.

There are classical operations for excision of hemorrhoids and strict contraindications, including:

• , which are localized in the region of the lower rectum;
• infectious lesion of the large intestine;
• rectal canal;
• decompensated stage of diseases of internal organs (respiratory and cardiovascular systems);
• bearing a child;
• low blood clotting, tendency to bleed.

But the above situations are not an absolute obstacle - as they say, once and for all. In most cases, the patient will simply have to wait a while to get rid of temporary contraindications and.

With minimally invasive methods, the number of contraindications is significantly reduced, including due to a more gentle effect on the human body.

What does preparation for surgery include?

With direct indications for surgical intervention and the absence of restrictions, the doctor prescribes hemorrhoidectomy. However, the radical method of treatment of proctological disease should be preceded by a preparatory period.

First of all, instrumental diagnostic methods are shown to accurately determine the location and size of hemorrhoids. The doctor usually performs anoscopy and sigmoidoscopy.

In addition, as with any surgical intervention (if they are not emergency), in the case of hemorrhoidectomy, the patient must pass some preliminary tests:

• a general clinical blood test, including, among other things, the determination of the duration of bleeding, the period of coagulation, the level of platelets;
• general clinical analysis of urine;
• biochemical blood test, which includes the determination of the level of glucose, bilirubin, urea, cholesterol, etc. (depending on concomitant diseases);
• determination of blood group and Rh factor;
• blood test for human immunodeficiency virus, hepatitis, syphilis.

Before the operation, the patient needs to clean the intestines. It is better to do this with an enema, but if this procedure is not possible, strong laxatives are indicated - for example, Fortrans.

You should also refuse a few days before an important event from medications that thin the blood. This list includes anticoagulants, antiplatelet agents, and some NSAIDs.

In addition, the correct psychological attitude of the patient is no less important. In order to avoid various fears and depression, it is better to trust the doctor, and not read, for example, various negative reviews and unpleasant comments from patients who have undergone hemorrhoidectomy.

Is there always a hospitalization? Usually, hospitalization is indicated if prescribed, involving the use of general anesthesia.

If minimally invasive treatment of hemorrhoids is expected, then the list of preparatory measures is reduced, the intervention is carried out on an outpatient basis, and after the procedure the patient returns home almost immediately.

Methods of radical removal of hemorrhoids

As noted earlier, radical operations are performed in exceptional cases, when all other treatment techniques have exhausted themselves and demonstrated inefficiency. There are several options for such interventions.

Hemorrhoidectomy

They consider it a kind of classic among operations for excision of hemorrhoids.

Such an intervention was developed quite a long time ago - back in 1937.

Proctologists constantly modified the course of the operation and especially its end, so today there are several types of this surgical intervention.

1. Open hemorrhoidectomy. This is the initial version of the operation, the essence of which is to remove both the nodule itself and nearby tissues. The edges of the wound are not sutured, the surface will heal naturally. Use a scalpel knife, laser or electric coagulator.
2. Closed hemorrhoidectomy. It was developed in the late 50s of the last century by the surgeon Ferguson. The main difference from the previous version of the intervention is the suturing of tissues after removal of the nodules. In this case, it is possible to carry out the procedure in an outpatient setting.
3. Submucosal hemorrhoidectomy. This option was proposed by the surgeon Parkes. During the operation, which is characterized by a certain complexity, only the hemorrhoid is removed, and the base of the formation is left, and the mucosa is not injured. This intervention is tolerated by the patient much easier than previous operations.

The main advantage of hemorrhoidectomy over other methods of treating the disease is to save a person from the direct source of unpleasant symptoms. The intervention also has serious disadvantages:

• duration of the procedure;
• use of general anesthesia;
• quite a massive loss of blood;
• the risk of complications;
• pain syndrome;
• long recovery period.

But in some cases, only hemorrhoidectomy saves the patient from the disease. In any case, there must be serious indications for such a procedure.

Hemorrhoidopexy

It is hemorrhoidopexy that is now actively replacing the classical options for removing enlarged cavernous formations due to less trauma.

How is the intervention going? The surgeon excised areas of the mucosa of the rectal canal in a circle, above the hemorrhoid nodule. Then the pathological formation is pulled up, where it is fixed with titanium clips.

As a result of the operation, there is a violation of the blood supply to the cavernous body, so after a short period of time it decreases in size, and then completely disappears.

The procedure has a number of advantages:

• complete painlessness, since there are no large accumulations of receptor formations in the excised areas. Local anesthesia is needed only for the introduction of a special dilator;
• the possibility of carrying out in elderly patients, people with chronic diseases, and even in expectant and nursing mothers;
• the speed of the procedure, because an experienced surgeon will perform manipulations in just a quarter of an hour;
• fast and painless recovery.

However, the operation on inflamed hemorrhoids also has some disadvantages. So, such an intervention is not carried out with the external form of proctological disease.

In addition, due to the use of disposable instruments, the operation is expensive, especially when compared with classical hemorrhoidectomy.

Further treatment tactics

Getting rid of hemorrhoids as quickly as possible is the main condition for successful treatment. However, if you still could not do without surgery, it is necessary to correctly go through the recovery period in order to prevent various undesirable consequences.

Doctors advise after hemorrhoidectomy to adhere to the following recommendations:

• do not eat for the first day . On the first day, you should generally refuse to eat in order to exclude natural defecation (feces can damage the wound surface or suture);
• stick to a strict diet. Throughout the rehabilitation period, it is necessary to eat properly, for example, soups, cereals. Then the diet can expand, but the rejection of harmful foods is required. Read more about the diet after removing hemorrhoids;
• consume the required amount of liquid. The doctor determines the volume of water and other fluids to prevent constipation by softening the stool;
• not tolerate pain. With open hemorrhoidectomy, the beginning of the recovery period is accompanied by a pronounced pain syndrome. In such a situation, doctors prescribe special drugs, usually in the form of ointments or suppositories;
• speed up healing. To speed up the regeneration processes, it is necessary to regularly lubricate the mucous membranes and skin in the anorectal region with ointment agents, for example, methyluracil ointment or Levomekol;
• apply folk recipes. To speed up recovery, alternative medicine recipes can also be used in consultation with a specialist. For example, doctors recommend regularly performing sitz baths with medicinal herbs.

If after the operation the patient suffers from constipation, the use of laxative medications is indicated. But that doesn't mean you shouldn't stick to a healthy diet. It is the correct diet after surgery for hemorrhoids that is a factor preventing the recurrence of hemorrhoids.

Usually after a classic hemorrhoidectomy lasts 4 weeks. In this case, the person must stay in the hospital for the first week.

Possible complications of hemorrhoidectomy

Unfortunately, the removal of hemorrhoids in the traditional way can not lead to getting rid of unpleasant symptoms, but to the acquisition of new problems - serious complications. What can happen in the most unfavorable scenario?

1. Bleeding. Blood loss after surgery is possible due to damage to the sutures, insufficient cauterization of veins and capillaries.
2. Urinary retention. A similar consequence occurs in men and is characterized by the inability to empty the bladder on their own. In this case, a catheter comes to the rescue.
3. Psychogenic constipation. Fear of discomfort when going to the toilet causes patients to retain feces, which further complicates the situation.
4. Prolapse of the lower rectal canal. If the surgeon damages the muscles and nerve clusters, the exit of the mucous membrane beyond the anal sphincter is not excluded.
5. Narrowing of the rectal canal. Occurs as a result of incorrect actions of the surgeon. For expansion, special tools are used or plastic surgery is prescribed.
6. Fistulas. Such formations are pathological tubules that connect the rectal passage with nearby organs or the skin.
7. The formation of pus. Inflammation and suppuration quite often complicate the postoperative period. This is due to the large number of pathogenic bacteria in the anus. Antibacterial therapy or opening of pustules is shown.

Many of the undesirable consequences described above can be prevented if all the doctor's recommendations are followed, especially regarding hygiene requirements.

Important! Hemorrhoidectomy usually in the vast majority of cases allows you to completely get rid of hemorrhoids. However, the patient is still advised to take preventive measures to avoid a possible relapse.

Minimally invasive techniques

From hemorrhoids, surgery can be gentle. It is to such procedures that the so-called minimally invasive methods of removing varicose hemorrhoids are referred.

The disadvantages include the ineffectiveness of most methods in the last stages of anal varicose veins. In addition, all symptoms of exacerbation of hemorrhoidal disease should first be removed.

Unfortunately, minimally invasive methods do not always lead to complete elimination of the disease, since the main cause of the disease, venous insufficiency, is not eliminated.

Doctors warn that with numerous cavernous formations, a course of several minimally invasive operations will have to be carried out, which means, among other things, an increase in the cost of the procedure.

There is also evidence that in some cases hemorrhoids return again, that is, there is a high probability of a relapse of the disease and the occurrence of unpleasant symptoms.

Interventions

The main minimally invasive techniques include the following gentle surgical interventions:

• . The specialist, using special tools, puts a ring made of environmentally friendly latex on the base of the knot, which excludes the flow of blood. The cone left without food dies after 14 days;
• laser coagulation. Hemorrhoids are affected by directed radiation. This leads to the coagulation of tissues, blood vessels, as a result of which the nodules decrease, and then in their place appear healed areas of the mucosa;
• . An apparatus is inserted into the rectal canal, which pulls the arterial vessel that feeds the hemorrhoids. A very promising method for the treatment of anal varicose veins;
• . A gluing agent is injected into the venous plexuses, which leads to disruption of the activity of the vessels that feed the nodules. The result is a cessation of bleeding and a decrease in the size of the cones;
• . Hemorrhoids are exposed to infrared rays, as a result of which the tissues coagulate, bake, in their place a crust is formed, which comes out when the intestines are emptied;
• cryodestruction. Therapeutic manipulation is carried out with the help of liquid nitrogen, which simply freezes and destroys varicose veins. The main advantage is complete painlessness and elimination of bleeding.

Operations to remove hemorrhoids can be carried out free of charge if there is a compulsory medical insurance policy. However, in this case, hemorrhoidectomy is prescribed, which, accordingly, is characterized by pain and a long recovery period.

That is why many patients turn to private clinics for minimally invasive operations. In such a situation, the money will have to be laid out from your wallet, and the amounts are quite impressive.

Depending on the chosen technique, the severity of the disease and the number of hemorrhoids, the price can vary from 3 to 60 thousand rubles.

The treatment of any disease, even surgically, will be effective if after the operation you change your lifestyle, follow hygiene measures and follow all medical recommendations.

Only when preventive measures are taken, negative symptoms will not return again. And, therefore, the operation is not yet the final stage in the fight against hemorrhoidal disease.

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

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

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

When surgical treatment becomes the only way to get rid of hemorrhoids, 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 operations to remove hemorrhoids.

Indications for removal of hemorrhoids

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

Removal of hemorrhoids in elderly patients suffering from hypertension, diabetes, colitis and constipation can not only be quite risky, but is not always justified. In most patients, rational conservative therapy, hygiene and diet give such a good result that the need for surgical intervention may disappear.

Indications for hemorrhoidectomy are:

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

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

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

Preparing for a hemorrhoidectomy

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

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

Particular attention should be paid to the diet, which determines the course of the subsequent postoperative period. Before the planned operation, you should refuse food that causes gas formation and the formation of excess feces, and preference should be given to fermented milk products, eggs, white bread. In addition, you need to drink more fluids.

On the eve of the operation and on the day of the intervention, a cleansing enema is indicated, which can be replaced with special preparations that cleanse the intestines (fortrans). By this time, if the patient has taken blood-thinning drugs, they should be discontinued.

Classic hemorrhoid surgery is performed under general anesthesia, the patient lies on his back, and the lower limbs are fixed on special supports. Foreign surgeons often perform the operation with the patient in the prone position, since this improves the outflow of venous blood from the dilated plexuses, which facilitates the process of their removal.

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

Types of operations to remove hemorrhoidal veins

To date, the most effective radical methods for removing hemorrhoids are recognized as the classic Milligan-Morgan hemorrhoidectomy and resection of the rectal mucosa using the Longo method. Each of them has both advantages and disadvantages, but the first type of intervention is more common, although Longo's operation can compete with him.

Hemorrhoidectomy

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

The stages of the operation include anesthesia and expansion of the anal canal, treatment of the intestinal mucosa with disinfectants and drying with a cotton swab. Hemorrhoidal veins are removed in a certain sequence. The surgeon, mentally imagining the watch dial, first captures the "bumps" located at three o'clock, then at seven and eleven. Having seized the node with a clamp, the doctor stitches its leg and cuts it off. It is advisable to use an electric knife, which leads to minimal trauma and does not contribute to bleeding. After removing the nodes, the wound is sutured and treated with an antiseptic.

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

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

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

Longo technique

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

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

Despite the undoubted advantages, the removal of hemorrhoids by the Longo method also has some disadvantages, including the impossibility of excision of externally located dilated veins, the need to monitor the patient for at least a week after the operation. In addition, due to the relatively short period of application of this operation, it is still impossible to judge the long-term consequences of the treatment.

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

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

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

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

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

Ligation- the most popular sparing way to deal with hemorrhoids, when using a special apparatus, latex rings are placed on varicose nodes. After about a week, hemorrhoidal "bumps" are rejected along with such a ring, without causing significant inconvenience to the patient. Ligation, carried out according to indications, avoids hemorrhoidectomy in the vast majority of patients.

ligation

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

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

Minimally invasive approaches to the treatment of hemorrhoids are used in 80% of patients in Europe and the USA, while in Russia three-quarters of patients undergo radical surgery. Minimally invasive procedures are carried out in the early stages of the disease, and thrombosis of the nodes, the formation of an anal fissure, acute and chronic inflammatory processes in the rectum and perineum can become a contraindication to them.

After operation…

The postoperative period usually proceeds quite well, but the need to defecate and ensure the painlessness of this process can bring significant inconvenience. On the first day after the intervention, the appearance of stool is highly undesirable, as it can cause severe pain and trauma to the postoperative wound, and in order to avoid this, a complete refusal to eat is shown while maintaining a good drinking regimen.

From the second day, food is gradually introduced that does not contribute to intestinal irritation and the formation of a dense stool: light soups, cereals, sour-milk products. Be sure to drink plenty of water. In the first few days, many patients experience severe pain, for the elimination of which analgesics are prescribed. In order to accelerate the healing of the rectum, baths are carried out with a weak solution of potassium permanganate, a decoction of chamomile flowers. Drug treatment consists in the use of ointments and suppositories with methyluracil, which improves regeneration processes.

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

The patient must necessarily perform all the necessary hygiene procedures, which the clinic staff will tell him about, do not ignore dressings and examinations. The post-surgery diet should contain enough fiber to make stools easier. You need to empty your bowels immediately, as soon as such a desire arises, but you should not linger in the restroom for too long, pushing or straining. If necessary, laxatives may be prescribed.

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

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

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

Recovery after surgery takes about 2 weeks, but rehabilitation after removal of hemorrhoids is not limited to the time spent in the hospital. To consolidate the positive effect of treatment and prevention of relapse, the risk of which persists regardless of the stage of the disease and the type of operation, the patient will have to constantly monitor the condition of the rectum, adhering to some rules:

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

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

If, due to the nature of professional activity, it is not possible to avoid prolonged sitting, then, if possible, you should take short breaks, get up and walk. Walking is an excellent means of preventing the recurrence of the disease.

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

An operation to remove hemorrhoids with a laser (laser coagulation) is performed in cases of a chronic course of the disease, in which conservative treatment is ineffective. Laser therapy can compete with standard surgery. The advantages of this technique are minimal surgical intervention, low traumatism, low risk of postoperative complications, as well as a short rehabilitation period.

Laser surgery is an innovative procedure that allows you to remove any nodular formations quickly and painlessly. Laser treatment helps to effectively deal with both internal and external manifestations of hemorrhoids, regardless of their location. It can be used at almost any stage of the disease.

Removal of internal hemorrhoids with a laser is carried out by excising nodular formations from the inside. In their place, a wound surface is formed, which is very quickly tightened. the operation is performed by cutting off the hemorrhoids with laser beams, with simultaneous cauterization of the vessels, which prevents the risk of bleeding.

The effectiveness of the procedure is due to the ability of the laser not only to cut tissue, but also to instantly glue them together. Under the action of a focused laser beam, blood proteins are coagulated, as a result of which it is possible to obtain the effect of sealing blood vessels. Due to this, the risk of infection is minimized, and the operation takes place without blood loss.

Laser treatment is carried out on, the action of which is to generate thermal waves of directional action, which have the ability to painlessly excise and cauterize any tissues of the human body.

The strength of the laser beam, as well as the depth of its penetration, can be adjusted during the operation, which allows you to focus the laser as accurately as possible and reduce the negative impact on healthy tissues. As a result, it is possible to minimize the risk of postoperative complications and accelerate the regeneration processes.

Indications and contraindications for laser coagulation

Laser surgery is used in the following pathological conditions:

Also, with the help of laser beams, it is possible to 3-, but it should be understood that the effectiveness of this procedure will be somewhat lower, since the laser will not be able to completely remove the volume. Incomplete excision of venous cones can lead to recurrence of the disease.

There are practically no contraindications for laser therapy, with the exception of the following:

• The disease is severe;
• Infectious processes in the anus.

How is laser hemorrhoid surgery performed?

The operation does not require a hospital, which allows the patient to leave the clinic almost immediately after the procedure. Therapeutic manipulations are carried out in a specially equipped room, on the operating table, chair or couch.

The first step in the procedure is local anesthesia. Then a special anascope device is inserted into the lumen of the rectum, which helps the coagulator to penetrate to the site of the affected area of ​​the rectum. The hemorrhoid is removed by cauterization of its base in several places, with simultaneous gluing of blood vessels. Volumetric formations are removed completely, while in small cones, only the stem can be burned.

At the end of the procedure, the patient should lie quietly for a while. He does not need postoperative dressing, since the operation is absolutely bloodless. If anesthesia was used, then the patient is allowed to go home only after its effect ends.

Laser treatment - pros and cons

Laser coagulation is an effective method of treating hemorrhoids, which has a number of significant advantages:

Despite the many positive aspects of this technique, there are some significant

limitations:

1. Laser treatment is an expensive procedure that not all patients can afford.
2. After excision of volumetric nodular formations, relapse is possible, since the laser is able to fully cope with only small ones.

How to prepare for laser surgery

Before carrying out surgery, it is necessary to undergo a special preoperative examination. Mandatory items of which are the passage of an ECG, and the delivery of a clinical analysis of blood and urine. Also, each patient must undergo a proctological examination.

The examination is carried out in an office specially equipped for proctological procedures. The patient lies on the couch, taking a lateral position, after which the proctologist conducts a digital examination. To minimize pain during the examination procedure, special creams are applied. Patients with a low pain threshold should be given pre-anesthetics with local anesthetics.

There are times when patients need a more thorough examination, using special proctological instruments. If the information obtained as a result of the initial examination is uninformative, the patient may be recommended to undergo a more in-depth examination. For example, in order to exclude the presence of a malignant tumor or internal bleeding in a patient.

The main operational activities are carried out in the projection of the rectum, so it must be clean. To do this, the day before the laser surgery, the patient may be offered several options for cleansing procedures. Bowel cleansing can be carried out with the help of (Lavacol, Fortrans and others) and enemas.

The volume of preparatory measures will depend on the type of surgical intervention being performed. For example, if a person undergoes cauterization of external venous cones, then the cleansing step can be skipped. In this case, the patient will be recommended for a certain period of time to change their usual lifestyle and diet.

He will be advised a few days before the proposed operation to completely exclude from his, causing constipation or flatulence. It will also be necessary to minimize the consumption of bakery products and try to introduce as many dairy and plant products into your diet as possible.

Postoperative period

Usually the rehabilitation period passes quite quickly, without any complications. The very next day after surgical manipulations, a person can return to his usual life. In the early postoperative period, there may be slight pain in the process of defecting.

This complication is not considered a pathological condition, but is only evidence of a successful process of regeneration of damaged tissues. Discomfort and pain
should disappear without a trace after a few weeks.

Sometimes after patients are faced with such a problem as a violation of the stool. You can prevent constipation by adhering to a special dietary diet, with a predominance of fruits, vegetables and dairy products in the diet. Herbal laxatives can be used to prevent the formation of hard stools, as well as to soften them. It is also necessary to limit the consumption of fatty and spicy foods, which can provoke the development of postoperative complications.

It is obligatory to carry out a daily hygienic toilet, with washing the anus with cool water. The reason for contacting a proctologist is pain that has not disappeared after a few weeks after laser coagulation.

Price of laser therapy

The cost of an operation to remove hemorrhoids depends on the professionalism of the surgeon-proctologist, on the prestige of the medical institution, as well as on the complexity of the manipulations. Also of no small importance is the stage of the disease.

When choosing a treatment method, it is necessary to take into account the fact that, in addition to the operation itself, additional examinations and preoperative procedures may be required, which are paid separately.

Laser coagulation is an effective and at the same time quite expensive operation, but the end result of the treatment fully justifies its high price.

Patient reviews

You can leave your feedback about in the comments to the article, they will be useful to our other readers!

Vasily, 45 years old:

Last summer, I removed an external hemorrhoid with a laser. The operation was performed under local anesthesia and lasted only 20 minutes. A slight discomfort during the injection was the only unpleasant moment for me. The operation was carried out very professionally. After the node was removed, I stayed in the clinic for about an hour, after which I was allowed to go home. There were no postoperative complications, and the next day I went to work.

Elena, 51 years old:

I thought for a long time about which method to use, and opted for laser coagulation. I was very pleased with the result, I especially liked the fact that there is no need to treat wounds and make dressings. After the effect of anesthesia ended, there was a moderate pain in the place, which was removed. Although the procedure is expensive, it is worth it.

Natalia, 35 years old:

A week ago, I was treated for hemorrhoids. Nodules were removed using laser beams. All necessary examinations were carried out before the operation. I was very afraid, and, as it turned out, in vain. This procedure is very simple and absolutely painless. It is also important for me that the removal of the nodes is carried out under local anesthesia. Small problems appeared later - for several days it was uncomfortable to go to the toilet.

How is an operation to remove hemorrhoids performed if the symptoms of this disease cause significant discomfort and they could not be eliminated by conservative methods of treatment? Hemorrhoids is considered a fairly serious disease that affects people of working age and is widespread among the population. When it appears in the form of itching, burning, as well as the formation of nodes and the discharge of blood from the anus, every attempt must be made to prevent the further development of the disease and its transition to a more severe stage.

Indications for surgery

The initial stage of the disease of hemorrhoids allows you to get rid of it with the help of therapeutic methods with the use of drugs and lifestyle changes. But this is not always feasible, since in most cases patients are delayed with, and in the last stages of the development of the disease, surgery is no longer enough.

Doctors try not to bring the matter to an operation and prescribe it only in extreme neglected cases, when the changes that have occurred in the body become threatening. If the patient seeks help in a timely manner, all measures are taken to use only conservative treatment. If the expected result is not achieved, and the symptoms of hemorrhoids continue to poison the existence, then it remains to resort to surgery.

Before the operation, it is necessary to carry out some preparation. For this, an examination is carried out, which includes tests, an examination using rectal instruments, as well as a consultation with a therapist.

The operation is carried out in case of indications for its implementation, namely:

If the disease occurs in young patients, then the operation for such indications is carried out without delay. For older individuals, minimally invasive treatments are offered. In cases where hemorrhoids have become aggravated in the elderly, conservative methods of treatment are more often used.

Contraindications to the operation are hypertension with high blood pressure, myocardial infarction and heart failure.

Operation types

To date, there are many methods used to remove hemorrhoids. Preference is given to minimally invasive methods, which are considered more gentle and painless, and also very rarely cause complications. In some cases, based on individual indications and the condition of the patient's body, a surgical operation is also performed using conventional methods.

The subtlety of minimally invasive interventions is the rejection of the scalpel. The whole process is carried out by piercing the tissues through which the necessary actions are carried out. Such methods are the least traumatic, have no contraindications and can be used even in an outpatient clinic.

The most popular minimally invasive methods include:

• sclerotherapy;
• cryotherapy;
• photocoagulation;
• latex ligation;
• disarterization.

During surgical operations, hemorrhoidectomy by the Milligan-Morgan method and hemorrhoidopexy by the Longo method are more often used. Operations using these methods involve a stay in a hospital and the use of anesthesia determined by the doctor.

The method used to remove hemorrhoid nodes is chosen based on the stage of development of the disease and the presence of complications. With 1 and the development of the disease, conservative therapeutic treatment is carried out in the same way as the methods of sclerotherapy and photocoagulation. At the third stage, desarterization of the node and the use of ligation are shown. In the case of the fourth, last stage of hemorrhoids, only a surgical operation is performed.

In addition to these methods, there are others that are less known and rarely used, such as the Sklifosovsky method, which consists in dragging a knot. The technique according to Martynov involves tying the knot and its subsequent cutting off. There is also the Whitehead technique, which is used for existing complications.

It must be borne in mind that operations are not carried out with an exacerbated course of the disease. To eliminate inflammation, before the operation, treatment with therapeutic drugs is carried out, with the help of which swelling in the tissues, existing bleeding or acute manifestation of pain are eliminated.

Operation cost

Carried out according to the health insurance policy, as a rule, are carried out using a radical method using conventional technology. Most patients who are indicated for surgery prefer to resort to minimally invasive sparing techniques, for which you have to pay. The average cost of such medical care ranges from several to fifty thousand rubles.

Such a difference in prices depends primarily on the type of services provided during operations, on the qualifications of the operating doctor, the level of the medical institution itself, and affiliation with commercial or government structures. But the most important and fundamental
what affects the cost of the operation is the severity of the disease, the presence of concomitant diseases, as well as the amount of intervention required.

For example, a simple method of sclerotherapy will cost 3,000 rubles per node, and the use of a laser or desarterization will cost 30,000 rubles. Ligation with latex rings - up to 5 thousand, and for hemorrhoidectomy you will have to pay more than 20 thousand rubles.

In addition, you will additionally have to pay for the cost of a specialist consultation, examination, tests, application or anesthesia, as well as hospital stay and postoperative monitoring. The severity of the disease has a great influence on the cost of the operation, so in severe advanced cases with existing complications, it will cost much more.

From this it follows that the operation in situations where conservative treatment has not been successful should not be delayed. The sooner the operation is performed, the easier it will be and the cost will be much less.

How is the operation

Patients are always concerned about whether the operation itself to remove the nodes is painful and how it is performed. Depending on the method used, the operation begins with anesthesia. When using general anesthesia, the patient does not feel any pain.
during the entire operation, and wakes up from anesthesia after its completion. The main pain symptoms by this time have already passed, and the patient does not suffer.

When using local anesthesia, the Vishnevsky method is used, when the patient is given injections of novocaine and adrenaline. Initially, a circular blockade of the skin is carried out, and then the pararectal area is also anesthetized. To provide access to the affected area, the anus is stretched with clamps, after which the knot is brought out without much tension. The next steps depend on which method will be used.

Postoperative period

Those who have undergone any type of hemorrhoid surgery need to follow some guidelines. In all patients, the recovery processes are individual and depend on the nature and complexity of the operation. Of great importance in the recovery processes is the general condition of the patient, as well as the severity of the disease. As a rule, the more severe the stage of hemorrhoids, the more time is spent on recovery after surgery.

The healing of damaged tissues after removed nodes can be complicated by inflammation, therefore, for a certain period of time after removal, the usual treatment for hemorrhoids is continued.

To heal the wounds faster, you can use rectal suppositories with, such as Natalsid. As a rule, these measures are enough for a successful recovery.

Often in the postoperative recovery period, complications may arise that can manifest themselves immediately or after a couple of weeks.

Most often these can be:

Recovery after the operation takes a certain period, after which you can not calm down. For example, after the usual knot tying, after 2-3 years, patients again experience discomfort in the anus.

Two-thirds of patients who have undergone surgery to remove nodes feel them again. This is due to the fact that during the operation a lot of the affected tissue remains in the same place. When certain conditions are created in the form of constipation, congestion in the veins due to insufficient activity, new nodes can form and inflammation will again occur in them.

Are operations better in Europe?

Patients at the appointment with a proctologist often have a question whether it is worth deciding to have an operation abroad. When making a decision, you need to keep in mind that the flight after the operation will take at least 4-5 hours, and this is very undesirable, since all this time will have to be spent in a sitting position.

During the flight, it is recommended to get up for at least 5 minutes every 3 hours. The very stay in a European clinic will last at least 10 days, and this is very expensive compared to Russian prices. Our clinics and specialists practicing in them are in no way inferior to foreign ones, and the methods and equipment used in them are sometimes even better than foreign ones.

Feedback from our readers

You can leave your own in the comments to the article, they may be useful to our other readers!

Hope, Moscow:

I have been living with hemorrhoids for about 8 years, I felt the first symptoms before childbirth, and decided to have the operation only when the child was three years old. Previously, she was saved by candles, and after childbirth, pain appeared, the nodes began to fall out and become inflamed. The doctor advised to agree to a hemorrhoidectomy, as this is the most effective way and also inexpensive. The operation took place in thirty minutes, I did not feel any pain, when the frost began to recede, I felt a tingling sensation, but it was quite bearable. At home, she made baths with potassium permanganate and applied Levomekol. The first visit to the toilet brought suffering, but endured. I want to tell women - when compared with childbirth, removing hemorrhoids is nothing. Fast and almost pain free.

Yuri, Tver:

And I survived the postoperative period with difficulty, I took Ketanol, but I can’t even remember about going to the toilet. Although the operation itself went quickly and without problems, the main thing is to endure a few days after it.

Sergey, Sochi:

I had no choice, there was a third stage of hemorrhoids with necrosis. The operation cost about one and a half thousand dollars, but now I am a full-fledged person! I don't regret it.

Masha, Novorossiysk:

I don’t want to scare you, but I didn’t believe in a painless operation in vain, it was painful, and the smell remained in my memory for a long time, something burnt. But now I can definitely say that I got rid of the knots completely.

Video: Hemorrhoidectomy. Removal of hemorrhoids

How are hemorrhoids removed? The answer to this question would like to know many who could not completely get rid of this disease, despite the fact that today there are many methods of treatment. If it was not possible to stop pathological changes in the rectum, then the subsequent stages of development put the patient before a choice - which method to resort to in order to say goodbye to hemorrhoids forever.

How to get rid without surgery

Despite the fact that the most effective way to treat hemorrhoids, passing the last stage of development, is considered to be a surgical operation, in some cases it is contraindicated for any reason. They also try not to resort to this extreme measure even in cases where the disease has not led to significant changes in the patient's body and the symptoms shown by him still do not cause great inconvenience. diseases, for the most part, are easily amenable to conservative methods of treatment with the use of drugs, the choice of which is quite large.

Drug treatments in the form of ointments, suppositories and tablets are also indicated for the elderly. It is recommended to resort to surgical intervention for patients belonging to this age category only as an exception, when the disease has reached the last stage of development and is life threatening.

These patients receive the necessary assistance, which, after a preliminary examination, will select an individual course of treatment using exactly those drugs that are necessary for a particular patient. With their help, you can significantly alleviate the condition of a person, relieve pain, eliminate inflammation and prevent prolonged bleeding.

If it has not reached its critical point and the condition allows you to avoid serious surgical intervention, then choose minimally invasive methods:

The advantage of any minimally invasive method is that a scalpel is not used when removing nodes. Manipulations are carried out through several punctures in the tissues. The advantage of such procedures is the absence of contraindications and a short recovery period.

How to remove with a laser

The main advantage of this method is the absence of pain, which allows the procedure to be carried out without painkillers. After the procedure, the patient can immediately move independently and painlessly. As a result of intervention and manipulation, the mucous membrane of the rectum and anus is not injured, this is also a weighty argument in this particular way.

Laser removal is used at any stage of the disease, as well as with a different location of the nodes. It is carried out as follows: with the internal location of the node, the laser burns it out from the inside, the growth of connective tissue begins in it, as a result of which the node decreases. Nodes with an external location are cut off with a laser, the tissues, in the process, are soldered and no blood loss occurs.

The advantages of the laser method are as follows:

1. Removal of nodes is almost painless, with a feeling of light warmth.
2. The duration of the entire procedure does not exceed 15 minutes, carried out on an outpatient basis.
3. There is no need to prepare for the upcoming operation.
4. After the end of the procedure, the patient is able to leave the office on his own.
5. The method does not cause bleeding.
6. As a result, no scar tissue remains at the site of the removed nodes.

With all the advantages of the method of removing hemorrhoids with a laser, it also has some disadvantages.:

• large nodes cannot be removed completely, which leaves the possibility for the development of repeated cases of the disease during the first 5 years after the application of the method;
• the laser method is considered expensive, requires appropriate equipment, so not everyone has the opportunity to use it.

How to remove hemorrhoids surgically

An operation using a surgical method to remove nodes is now resorted to in the case of advanced last stages of the disease, when other methods that were used to treat the disease did not bring the expected result and turned out to be ineffective.

In addition, such operations are performed when a complication of the disease occurs in the form of thrombosis of the node. Such a pathological situation as protruding nodes with the threat of pinching, accompanied by profuse bleeding, is also a significant reason for surgical intervention.

Restriction for the operation to remove the nodes of hemorrhoids, can serve only the stage of exacerbation with pronounced symptoms of inflammation, passing in the location of the rectum. The developments of scientific medicine with the help of advanced instruments make it possible to carry out the operation in a gentle way - without pain, quickly and without further relapses.

The validity of the operation, aimed at removing hemorrhoids, occurs when the nodes fall out in young people, which accompanies bleeding. In those situations where the disease progresses in middle-aged patients, and the doctor does not find another way to eliminate the disease, it is recommended to agree to the operation.

Significant contraindications, when surgical care has to be abandoned, may be the following cases:

• existing heart failure;
• pathological conditions of the intestine, when there are ulcerated areas or acute inflammation occurs;
• malignant neoplasms;
• diabetes mellitus with poor healing of lesions;
• immunodeficiency disorders.

A contraindication for the removal of hemorrhoids with the help of a surgical operation is pregnancy. Unfortunately, until now, surgical removal of hemorrhoids is resorted to in half of the cases of the onset of the disease. This happens because most resort to medical help late, when conservative methods of treatment are no longer able to help.

How are hemorrhoids removed?

It is difficult to determine exactly what and how many opportunities are left to remove nodes and deal with hemorrhoids. Of all the variety, the specialist selects the most suitable method, based on the stage of the disease and on
characteristics of the patient's condition.

First, minimally invasive methods are used, which are carried out without the use of anesthesia and without placing the patient in a hospital. Minimally invasive methods that are used most often include sclerotherapy, ligation, photocoagulation using infrared radiation, mono- or bipolar coagulation, laser coagulation, cryodestruction. Separate cases of development of hemorrhoids, requiring the removal of nodes, involve surgical operations.

This method includes:

1. carrying out a normal operation with the removal of nodes;
2. the use of radio waves to remove drop-down nodes;
3. method of hemorrhoidectomy;
4. the use of deserterization, when knots are simply tied;
5. removal of nodes by the Longo method.

In addition to these methods of treating hemorrhoids using a surgical operation, vacuuming, dosing, and the Milligan-Morgan method are also used to effectively remove nodes. When using each of these methods, the patient is informed about all the benefits of one or another method of intervention to remove the nodes, as well as the risks and possible side effects.

Is the removal of hemorrhoids different for women and men?

There are no significant differences in the removal of hemorrhoids in men. Both of them, before choosing a method, should be examined and tested. Attention should only be paid to the fact that it is desirable for women to perform the operation after the end of menstruation, since before it begins and during menstruation there is an increased rush of blood to the pelvic area, which can increase the risk of bleeding during the operation.

There is and which, although rare, makes itself felt. After surgery, men often experience urinary retention, so to eliminate this violation and facilitate the process of urination, a catheter is applied to them.

Once the nodes are removed, steps must be taken to prevent recurrence. To do this, you need to follow the doctor's recommendations aimed at preventing various complications. For this purpose, use with decoctions of chamomile or. use drugs based on analgesics, and with residual inflammation - use special ointments and suppositories.