Surgical treatment of hemorrhoids. Hemorrhoid: removal and other treatments. Removal of hemorrhoids by surgical methods.

02.07.2019 -

The operation to remove hemorrhoids is a radical method of treating this unpleasant disease, which is used in chronic forms of rectal varicose veins and an acute process accompanied by severe pain. Proctologists in most cases recommend to patients, however, if they do not bring relief, and the patient is in remission, you can think about prompt removal nodes.

The risks associated with surgery increase significantly, so patients are advised not to rush into the operation and go through all therapeutic measures first. After elimination of inflammation and stabilization of the condition, a decision is made on the appropriateness of the operation.

Hemorrhoids of moderate severity are not an indication for surgery. Surgery is necessary when serious complications occur:

loss of nodes;
pinching and ;
frequent bleeding of inflamed veins;
rare but profuse bleeding.

The constant excretion of blood entails the risk of developing anemia. The protrusion of the nodes creates a favorable environment for inflammation skin in the perianal region. The mucus released from the surface of the nodes irritates and reduces the protective properties of the skin, which becomes vulnerable to microbial infection.

In addition, the patient may experience severe pain and excruciating itching that push him to take radical measures against the disease. The patient himself insists on the operation, because in order to get rid of hemorrhoids he is ready to endure all the hardships of surgical intervention.

Types of operations to remove hemorrhoids

Today, minimally invasive techniques for the surgical treatment of hemorrhoids, which are popularly called "sparing removal", are widely used. This is the impact on the nodes using:

(injection with a syringe into the base of the node of an adhesive that “solders” the venous walls);
cryodestruction (“freezing” with liquid nitrogen of ultra-low temperature);
laser and radio waves (destruction of nodes);
IR rays (focal infrared coagulation);
ligation with latex rings (ligation, as a result of which the knot disappears).

These operations are performed on an outpatient basis and do not require general anesthesia, the patient can go home immediately after treatment. However, the physical removal of nodes does not mean a cure for the disease. The weakness of the vascular walls and internal varicose veins cannot be eliminated in this way. These methods are suitable for use in initial stages diseases.

In traditional operations, diseased tissues are excised using a laser. This is serious surgical intervention with all the risks and heavy recovery period.

1. Hemorrhoidectomy or Milligan-Morgan surgery- the oldest and most traumatic method of removing hemorrhoids. After this procedure, the patient remains disabled for several weeks and must carefully treat the postoperative wound until complete healing. The Milligan-Morgan method is justified when the patient has large hemorrhoids and the risk of massive bleeding. Venous cones are removed completely, along with the affected mucosa. The obvious advantage of this method is the ability to save the patient from the cause of the disease. But the disadvantages of the operation are significant, these are:

duration of the procedure, the need to be under anesthesia for a long time;
profuse blood loss;
numerous complications;
prolonged stay in the hospital and on sick leave;
hard recovery.

2. Parkes method- one of the options, less traumatic and painful for the patient. In the process of manipulation, the hemorrhoid is excised without affecting the mucous membrane. The operation has a complex technique, but allows the patient to do without severe pain in the recovery period.

3. considered the most effective way surgical treatment of hemorrhoids. The result is achieved. The operating equipment is inserted into the rectum under ultrasound control, where a piece of the artery that feeds the hemorrhoids is cut and tightened. The operation is performed on an outpatient basis for 15-20 minutes, under local anesthesia. Advantages of this method:

allows you to delete multiple internal nodes;
bloodless and painless procedure;
fast conduction and recovery (maximum 5 days);
short hospitalization (1 day) or its absence;
there is no postoperative wound.

The Longo operation has one significant drawback - it is not used to remove external hemorrhoids.

Removal of hemorrhoids: preparation for surgery and recovery

The preparatory stage of the operation is to comply with general surgical requirements:

carrying out the necessary analyses;
diagnosis of concomitant diseases;
identification of contraindications and risk factors.

Specific preparation for proctological manipulations is, first of all,. Cleansing measures are carried out not only on the eve of the intervention (taking laxatives or a medical enema), but also for several weeks before it. It is important to follow a diet that will normalize bowel function, eliminate stool disorders that often provoke the development of hemorrhoids. Improper nutrition, constipation can complicate recovery and cause complications, therefore, without this important step, the operation is pointless.

Be sure to remove the inflammation in the anus, if any. Irritation, ulcers, swelling must be minimized with the help of drug therapy and folk remedies.

The course of the postoperative period depends on the chosen method of treatment and the general well-being of the patient. In most cases, the patient is advised to follow a special diet that does not burden the intestines; on the first day it is highly desirable to refrain from defecation. The postoperative wound is subject to careful treatment with the means recommended by the proctologist surgeon.

To reduce pain the doctor may prescribe analgesics and apply nitroglycerin ointment to the area of intervention. Complications after surgery to remove hemorrhoids can be quite serious, so the main task the patient - to comply with all the prescriptions of the doctor and not to engage in amateur activities.

Unfortunately, the likelihood of complications after surgery is quite high. This is due to the traumatic nature of the manipulations themselves and the location of the surgical field ( a large number of bacterial content). Correct technique performing the procedure and careful hygiene after it will help to avoid unpleasant consequences, such as:

Suppuration is one of the most common complications that occurs when pathogenic microbes enter the wound, which is not surprising in the perianal region. When purulent inflammation the patient is prescribed antibiotic therapy and anti-inflammatory drugs, in case of an abscess formation, it is opened and the purulent contents are cleaned out.
- one of the most serious consequences of the operation, which is formed a few months after it. An intestinal fistula is a channel that opens in the wall of the rectum and connects it to an opening in the surface of the skin or in nearby hollow organs (such as the vagina). Treatment this disease- surgical.
Narrowing of the anal canal - occurs when the operation technique is violated. The cause of the complication is an incorrectly applied suture. The expansion of the passage is carried out using special devices, in difficult cases shown plastic.
Bleeding - a lot of blood loss postoperative period can be caused by poor cauterization of blood vessels during surgical procedures and tissue injury during suturing.
Urinary retention is a common complication in the early postoperative period, which consists in the inability to independently empty bladder. treated with catheterization.
heavy psychological condition- pain, fear and other feelings that accompany being on the operating table and in the hospital ward can adversely affect the patient's mood. This is completely natural and passes quickly. However, there is a danger that psychological trauma cause neurogenic constipation. Laxatives and sedatives are recommended for prevention.
, weakness of the anal sphincter - rare complications that occur when the intestinal nerve channels are damaged during surgery. Treatment is conservative, aimed at restoring sensitivity in mild cases, otherwise - surgical intervention.

The cost of removing hemorrhoids

As a rule, operations to remove hemorrhoids, provided for by a policy of mandatory health insurance(that is, for the patient for free), are performed by the most radical methods. Therefore, most people suffering from hemorrhoids prefer gentle surgical methods seeking treatment at their own expense. The cost of such operations can vary from a couple of thousand rubles to fifty.

Prices for the treatment of hemorrhoids depend on the type of operation, the qualifications of the surgeon, the level of the clinic, whether it belongs to commercial or state medicine. But the main thing that affects the cost is the volume of intervention and the severity of the disease.

The average order of prices in Moscow by type of operation is:

- 5 - 7 thousand rubles for 1 knot;
classic hemorrhoidectomy according to Molligan-Morgan - from 20 thousand rubles;
deserterization by the Longo method - from 30 thousand rubles;
electrocoagulation of nodes, - from 30 thousand rubles;
sclerotherapy - 3 thousand rubles. for each node.

To the cost of directly removing the nodes, it is necessary to add (from 1 thousand rubles), examination of the rectum (sigmoidoscopy - from 3 thousand rubles), anesthesia (5 - 7 thousand rubles), hospital stay.

It is possible to determine the approximate costs of the operation only after an examination by a surgeon, since the difference between and a running process of 3-4 degrees of severity can differ significantly. Therefore, proctologists recommend not to delay, and if conservative treatment does not give noticeable results, the disease often recurs, it may be worth thinking about radical methods. The earlier the operation is done, the better will be its effectiveness and the lower the likelihood of re-inflammation.

Published: July 25, 2016 at 03:52 pm

A person who is faced with inflammation and the flow of painful nodes from the anal canal seeks to avoid surgical intervention and solve this problem with the help of conservative treatment. But in the case when ointments, suppositories and tablets did not help to cope with the pathology, any proctologist will prescribe an operation to remove hemorrhoids, since the radical method is the only optimal way to get out of this situation. Thanks to modern technologies which make this process safe, all therapeutic tactics used for this are practically painless and highly effective.

Many patients who, despite the use of ointments and suppositories, have developed and are developing alarming symptoms, are interested in where they perform operations to remove hemorrhoids. All types surgical intervention on the area of the anus and rectum is performed in the proctology departments on an outpatient basis or in a hospital by coloproctologists or surgeons. In order to avoid surgery to remove hemorrhoids, you should immediately contact the appropriate specialist in cases where:

Pain and itching in the perianal region;
Frequent and prolonged stool disorders, especially not due to nutrition;
Bloody discharge from the anus;
The feeling that in anus there is a foreign body.

When hemorrhoids are found on early stages and the patient strictly follows all the recommendations of a specialist for his treatment in a conservative way, removal of nodes with complex surgical methods almost always avoidable. In extreme cases, a minimally invasive operation will be offered, which is performed without incisions and sutures on an outpatient basis and does not cause discomfort to the patient.

Modern methods of removing hemorrhoids

Not so long ago, modern radical methods for eliminating this pathology came to domestic surgery from Europe. These include such types of operations as the operation according to the Longo method and deserterization. Remains on this list and the traditional "excision of nodes" - hemorrhoidectomy.

Desarterization is the most modern method that is used to remove hemorrhoids. This surgery lies in the fact that the artery supplying blood to the inflamed bump is pulled over by the proctologist. But he does not act blindly, as in sclerotherapy, but uses an ultrasound machine. Thanks to this method, all pathological veins are found accurately. This intervention is performed on an outpatient basis, and in rehabilitation period no need for analgesics.

The Longo operation is considered the most common among modern ways removal of hemorrhoids. With it, a part of the intestinal mucosa is cut out with a special knife, which is located slightly above the node filled with blood. The operation can be applied both at the 1st and at the 2nd stage of the disease. Its advantage is that it lasts for a fairly short time.

Surgical removal of hemorrhoids - hemorrhoidectomy

When the time for conservative or minimally invasive therapy is missed, the most optimal solution remains surgical treatment. Currently, many clinics practice a classic operation called hemorrhoidectomy. It is quite complicated and is performed by completely excising the inflamed nodes with a scalpel or electric knife.

Quite popular is the method of removing hemorrhoids, which is at the III or IV stage of development using an ultrasonic scalpel. This way of intervention is taken in by a specialist in the case when the inflamed bumps have fallen out. The procedure itself with its use involves the removal of a section of the colon located above the nodular formation of hemorrhoids. If an ordinary scalpel without ultrasound is used during this intervention, the patient will have a rehabilitation period of up to a month, and all this time he will feel pain during defecation and urination.

A good alternative to a scalpel is an electroknife (coagulator). AT recent times it is being used more and more. The advantage of the electroknife is that during the operation to remove hemorrhoids, it not only excises the inflamed node, but also “brews” the smallest vessels on its surface. This property of the coagulator avoids profuse blood loss. The question is often asked about how exactly the classic surgical intervention called hemorrhoidectomy is performed. This is enough complex operation which is made under general anesthesia, consists of several stages:

The patient who is to be removed in this way and who has undergone preliminary preparation is laid on his back. At the same time, his legs are spread apart, pressed to the stomach and securely fixed;
The patient is anesthetized, and the perianal region and the anal canal are treated with a disinfectant composition;
A rectal speculum is inserted into the anal canal, and the doctor pulls the hemorrhoid out with a special clamp;
The leg of the inflamed bump is stitched with a catgut thread, and it is excised with a scalpel or an electric knife;
After all nodes are removed, the sutures are disinfected, and a swab with ointment is inserted into the anus for 6 hours.

Indications for this method of surgical intervention will be a disease that is in stage III-IV or postoperative complications. The question is also asked about whether there are age restrictions on the removal of hemorrhoids in this way. Yes, there are age restrictions. Intervention by this method is usually performed on patients older than 40 years. This happens for the reason that if it is done to people younger than this age, there is a significant risk that a long-term result will not be achieved.

No less interesting is how long the operation to remove hemorrhoids takes. It depends on which path of intervention is chosen by the specialist. In the case when the proctologist, according to diagnostic indications, preferred a minimally invasive technique performed on an outpatient basis, it will last no longer than 10-15 minutes. If the removal of hemorrhoids is carried out in a hospital, in time it will take from 40 minutes to an hour. Yes, and the rehabilitation period will last much longer after the classic operation. That is why it is recommended to contact a specialist when the first alarming appears.

How to prepare for the removal of hemorrhoids?

The preparation of the operation depends on which type of intervention is chosen, minimally invasive, performed on an outpatient basis, or surgical. But in in general terms preparation for both types of intervention is similar, it reduces the risk of complications and proceeds in the following sequence:

A week before the removal of hemorrhoids, you must begin to follow a diet that does not call for fermentation processes in the intestines and improves its peristalsis;
Before hospitalization, the patient should normalize the stool by eliminating constipation. If this does not come naturally, the specialist recommends some kind of laxative. You should not do this on your own, since any remedy has its own indications and contraindications that must be taken into account;
In the preparatory period before the removal of hemorrhoids by the method of radical intervention, the patient should consult with a specialist about the constant intake of any medicines. This is necessary for the reason that in preparation for an operative surgical intervention, the intake of certain medications(anticoagulants, hormones) should be discontinued.

Do not forget about the preparation on the day of the operation. It is considered no less important and contains the following points:

Eating stops 10-12 hours before the intervention;
The day before, a hygienic shower is taken;
Before the hemorrhoid removal operation itself, a cleansing enema is performed.

Carrying out all these procedures is necessary no less than passing tests, since they determine how the intervention will proceed and whether complications can arise during the rehabilitation period.

Removal of hemorrhoids in portal hypertension

Pathology called "portal hypertension" is one of the main manifestations of a serious and unpleasant disease, liver cirrhosis. It is formed due to the fact that in the portal vein, which is responsible for the delivery of blood to abdominal cavity, the pressure rises. As a result of this, blood stagnation occurs and, as a result, the walls of the venous vessels weaken and blood-filled and constantly inflamed bumps begin to bulge out of them. If in such a situation you do not start appropriate therapy, they will fall out of the anal canal. In this case, the patient with such a pathology will have only one way to get rid of hemorrhoids to do an immediate operation to remove the nodes.

But to completely get rid of the disease, one surgical intervention is not enough. Due to the fact that hemorrhoids are secondary disease, it is necessary to remove the root cause, that is, to restore the functioning of the liver. Moreover, when portal hypertension bleeding from inflamed nodes often reduces its manifestations. In such a situation, the reckless removal of hemorrhoids by surgical methods can cause irreparable harm to the patient, as it will contribute to the rapid increase in the pathology and lead to advanced cirrhosis. That is why surgical intervention to eliminate inflamed and prolapsed nodes in this situation is rarely performed so as not to provoke an aggravation of the patient's condition.

How to remove hemorrhoids at home?

At the second stage of the pathology, the elimination (reduction) of the protruding cones is carried out at home independently. This procedure is not dangerous if performed in accordance with the following rules:

The procedure for removing inflamed bumps is carried out only with medical gloves;
The area affected by hemorrhoids is anesthetized using anesthetic ointments (Troxevasin, Heparin), intended for the treatment of the disease, or an ice compress;
The patient, with an emphasis on the elbows, kneels down. At the same time, his legs should be moved apart;
With one hand, it is necessary to move the buttock in the direction opposite to the deformed bump;
With the second hand, the middle finger, she is pushed inside the anus, and the finger must first plunge into the anus, and then it should be jerked out;
In order for the removal of the hemorrhoidal bump to be successful and it does not jump out again, it is necessary to slowly tighten the sphincter muscles and squeeze the buttocks with both hands;
For 0.5 hours, you should lie on your stomach, and lie down in this position, squeezing the sphincter.

It is impossible to completely remove the hemorrhoidal bump with such a procedure, but it must take its place. If this does not happen, the disease has moved to the next stage and it is urgent to contact a proctologist. Many patients ask the question about the danger of an operation to remove hemorrhoids. By itself, it does not carry risks, but complications can arise. Specialists most often encounter such side effects:

After the termination of the anesthesia, a pronounced pain syndrome may occur. In such cases, narcotic analgesics are prescribed;
Men often develop acute urinary retention. It is managed with the help of bladder catheterization;
After removal of hemorrhoids at the suturing sites, trauma to the mucous membrane is possible with dense stool. This factor can cause severe bleeding;
In the case of improper suturing, the anal canal narrows. It can occur even 1-2 months after the procedure. Cope with it by holding plastics;
most unpleasant side effect are fistulas. In order to eliminate them, conservative therapy is used.

Tumors, edema and enlarged The lymph nodes in the anus area cause significant discomfort and pain during defecation. Hemorrhoid surgery is a procedure that helps surgically correct the pathology of varicose hemorrhoidal veins.

When is surgery needed?

For young people who are diagnosed with rectal prolapse and bleeding, immediate surgical correction of the rectum, nodes and other anomalies of the excretory system is recommended. Often, hemorrhoids develop after traumatic childbirth with ruptures and prolapse of the uterus, in which case the cause that provokes the development of the disease should first be eliminated.
In older people who long time live with hemorrhoids, the operation is performed quite rarely. Proctologists and surgeons are inclined to believe that the disease should be operated on at an early stage of development, and not in a complicated one. chronic form. Treatment of hemorrhoids in elderly patients is carried out with minimally invasive techniques.

Operation types

Specialists select a variety of therapeutic effects depending on the existing pathology, anatomical features and the patient's condition. All operations are carried out in proctology or surgical departments medical centers. A few days after the procedure, the patient must be in the hospital, under the supervision of doctors.
The most common operations are the removal of dilated hemorrhoidal veins and the ligation of their vascular legs. Quite complex and lengthy surgical correction the immersion of the hemorrhoid into the submucosal layer and suturing of the mucosa is considered.
In emergency cases, if other methods do not solve the problem, a proctologist surgeon performs a hemorrhoidectomy - excision of the mucous membrane of the anal canal and the hemorrhoid itself. With such a traumatic correction, a tightening and suturing of the mucous membrane to the anus canal is performed.
A modern way to solve the problem of hemorrhoids is also ligation with latex rings. In the knot tightened with a latex ligature, blood circulation stops, and it itself is rejected after 10-14 days.

Where in Moscow they perform surgical treatment of hemorrhoids

Online information portal Zoon you will find the coordinates of proctology centers, surgical departments public clinics and private medical institutions in Moscow. Here you can get acquainted with the questionnaires and the cost of services of leading specialists, doctors of sciences, professors and qualified specialists with experience working abroad.

During the procedure, the doctor expands the anus and detects a pathological formation. After that, a resection of the mucous membrane is carried out over the resulting bump. The incision is subsequently sutured and the knot is somewhat tightened. After the manipulation, the patient is shown staying in the hospital for several days. Often occur pain which go away on their own over time.

Application of desarterization

If you have formed a hemorrhoid, the removal of the pathology can be done using the latest and most gentle methods. The desarterization technique speaks for itself. The method is very effective and less traumatic.

During the procedure, the doctor inserts a catheter into an artery that supplies blood to the bump. This vessel is ligated and blocked. Subsequently, the node simply dies. It should be noted that the procedure requires some control. Most often it is carried out using the standard ultrasonic device.

surgical method

If you have a large hemorrhoid, removal is the most effective procedure. During the manipulation, anesthesia is necessarily used. The patient will need a long hospital stay and a long period recovery.

During treatment, the doctor performs excision of hemorrhoids. After that, healthy tissues are sutured with special absorbable threads. It should be noted that in recent years this manipulation is used less and less. This is explained by the difficult recovery period for the patient.

Complex treatment

Quite often, after minimally invasive procedures and surgical interventions, doctors prescribe conservative therapy. Many patients wonder why they need it. However, such preventive actions help to avoid relapse and recover faster after treatment.

If you have been prescribed medication, do not neglect taking them. Listen to the advice of a specialist and follow all appointments. In this case, the effect of the correction will be maximum.

Folk methods of treatment

Often patients avoid going to the doctor and use grandmother's recipes for the treatment of hemorrhoids. Of course, these methods are less painful and do not cause much discomfort. However, we can say that they are not so effective. Some of them can not only not help, but also aggravate the situation.

Often patients use propolis lotions. They may dissolve some of the outer bumps, but will not remove them. For the treatment of internal nodes, home-made candles from raw potatoes are used. This tool is also ineffective and is not a panacea.

Decoction baths help relieve inflammation and itching medicinal herbs. These include chamomile, string, and so on. However, all this will not save you from hemorrhoids, but only slightly dull the symptoms of its manifestation.

Hemorrhoids: treatment reviews

Patients say that the most comfortable method of correction is drug therapy. In the early stages of pathology, it is quite effective. However, such courses must be repeated several times a year, as there is a possibility of relapse.

Sclerotherapy has also won great confidence. This method is quite effective and has a relatively inexpensive cost. Relapse in most cases does not occur, but the patient also has to use appropriate medications several times a year.

Removal method in most cases has positive reviews. However, this method is very traumatic. It requires a long recovery and adherence to a certain diet and lifestyle. This is not very convenient for business and busy people.

Summing up or a short conclusion

Now you know the basic methods of treating a hemorrhoid. Which method is suitable in your case - a qualified proctologist will tell you. Do not delay in contacting the doctors. Otherwise, the situation may worsen and surgery is required. Treat hemorrhoids on time and be always healthy!

Not every form of hemorrhoids responds well conservative treatment. Sometimes even the most effective medicines useless, and the only way to cope with the disease is removal.

For this, there are so-called minimally invasive manipulations and special surgical operations. The former include cryotherapy, ligation of cones with latex rings, infrared photocoagulation, sclerotherapy, disarterialization of nodes and laser photocoagulation. To the second - hemorrhoidectomy according to the Milligan-Morgan method and Longo's operation. Let's take a look at these methods in more detail.

Minimally invasive techniques in the treatment of hemorrhoids

What are the ways to remove nodes?

Although, in fact, such techniques are surgical intervention, they are not classified as operational methods treatment. Each technique is characterized by unique features, but at the same time they all have much in common:

Minimally invasive techniques are accompanied by minimal tissue damage.
Almost all of them are performed on an outpatient basis within 10-30 minutes.
Manipulations are carried out without anesthesia, maximum - under local anesthesia. Moreover, the pain after their completion is not intense and short-term - no more than two days.
It takes only a few hours after the intervention, and the patient can start working. So the period of disability is reduced to a minimum.
Minimally invasive procedures do not leave behind rough scars and deformities.
The number of contraindications is minimal, so such techniques can be used even in elderly patients and patients with serious comorbidities.
Most minimally invasive techniques are most effective at stages 2 or 3 of the disease.

What is the essence of each method?

Cryotherapy

The method is based on the use of liquid nitrogen, with which the node is frozen. As a result, its tissues die off, and after a certain time it is rejected.

Note! Cryotherapy is effective in stage 2 or 3 disease and can be used to remove both external and internal nodes.

Ligation with latex rings

Alloying knots with latex rings

Unlike other minimally invasive techniques, ligation is used to treat only internal hemorrhoids 2 or . The essence of the method is that a special latex ring is put on the knot leg. It squeezes the blood vessels leading to the hemorrhoidal bump, and it gradually dies off, falling off on average by the end of the 2nd week.

Manipulation is carried out very quickly - within 10 minutes, while the doctor works with only one node. If they are multiple, the procedure is repeated after 2 weeks.

Note! Ligation is contraindicated when there are rectal fissures, as well as with active inflammatory process in this area - proctitis or paraproctitis.

infrared photocoagulation

It uses focused infrared rays. With the help of an apparatus - an infrared coagulator - they act on the leg of the node. As a result of the action of heat, the tissues, including the blood vessels leading to the node, curl up and it dies.

Photocoagulation gives best effect with stage 1 or 2 internal hemorrhoids, especially if it manifests itself as a symptom such as bleeding.

Sclerotherapy

Node sclerotherapy

This technique is used for both internal and external arrangement of knots. A sclerosing agent is injected into the thickness of the node, which literally "wrinkles" the hemorrhoidal bump. As a result, it is significantly reduced in size.

Note! The method can be used in the first two stages of hemorrhoids. At stage 3, sclerotherapy is also used, but not to reduce the size of the node, but to stop bleeding.

Laser coagulation

Using a laser

This method uses the ability of the laser to perfectly cut and cauterize tissue. The technique is equally effective for both external and internal nodes. In the first case, cauterization of hemorrhoids inside the intestine occurs, and in the second, the bump is simply cut off. In this case, bleeding does not occur, since the laser immediately seals the tissues.

Big plus laser coagulation is the possibility of its implementation even in the presence of fistulas and fissures of the rectum or its inflammation. A significant disadvantage compared to other techniques can be considered the high cost of the procedure.

Dearterialization of nodes

Desarterization of hemorrhoids

Unlike others non-surgical methods treatment, dearterialization can be carried out even at stage 4 of the disease. But the best results are achieved at stages 2-3.

The technique is not used to remove external hemorrhoids, but is used only when inner form diseases. It is carried out under conditions day hospital where the patient stays for 2-3 days. Manipulation is necessarily carried out under anesthesia - epidural or intravenous - and comes down to ligation of the arteries that feed the node.

Having lost its blood supply, the bump begins to "dry out", to be replaced connective tissue and after 2 to 3 weeks significantly decreases in size.

Note! Disarterialization cannot be carried out with thrombosis of the node or paraproctitis - inflammation of the tissues around the rectum. However, after these conditions are eliminated, manipulation is quite acceptable.

Despite the fact that minimally invasive methods are characterized by minimal intervention, in some cases they are accompanied by some complications.

Complications and disadvantages of minimally invasive techniques

Although there are not very many of them, they can bring a lot of discomfort to the patient:

Intense pain syndrome. Moderate soreness after manipulation is quite acceptable, since the rectal mucosa is rich in nerve endings and is a very sensitive area. Sharp pain occurs after ligation with rings and is associated with their incorrect imposition and capture of healthy tissues. It also occurs when the rings are simultaneously applied to several nodes at once. Intensive pain may be accompanied by infrared photocoagulation.
To eliminate pain, analgesics are used, and in case of improper ligation, the rings are cut, thereby eliminating compression of the nerve endings.
Bleeding. This complication can develop with almost any minimally invasive technique. The exception is laser excision of the node, when the blood vessels are immediately cauterized. The cause of bleeding may be the detachment of the dead node after infrared photocoagulation or ligation with latex rings, the ring jumping off the node, traumatization of the lump that has not yet fallen off with dense feces.
Thrombosis of the external node. Occurs after ligation in the absence of obvious boundaries between the outer and inner cones. And also after infrared photocoagulation, if the vessel feeding the node is not completely coagulated. Then the blood enters it, accumulating and leading to thrombosis.

The disadvantages of minimally invasive techniques include:

The possibility of a recurrence of the disease, since it is not the cause of the disease that is eliminated, but only its consequence.
The high cost of some manipulations - this especially applies to laser coagulation.
The need for high qualification of the doctor conducting the intervention. For example, disarterialization requires from the proctologist not only a brilliant knowledge of anatomy, but also precision in ligation and stitching of the arteries.

When the chances of getting the desired effect from minimally invasive techniques are zero, surgical methods are used.

Surgery for hemorrhoids

To remove nodes surgically, Milligan-Morgan and Longo operations are used. An indication for their conduct is, as well as a complication of the disease in the form of thrombosis of the node.

Removal of nodes according to Milligan-Morgan

This type of intervention allows you to carry out, as well as remove internal bumps, which are simply excised.

The operation is performed in one of the ways - open or closed. The second option is preferable, because, unlike the first, it has a number of advantages:

With the closed method, surgical wounds are sutured (with the open method, no sutures are applied), so they heal much faster.
The operation can be performed in an outpatient setting under local anesthesia. With the open option, the patient must be in the hospital, and the operation itself is performed under epidural or intravenous anesthesia.
The patient's ability to work is restored after 2 to 3 weeks, while with open hemorrhoidectomy this period lasts up to 5 weeks.

The Milligan-Morgan operation allows the patient to forget about hemorrhoids for 10-12 years, and for someone to say goodbye to the disease forever. But despite this, the operation has several disadvantages:

Like any major surgery, it is usually performed in a hospital setting.
The patient loses his ability to work for at least 3 weeks, or even more. In addition, he “falls out” of his usual way of life and is forced to limit himself in physical activity.
The postoperative period is always accompanied by a pronounced pain syndrome. And its manifestations are aggravated during a chair and even when walking.
Serious contraindications:
- oncological processes
- Crohn's disease
- pregnancy
- inflammatory processes in the tissues surrounding the anus

Another type of intervention - Longo's operation - is fundamentally different from the first in its technique.

Operation Longo

Hemorrhoidopexy according to Longo

In another way, this surgical procedure is called hemorrhoidopexy, or knot tightening.

Its essence is that it is not the node itself that is removed, but the mucosal area in the intestine, located above the dentate line. The free edges of the mucosa are combined with special staples, as a result of which the nodes are pulled up. At the same time, their blood supply is disrupted, a sclerotic process develops in them, and they decrease in size.

Longo's operation has both advantages and disadvantages. The first ones should include:

A short recovery period - the time of stay in the hospital is only 2-3 days, and the period of temporary disability does not exceed 7 days.
Pain after surgery occurs only in 10–17% of patients, while it is not intense and persists only for the first day.
The operation can be performed at any stage of the disease.
There are practically no contraindications for this type of intervention.

Impossibility of its carrying out in out-patient conditions.
Using the method only to eliminate internal hemorrhoids.
The cost of the procedure.

Fortunately, modern patients there is a choice, but how and what method to use for this, the doctor still decides. In this case, the form of the disease, its stage, the presence or absence of complications, as well as the financial capabilities of the patient, matter.

You should also remember that by resorting to minimally invasive techniques or surgical treatment and by removing the nodes, you do not rid yourself of hemorrhoids once and for all. After all, without exception, all methods of removing nodes eliminate not the cause of the disease, but its consequence. And if you don't want hemorrhoids to reappear, without preventive measures not enough.