Most people are convinced that such an ailment as hemorrhoids is most prone to men of advanced age, but this is far from the case. According to doctors, this disease with the same frequency is diagnosed in absolutely everyone, regardless of gender, type of activity and age category. Moreover, the whole problem is that most are ashamed to go to the hospital for qualified medical help and try to cope with it on their own. As a result of self-treatment, hemorrhoids continue to progress and gradually flow into a more complex form, in which drug treatment does not give almost any result, and the only way out is surgery - Milligan-Morgan hemorrhoidectomy. The article provides information on what this method is and how effective it is in combating an insidious disease.
What is hemorrhoids?
This is a very unpleasant disease that brings a lot of inconvenience to a person’s daily life, most often due to inflammation of the soft tissues of the anus, thrombosis, the formation of nodes in the colon and the expansion of hemorrhoidal veins. In the early stages, it can be cured without surgery, however, in a neglected form, in most cases hemorrhoidectomy according to Milligan-Morgan is prescribed (the technique of the operation will be described in detail later in this article). Moreover, it is not the disease itself that is scary, but various complications, which are very difficult to eliminate.
General information about surgical treatment
Milligan-Morgan hemorrhoidectomy was invented in the early 30s of the last century by two famous proctologists of his time, in whose honor this procedure got its name. Over the years, the method has undergone many changes and improvements until it has acquired a modern form.
Today, the following types of hemorrhoidectomy are distinguished:
- Ferguson closed;
- submucosa in Parks.
The first is prescribed for patients with poor blood coagulation, in which hemorrhoidal nodes are small. During the operation, the wounds are stitched tightly, so that the recovery of patients is much faster.
The second method is more complicated, but it minimizes the likelihood of various complications.
Advantages and disadvantages
Let's look at them in more detail. Despite the fact that hemorrhoidectomy according to Milligan-Morgan refers to radical methods of treatment, nevertheless even it has certain advantages, among which the following can be distinguished:
- Complete cure for hemorrhoids with a low probability of relapse. As practice shows, the disease again makes itself felt in very rare cases.
- The ability to conduct surgery at any stage of the course of the disease.
Unfortunately, there were some flaws as well. The main disadvantages are:
- A long period of rehabilitation.
- The need to stay in hospital for a certain time before and after surgery.
Whatever the advantages and disadvantages of hemorrhoidectomy, it is important to understand that today this method is one of the most effective in combating hemorrhoids, so the relevance of its use is very high.
In which cases resort to surgical intervention?
One of the most common and effective methods of treating hemorrhoids today is Milligan-Morgan hemorrhoidectomy.
Indications for its use are as follows:
- The late stage of the disease. The third and fourth phases of hemorrhoids do not lend themselves to any drug therapy, so doctors are forced to resort to the most radical methods.
- Abundant discharge of blood from the nodes. This can happen not only in the late, but also in the early stages of the disease. If nothing is done, then the patient may develop anemia, which poses a serious threat to human health and life. As practice shows, drugs in very rare cases can achieve any result, so you have to remove part of the colon.
- Hemorrhoids of the mixed type. This kind of ailment is difficult to treat, therefore, in almost all cases, a hemorrhoidectomy according to Milligan-Morgan is prescribed.
In addition to all of the above, surgical intervention is also necessary if minimally invasive therapy for a long period of time does not bring the patient any improvement or he develops various complications.
Contraindications
This issue should be given special attention. Like any other treatment, Milligan-Morgan hemorrhoidectomy has a number of contraindications.
The decision on the purpose of the operation is made on the basis of the patient’s clinical picture and it is unacceptable in the following cases:
- advanced age;
- the presence of any diseases of the heart and circulatory system;
- violation of immunological reactivity;
- severe infections recently transferred.
Milligan-Morgan hemorrhoidectomy implies that after surgery the patient will have open wounds in the anus, where ideal conditions for the life of various pathogenic microorganisms are created. Deficiency of vitamins and minerals greatly complicates the process of recovery after surgery. In addition, there is a high likelihood of developing acute or chronic inflammation of pararectal fiber with its subsequent necrosis, as well as various pathologies and fistulas. In this case, the efforts of doctors are aimed at stopping hemorrhoids through the use of complex treatment using drugs.
Preparing the patient for surgery
What is she like? Before a Milligan-Morgan hemorrhoidectomy is performed, the patient must first be prepared for surgical intervention. This is a very important process, on which depends not only the success of the operation and the time of rehabilitation, but also the likelihood of various complications. At the same time, no special procedures are performed, and the intestines are cleaned by using an enema. In addition, the patient is forbidden to eat food 24 hours before the prescribed procedure, and you also need to drink as much fluid as possible. The last purification session is performed before the hemorrhoidectomy itself.
Actions during surgery
Milligan-Morgan hemorrhoidectomy, the implementation technique of which is very complex, is performed on a special operating table, which in its appearance and design features has much in common with its proctological colleague. The patient assumes a supine position, slightly raising and spreading his legs.
First of all, the anus is expanded with a special tool, after which a surgical mirror is inserted into it. The affected areas of the soft tissues are treated with an antiseptic.
Then everything happens according to the following scheme:
- A special material resembling an ordinary thread is implanted in the cones, which eventually resolves and prevents the flow of blood to pathological formations.
- The nodes are removed using a special ultrasonic device or electrocoagulation.
- Slicing areas are cauterized to speed the healing process. The wounds themselves are not treated in any way, so they remain open.
- At the end of the operation, a tampon soaked in a special solution with a hemostatic and bactericidal property is inserted into the anus.
According to this principle, hemorrhoidectomy according to Milligan-Morgan is performed. The technique of the operation involves the execution of the last paragraph only in the presence of heavy bleeding, which cannot be stopped. In all other cases, it is undesirable.
Anesthesia
Hemorrhoidectomy does not fall under the category of abdominal operations, i.e., performed on internal organs, so in most cases it is performed without general anesthesia. There are known cases of the removal of characteristic growths in the anus with latex rings even without local antiseptics. Nevertheless, patients can also be given special anesthesia, so that surgery is completely painless.
In some cases, epidural anesthesia is preferable, but its use is permissible only if the patient does not have osteochondrosis, as well as injuries in the spine. In the presence of these diseases, the anesthesiologist chooses the most optimal type of anesthesia. As a rule, local anesthesia is used, under which the patient does not feel pain during removal of hemorrhoids.
Rehabilitation period
The patient’s body needs recovery after he has undergone a hemorrhoidectomy according to Milligan-Morgan. The postoperative period, as a rule, takes about one month. If there are complications, it may take longer. It is very difficult even for doctors to give exact dates, since each case is individual.
The patient should be hospitalized for the first week under the supervision of a doctor. As soon as he can go to the toilet on his own, an extract is issued and he is allowed to go home. For the first few days, the operated person experiences severe pain, so he is prescribed pain medication. It is forbidden to eat food for 24 hours after returning to the ward, and a laxative is used to empty the intestines.
Nutrition recommendations
For a final recovery, they are definitely worth observing. Diet after hemorrhoidectomy according to Milligan-Morgan is one of the key aspects of rehabilitation, which determines the time required for a complete recovery of the body. Everyday diet should be balanced and rich in vitamins and nutrients, as the body needs strength to recover.
Doctors recommend that their patients consume the following during the first week after surgery:
- first dishes cooked in vegetable broth;
- boiled fish and chicken;
- liquid cereals;
- low-fat dairy products;
- dried fruits;
- fresh and boiled carrots and beets;
- cucumbers.
From the second week, the menu can be made more diverse. As for the prohibited products, these include cow's milk, oranges, sweets, black tea and coffee, mushrooms of any kind, pastries, spirits and fatty meats.
What could be the consequences?
Any surgical intervention can have various complications.
As for hemorrhoidectomy, then after it the patient may experience the following:
- strong pain;
- bleeding
- difficulty urinating and defecating;
- stenosis of the anus and rectum;
- anal fissures;
- fistula formation;
- hematomas;
- suppuration of wounds;
- fecal incontinence;
- infectious infection.
In addition to all of the above, hemorrhoids can also give relapses and return again after the patient has fully recovered. Most often, a similar problem is faced by young people.
What do the patients themselves say about the operation?
As already clear, for the treatment of hemorrhoids in advanced form, hemorrhoidectomy according to Milligan-Morgan is prescribed. Feedback on this method is very controversial. Some argue that the operation is very painful and does not bring the desired effect, while others, on the contrary, are completely satisfied. Most patients claim that after surgical removal of hemorrhoidal nodes, they forever forget about their problem. In this case, the recovery process is quite fast and no complications arise.
Conclusion
Hemorrhoids are a very serious disease that can bring a lot of inconvenience to a person’s life. Modern medicine is able to completely cure it at any stage, but profiled experts recommend that you do not start the ailment and do not self-medicate, but immediately go to the hospital. Only in this way can a disease be quickly defeated with the help of drugs without using radical methods.