Hemorrhoids are a disease that affects millions of people around the world. The treatment of this pathology at an early stage is carried out using drugs, however, in advanced cases, the only effective way is surgery. In proctology, the Milligan-Morgan operation is used. What is it and how effectively does it combat the manifestations of hemorrhoids?
Basic concepts
This type of operation was first performed in 1935 under the supervision of two surgeons (Morgan and Milligan). In this regard, the procedure got its name. During the classic Milligan-Morgan operation, hemorrhoidal nodes and a small area of the mucosa are removed .
The effectiveness of such a radical method of treatment has been proven for many decades. For this reason, this surgical approach is used in most countries of the world.
In order to improve the result and optimize the procedure itself, attempts were made to modify the course of the operation. In this regard, in modern proctology, there are several varieties of Milligan-Morgan surgery: open, closed and submucosal hemorrhoidectomy.
Open hemorrhoidectomy
A characteristic feature of such an operation is that after resection of the hemorrhoidal nodes, no sutures are placed at the site of removal. Thus, postoperative wounds remain open - they heal naturally.
Carrying out such an operation requires epidural or intravenous anesthesia. In the postoperative period, the patient should be kept in a hospital under the close supervision of doctors. The recovery period reaches 7-10 days.
Closed hemorrhoidectomy
This kind of procedure was first introduced into medical practice in the 50s. The founders are the surgeons Quinon and Ferguson. The principle and course of such an operation does not differ from the open method, however, this method has several features.
- There is no need for general anesthesia, you can use local anesthesia. This option is suitable for patients for whom general anesthesia is contraindicated.
- After resection, the edges of the wound are sutured (hence the name).
- The recovery period is reduced, which facilitates the condition of patients.
Submucous hemorrhoidectomy
This type of surgery is known as the Parks method. The development of this procedure was required due to the shortcomings of existing methods. The essence of the operation is that only the hemorrhoidal node is subject to removal, the mucous membrane remains intact.
Such a procedure requires more time, effort and professionalism of the surgeon. Moreover, it is possible to achieve a higher result:
- recovery period is reduced;
- the patient tolerates the postoperative period more easily;
- the number of relapses of the disease is reduced.
In what cases is Milligan-Morgan surgery prescribed for hemorrhoids
Such surgical treatment is prescribed only to those patients who are diagnosed with stage 3 or 4 hemorrhoids. At the initial stages of the disease, surgical treatment is not used, since there is the possibility of therapeutic treatment using drugs and minimally invasive methods.
Among the patients are those who have previously undergone therapeutic treatment that did not give positive results.
Contraindications to hemorrhoidectomy
Doctors call several cases in which the operation Milligan-Morgan is prohibited. This list includes:
- the period of pregnancy in women (in this case, the operation is postponed for some time);
- immunodeficiency;
- oncological diseases (malignant tumors);
- Crohn's disease;
- acute and chronic inflammatory diseases that can complicate and slow recovery after surgery.
An important role is played by the age of the patient. Most often, complex surgery is prescribed to people over 40 years old. Young people are advised to undergo minimally invasive treatment. Among them are ligation with latex rings, exposure to a laser or liquid nitrogen. Exceptions are only cases with 3 or 4 stages of hemorrhoids.
Diet before surgery
An important step before the Milligan-Morgan hemorrhoid surgery is to cleanse the intestines from feces and restore its proper functioning. To achieve this goal, the patient should adhere to a special diet, which contributes to the normal functioning of the gastrointestinal tract and facilitate the emptying of the intestinal canal.
The following foods are completely excluded from the diet:
- cabbage;
- legumes;
- fried, spicy and fatty dishes;
- products containing cocoa;
- sweets;
- tea and coffee;
- carbonated drinks;
- alcohol.
The presence of these products in the diet causes gas formation in the intestines and constipation, and also overloads the digestive system.
At least 1.5 liters of fluid should be consumed per day. This will restore the water balance in the body, which in turn reduces the risk of constipation.
Preparation for surgery
To prevent complications, the doctor prescribes a thorough diagnosis of the patient for concomitant serious illnesses. A few hours before surgery, the intestines are completely empty with an enema. The hairline in the anus is removed.
In some cases, immediately before surgery, the patient's body temperature may increase. This indicates an exacerbation of hemorrhoids. Under such conditions, surgery is delayed until the condition stabilizes.
Operation progress
According to the standard, there are several stages of the Milligan-Morgan operation. The technique of excising nodes remains standard regardless of the type of procedure selected.
The patient during the operation is on the operating table lying on his back. At the same time, his legs are fixed with special stands.
In order to disinfect the skin in the area of surgical intervention, the surgeon treats with a special preparation based on water.
The patient is anesthetized and an anoscope inserted into the anus. This is necessary for easier and more convenient access to hemorrhoidal nodes.
Each node is captured with a special clamp, after which they are pulled and blood vessels are pinched. If several nodes are detected, deletion occurs clockwise.
After capturing the unit, fix its leg. To do this, use a special thread folded in the form of a loop.
The node captured in this way is excised with a scalpel or laser. The latest technique of surgery during Milligan-Morgan surgery began to be used more and more often. This is explained by the ability of the laser beam not only to make an incision in the tissue, but also to cauterize the edges of the wound and blood vessels. This helps to reduce the risk of bleeding and accelerate healing.
At the site of excision of the hemorrhoid, the surgeon sutures and disinfects this area.
The final stage of the operation is the establishment of turunda with the application of a therapeutic ointment.
Postoperative recovery period
The duration of recovery after Milligan-Morgan surgery completely depends on the method of the procedure.
- With open hemorrhoidectomy, the recovery period can reach 2-3 months.
- With a closed type of surgery, a full recovery is possible in 1-1.5 months.
During the first few days, the patient experiences severe pain, in addition, the presence of fresh wounds increases the risk of infection and tissue injury. In order to prevent complications, the patient must carefully follow the doctor’s instructions.
From food for 2-3 days should be completely abandoned. Only liquid intake is acceptable. This is necessary to unload the intestines and reduce the risk of injury during bowel movements.
During the first weeks, strict bed rest should be observed. You can’t sit at this time, as this can provoke severe pain and complications.
Methods of therapy after surgery
Within 7-14 days after Milligan-Morgan surgery, the patient experiences pain and swelling. In some cases, mucous discharge from the anus is allowed. In this case, the mucus should not have bloody or purulent inclusions.
To alleviate the condition of the patient, speedy recovery and prevent complications, doctors use drug therapy:
- painkillers;
- anti-inflammatory ointments or rectal suppositories (among the most common - methyluracil ointment);
- laxatives;
- anti-inflammatory drugs (baths or lotions with chamomile broth or a weak solution of potassium permanganate).
In the absence of complications, doctors recommend performing Kegel exercises. They help improve blood circulation in the pelvic organs and strengthen muscles.
Possible complications
In some cases, after Milligan-Morgan surgery for hemorrhoids, patients have complications, but this happens quite rarely.
- Fear of bowel movements due to severe pain. To eliminate the problems associated with the discharge of feces, the patient is prescribed laxatives, analgesics and drugs to relieve spasms.
- Bleeding. This complication is possible for several reasons: damage to the mucosa by fecal masses or slipping of the ligature thread. Such treatment does not require special treatment. In some cases, the adoption of hemostatic drugs is possible.
- Urinary retention. Male patients may have difficulty urinating. In these cases, catheterization is performed. In female patients, such complications appear extremely rarely.
- Narrowing of the anal canal. The cause of this pathology is the flaws of the surgeons during the operation (suturing of wounds occurs with an error). Correct the situation can a special expander or surgery.
- Soft tissue inflammation at suture sites. This complication can be detected by bloody or purulent discharge from the anus. The cause may be pathological microorganisms that enter the wound from the rectum. To eliminate the inflammatory process, the patient is prescribed antibacterial and anti-inflammatory drugs intended for topical use.
- The appearance of fistulas. Such a complication may arise due to the seizure of muscle tissue. Subsequently, the wound becomes infected, suppuration and fusion of soft tissues appear. Conservative and surgical treatment can solve this problem.
- Weakness of the anal sphincter. The main problem associated with such a pathology is rectal prolapse. In medical practice, this is one of the most rare complications after Milligan-Morgan surgery. For recovery, medication or surgery can be performed.
In order to accelerate healing and to protect yourself as much as possible from possible complications, you should strictly follow the doctor's recommendations in the postoperative period. Especially important is the first week after the surgical procedure.
Treatment Predictions and Possible Relapses
The operation to remove hemorrhoids in most cases allows you to eliminate the manifestations of pathology. During the first few years, remission is achieved, but the patient's condition is completely dependent on his habits and rhythm of life.
The following rules can significantly reduce the risk of relapse (re-development of the disease):
- The diet should be as diverse as possible (it should include lean meat, fish, vegetables, fruits, cereals).
- From the menu you need to completely exclude or minimize the consumption of fatty, spicy, smoked, fried foods.
- You need to eat in moderation. Overeating is unacceptable - such a diet causes disruption of the gastrointestinal tract, frequent constipation.
- Moderate exercise is recommended. In this case, overvoltage, weight lifting, excessive fatigue should be avoided.
Testimonials from doctors and patients
According to medical reviews, Milligan-Morgan surgery for hemorrhoids acts as an effective treatment. For many patients with an advanced stage of the disease, this approach becomes the only possible way to get rid of the pathology. This method has few contraindications. In addition, unlike drug treatment, surgery reduces the number of relapses.
Patients are also pleased with the results of the Milligan-Morgan operation.
Reviews relate to both the recovery period and the subsequent condition. People who survived the surgical treatment of hemorrhoids emphasize: the first few days after the procedure are the most difficult. At this time, the patient is tormented by constant pain and weakness throughout the body. Some relief comes after 5-7 days. After 4-6 weeks, the patient's condition stabilizes, and he can gradually return to a normal lifestyle.