What is hemorrhoidectomy? This is the type of surgical intervention that is often used in proctology. If a hemorrhoidectomy is prescribed to a person, then the specialist should explain in more detail to his patient what the nuances of this operation are. In addition, when answering the question of what is hemorrhoidectomy, the doctor should also talk about the most effective method for resolving the problem using the Milligan-Morgan method. In this article, it will be possible to become more familiar with the cases in which patients are prescribed radical removal of varicose veins in the anorectal region. But before that, let's take a closer look at what hemorrhoidectomy is. What it is? In what cases is appointed? How is it done?
General description of the procedure
Currently, various pathologies of the rectum are in the leading positions among other diseases of the gastrointestinal tract. Thrombosis and inflammation of the hemorrhoids are observed in every fifth inhabitant of the planet. These statistics are largely determined by the modern way of life, as well as a decrease in human motor activity. In some cases, this disease proceeds with such severe symptoms that a specialist prescribes a hemorrhoidectomy to the patient. What it is? This procedure is an operation during which hemorrhoids are removed.
Indications and contraindications
When planning a hemorrhoidectomy, the patient reviews of which can be seen in this article, the specialist must necessarily assess the perceived risk and benefit of such treatment. In parallel with this, the general condition of the patient, his age, as well as the presence of concomitant pathologies and diseases are taken into account.
In most patients with hemorrhoids, rational conservative therapy, as a rule, gives good results. But it may happen that such a treatment measure does not lead to stabilization of the state. Then the patient is prescribed surgery. In parallel with this, Morgan hemorrhoidectomy is prescribed in the following cases:
- Hemorrhoids occurring at the third or fourth stage of their development.
- Hemorrhoidal prolapse during a bowel movement.
- Hemorrhoidal vein thrombosis.
- The development of anemia due to constant bleeding.
There are also many different limitations to such surgery. For example, a hemorrhoidectomy operation can be a rather risky method of treatment, which does not always justify itself if the patient has a history of hypertension or diabetes mellitus. The elderly patient is also often a contraindication to surgery.
Among other contraindications to open hemorrhoidectomy of the anorectal zone, there are the following:
- The presence of malignant neoplasms.
- Exacerbation of intestinal diseases occurring in acute form.
- Blood clotting disorder.
- Acute infectious process.
- Severe decompensated pathology of internal organs.
Considering the features and reviews of patients about hemorrhoidectomy, it should be noted that this operation is divided into several types.
Types of Surgery
Currently, the most effective surgical method for removing varicose veins in the anorectal region is an open (classic) operation. It is called Milligan hemorrhoidectomy. The closed type is called submucosal hemorrhoidectomy or Ferguson hemorrhoidectomy. Such an operation involves resection of the mucous membrane of the anal canal of the rectum according to the Longo method. Each of these techniques has both positive and negative qualities. However, the classic method of radical intervention is the most popular. Despite this, Longo hemorrhoidectomy in the near future may be quite good competition.
Morgan's method is the most traumatic. It is performed exclusively under general anesthesia, so the patient must be thoroughly prepared for this procedure. The undeniable advantage of this operation is the ability to remove both the internal and external hemorrhoidal nodes of the rectum.
Dr. Ferguson’s technique is a relatively new method for removing pathologically altered veins in the anus. Closed hemorrhoidectomy is qualitatively different from other varieties of surgical resolution of this problem in that after this operation, the tissues of the rectum are sutured. For this reason, wounds heal much faster after hemorrhoidectomy. Patient reviews prove this. It is worth paying attention to the fact that the risk of complications after such therapy is generally small, but it is associated with some negative conditions, which are as follows:
- Prolapse of the rectum.
- Bleeding.
- The occurrence of puffiness.
- Divergence of seams.
If we compare the Longo operation with the classical method, the first is the most sparing. During surgery, only a small area of the mucous membrane in the rectum is resected. In this case, the hemorrhoidal nodes are not excised, they, relatively speaking, are slightly tightened and fixed at a certain distance from the anus.
After hemorrhoidectomy by the Longo method, instead of sutures, special staples are applied to the damaged areas of the mucous membrane. An additional advantage of this method of removing hemorrhoids is the lack of need for general anesthesia of the patient. However, there is a drawback to such an operation. It consists in the inability to eliminate externally located nodes. For this reason, the circle of its direct use is narrowed.
Preparation for the operation
Before starting surgery, the specialist advises the patient to undergo some examinations in order to identify hidden infectious and inflammatory processes in the body and possible pathologies of internal organs.
For this purpose, an ultrasound is prescribed to the patient, as well as a laboratory study of urine and blood. In addition, it is mandatory to perform a digital examination of the patient’s rectum, as well as perform anoscopy.
What else needs to be done before hemorrhoidectomy? Diet is also important in preparing for surgery. Experts advise against eating foods that provoke gas formation, as well as the formation of feces in excess before surgery. Preference should be given to easily digestible products: dairy products, eggs, semolina.
In parallel with this, the preparation of the patient on the eve and on the day of the surgical intervention to remove hemorrhoids implies the following points:
- The patient’s last meal should be 12 hours before surgery. You can’t eat anything later.
- Before the operation, the patient should take a bath or shower, and also put on clean underwear.
- In anticipation of surgery, a cleansing enema should be performed, which is often replaced by the use of Fortrans or Mikrolaks laxative medications.
Morgan Surgery Technique
The essence of this surgical intervention is the excision of varicose-dilated external and internal hemorrhoidal veins. But before this, the vascular legs of the node are pre-stitched.
At the preparatory stage, the patient should sit on the couch. Specialists fix his legs with the help of special stands. Abroad, this operation according to the method of Morgan is carried out with the patient lying on his stomach. At the same time, the patient's pelvis rises slightly, due to which there is an outflow of venous blood.
Hemorrhoidectomy is performed, as mentioned earlier, under general anesthesia. In addition, it is carried out according to a certain algorithm:
- The anal sphincter expands.
- An anoscope is inserted to gain access to the pathological area.
- The bump is grabbed and pulled out.
- The foot of the assembly is clamped.
- A vessel is stitched and ligated with a varicose region.
- The node is deleted.
Laser hemorrhoidectomy
This method is one of the minimally invasive types of surgery. Laser excision of the hemorrhoid is highly effective. During this procedure, local anesthesia is used. The undeniable advantage of this method is the speed of the manipulation, as well as low pain. After several hours after the end of the procedure, the patient can already go home.
Laser coagulation of the hemorrhoid involves the following several steps:
- A rectal divulsion is made.
- An anoscope is introduced.
- After this, the localization of the pathological region is determined.
- A layer-by-layer burning of hemorrhoids is made.
Postoperative period
What can be said about the postoperative period of hemorrhoidectomy? Recovery of the patient after such a surgical intervention is carried out quite safely. However, reviews of hemorrhoidectomy by patients indicate that they experience significant inconvenience, for example, the process of bowel movement was noticeably difficult. Many patients report experiencing soreness during this action.
On the first day after surgery, it is necessary to completely abandon the use of products, but at the same time maintain the correct drinking regimen. On the second day after hemorrhoidectomy, specialists allow patients to eat light soups, cereals and dairy products.
To speed up the process of regeneration of postoperative wounds, they are treated with special ointments, which are made on the basis of methyluracil. As a rule, the patient remains in a hospital for 10 days. However, in reviews of hemorrhoidectomy, patients report that the rehabilitation period lasts for approximately 2 weeks.
To consolidate the therapeutic effect and prevent the relapse of the disease, the risk of which is still preserved with any type of therapy, patients are recommended to adhere to the following simple rules:
- Do not be seated for a long time.
- Exclude any physical activity that involves tension of the abdominal muscles.
- Do not lift weights.
- Eat a healthy diet.
- To live an active lifestyle.
Possible complications
Like any other operation, this procedure is dangerous for the development of various postoperative syndromes. If the patient has been shown hemorrhoidectomy, he should first become familiar with the possible complications after surgery. Patient reviews suggest that bleeding often occurs due to poor hemostasis or due to falling off of the crusts of all blood vessels after burning. Among the other adverse effects of the operation should be highlighted:
- The formation of anal fissures.
- Problems with bowel movements and urination.
- Fistula.
- Relapse of hemorrhoids.
- Narrowing the anus.
- Various infections.
- Prolapse of the rectum.
Swelling
This kind of complication after surgery can be observed for a variety of reasons. Perianal edema after hemorrhoidectomy is often the result of preoperative fusion of varicose vessels. In addition, these adverse effects can also act as an individual reaction of the human body to the radical therapy. Regardless of exactly what reason caused the formation of puffiness, subject to all the requirements of specialists, the swelling should go away on its own several weeks after the intervention.
Operation cost
As for the cost of surgical intervention, it will depend on the degree of neglect of the disease, as well as on the status of a medical institution. The cost of the operation in different regions of the country also differs. In private clinics, it is a priori higher, which can be explained by the use of good modern expensive equipment. However, do not forget that hemorrhoids can be cured for free if you seek help from a state medical institution. True, in this case, the patient will need to wait in line for him to have surgery. Patient reviews suggest that it takes a very long time.
For example, in a Moscow clinic hemorrhoidectomy for Milligan can be done, on average, for 20,000 rubles. Closed type of operation is carried out at about the same cost. As for the laser removal of hemorrhoids, the cost of such a procedure is about 30,000 rubles.
The most expensive operation is a Longo hemorrhoidectomy. For its implementation will have to lay out about 50,000 rubles in Moscow. As for other regions of Russia, as a rule, the cost in them for carrying out this procedure is an order of magnitude lower.
Patient Reviews
Consider what patients who have already experienced the treatment of hemorrhoids with hemorrhoidectomy write in the reviews. Most of them report that Milligan hemorrhoidectomy was used to treat this disease. The rehabilitation period after surgery is not so long, but also not fast. As a rule, it takes about three weeks to fully recover. However, the result is worth it.
On the side effects in the form of bleeding from the anus, the formation of fistulas and prolapse of the rectum write units. In general, those who have undergone surgery have problems with bowel movements (in the first days after the operation), but when the mucous membranes heal, everything returns to normal.
Patients who underwent Ferguson's hemorrhoidectomy to treat hemorrhoids note that rectal wounds heal much faster. However, far from all clinics, specialists offer this type of surgical intervention, which is inconvenient.
As for the choice of clinic, most patients with hemorrhoids choose private medical institutions for the operation. As a rule, in such clinics, hemorrhoidectomy is performed more accurately, and the conditions for the recovery of patients are quite acceptable.
We have examined what it is - hemorrhoidectomy. Before the operation, the patient must undergo an examination, as well as get acquainted with possible contraindications.