Despite the fact that many are silent about this disease, hemorrhoids is considered one of the most common pathologies of the vascular system. The disease develops for various reasons, including: a sedentary lifestyle, or, on the contrary, constant stay in a standing position, hereditary features of veins, nutrition, etc. The disease is common among both the male population and women. However, most people ignore the symptoms of hemorrhoids, not considering them serious, or feeling awkward in front of a doctor. If the disease is not treated, it progresses, and complications develop. One of them is hemorrhoidal thrombosis . This condition is not only accompanied by severe pain, but also quite dangerous. To prevent death, a thrombectomy of the hemorrhoid is performed . It consists in removing a clot from a vein and restoring blood flow.
Thrombosis with hemorrhoids: causes
Hemorrhoids are a pathological change in the veins that carry out the outflow of blood from the muscles of the anus. The vessels become crimped, areas of expansion appear. As a result of this, nodes are formed which, upon physical exertion, can fall out. Depending on which veins are involved in the pathological process, internal and external hemorrhoids are secreted. In the initial stages, the disease is characterized by periodic itching in the anus and the appearance of small nodes with constipation. With hemorrhoids 3 and 4 stages, the affected veins constantly fall out of the anus, hurt and bleed. Due to the fact that hemorrhoids are outside the anus, the sphincter is strongly reduced. This leads to the fact that the muscle infringes on the dropped vessels, and the blood flow in them is disturbed. Similar changes are accompanied by pain in the hemorrhoid.
Due to the infringement of the vessel, the blood loses the ability to circulate and thickens. This leads to the formation of a clot - a blood clot. The main causes of this complication include constipation and excessive physical exertion in people suffering from chronic hemorrhoids. As you know, thrombosis is one of the main causes of death. Despite the fact that the clot formed in the vein of the anus, it can circulate with a blood stream and end up in vital vessels, namely in the pulmonary artery. In addition, such a complication is dangerous tissue necrosis and the development of sepsis. To prevent this, a thrombectomy of the hemorrhoid is required. This is a surgical procedure owned by proctologists.
Indications for thrombectomy
In the initial stages of thrombosis, therapeutic treatment is prescribed. It consists in the use of anti-inflammatory ointments and suppositories. These medications help reduce swelling and pain. Additionally, medications that thin the blood are prescribed. If, after the measures taken, the thrombus does not resolve, surgery is required. In addition to the lack of effect from conservative therapy, the following indications for surgical intervention are distinguished:
- Pain syndrome that is not amenable to medical treatment.
- Symptoms of acute hemorrhoids combined with signs of thrombosis.
- Contraindication to drug therapy (lactation, pregnancy).
- Signs of necrosis of a restrained node.
- The patient's desire to eliminate the ailment in an operative way.
Based on this, a hemorrhoidal thrombectomy is not always an emergency operation, but can also be performed as planned (if there is no risk of complications in the near future). This manipulation is performed both in the surgical departments of regional and city hospitals, and in specialized proctological clinics.
Contraindications to surgical treatment
Removing a blood clot from a hemorrhoid is not considered a complex operation for an experienced surgeon. This manipulation does not require intravenous anesthesia, so there are few contraindications to it. Thrombectomy of a hemorrhoid during pregnancy and lactation is carried out only if there is an urgent need for surgery. Such physiological conditions do not belong to contraindications.
Surgical treatment can not be performed in cases where there is a risk of spread of infection throughout the body. Therefore, the following diseases are referred to contraindications:
- Inflammation of the rectum (proctitis) and surrounding fiber.
- Infectious lesion of the perianal region.
- Systemic blood poisoning - sepsis.
In addition to acute inflammatory processes, a contraindication is the extremely difficult general condition of the patient.
Types of Surgical Interventions
Hemorrhoidal nodes complicated by thrombosis can be removed in several ways. The choice of surgical method depends on what equipment is available in the clinic, the severity of the patient's condition and the presence of contraindications. External hemorrhoidal nodes are removed in the following ways:
- Surgical treatment according to Milligan-Morgan.
- Laser photocoagulation.
- Radio wave treatment.
Such surgical procedures are performed for severe hemorrhoids, when complete removal of the node is required. If the vessels can be preserved, only the clot is removed from the vein. Thrombectomy of the internal hemorrhoid is more difficult, since surgical access in such cases is limited. For this reason, it is easier for the doctor to completely remove the damaged vessels using Milligan-Morgan surgery.
Thrombectomy Preparation
Thrombectomy of hemorrhoidal vessels is a simple operation and takes about 10-15 minutes. This treatment method does not require general anesthesia. In some cases, this manipulation is performed in a outpatient setting with a treatment room and surgical equipment. Despite this, standard tests are required before thrombectomy. These include: a study on HIV and hepatitis, microreaction, OAA, OAM, determination of glucose in the blood. Also, patients must undergo fluorography and ECG before surgery.
2-3 days before thrombectomy, the patient should refuse food that causes gas formation. It is recommended to drink kefir, give preference to baked vegetables and soups. Dinner on the eve of the procedure should be easy. A few hours before the operation, the lower intestines are cleaned. For this purpose, 2 enemas are made with an interval of 40-60 minutes.
Thrombectomy Technique
To provide access to the thrombosed site, the patient should take the correct position: it is necessary to lie on the right side with legs bent and pressed to the stomach. The surgeon isolates the damaged vessels and chips them with an anesthetic solution. After processing the node, an incision is made in the thrombus projection. If the blood flow in the vein is not disturbed, the clot leaves on its own. Sometimes, a surgical clamp is required to remove it. After clearing the clot, several sutures are applied to the vessel.
Immediately after the procedure, the patient's condition improves. Within a few hours, the symptoms of thrombosis are completely stopped. Within 4-5 days, you need to change the sterile dressings on the wound. The incision site heals quickly, and the patient can lead a familiar lifestyle.
Benefits of Laser Surgery
An alternative to the surgical method is laser thrombectomy of the external hemorrhoid. A similar method is similar to an operation. The difference is that instead of a scalpel, a laser beam is used to incise the vessel. However, removal of a thrombus from a vein by this method is rarely performed. In most cases, laser treatment is aimed at excising the hemorrhoid. The advantages of this method are the speed of the operation and the absence of bleeding, which is accompanied by a traditional incision. The laser allows you to simultaneously coagulate blood vessels, thereby sclerosing them.
Treatment is performed on an outpatient basis. It takes no more than half an hour, after which the patient can go home. After laser removal of the external hemorrhoid, it is not necessary to suture and perform dressings.
Possible complications of thrombectomy
One of the minimally invasive surgical treatments is thrombectomy of the hemorrhoid. Complications after this manipulation are extremely rare. Often, surgery and healing are quick and painless. Possible complications include:
- Pain syndrome.
- Bleeding.
- Wound surface infection.
With severe discomfort in the anus, suppositories and ointments with an analgesic effect are prescribed. They help eliminate swelling and pain. After 5-7 days, the need for medication disappears. Infection or bleeding occurs when hygiene is not observed in the postoperative period. To prevent these complications, wash the area of the anus with warm water after each bowel movement. Also, constipation should not be allowed.
Recovery period
A return to the usual lifestyle after thrombectomy is possible after 1 week. Special rehabilitation is not required. Painful symptoms disappear immediately after a thrombectomy of the hemorrhoid. Recovery is quick, the patient feels relief already during the operation. When examining the anus after 3 hours, signs of thrombosis are already completely absent.
It should be remembered that such surgical intervention does not relieve the patient of the underlying disease - hemorrhoids. Therefore, to prevent exacerbation and repeated thrombosis, diet and hygiene are essential.
Reviews
Thrombectomy of the hemorrhoid is a necessary procedure. If this measure is not followed, severe complications develop with a possible fatal outcome. According to doctors, a hemorrhoidal thrombectomy is an important operation that every surgeon must be able to perform. Only in this way can tissue necrosis and infection be avoided. However, thrombectomy will not help eliminate hemorrhoids, which cause not only thickening of blood in damaged vessels, but also other complications. Therefore, doctors recommend first of all to treat the underlying disease, as well as to engage in its prevention.
As for patients, they respond positively to this procedure, since it can significantly alleviate the pathological condition and get rid of the acute manifestation of symptoms.
Which clinics perform thrombectomy?
Currently, thrombectomy of a hemorrhoid in Moscow is carried out in many clinics. The operation is performed both in public hospitals and private medical institutions (the laser surgery center ATLANTiK, the multidisciplinary medical center DeltaKlinik, the medical center Zdorovaya Stolitsa and others). In an emergency, surgical treatment is free. If the patient wants to perform an operation in a private clinic or at his own request (in the absence of strict indications), the cost of manipulation ranges from 1.5 to 8 thousand rubles.