How hemorrhoids are treated with proctological Surgery

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The  hemorrhoidal disease is a very common condition. More than one in two adults is affected at least once in their life by symptoms related to hemorrhoids (bleeding, pain, anal lump or itching). When the symptoms are debilitating or the hemorrhoidal attacks are repeated, surgical treatment can be offered.

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How hemorrhoids are treated with proctological Surgery

WHAT ARE HEMORRHOIDS ?

The Hemorrhoids are veins, usually 3 in number, forming pads in the anal canal. These venous pads are supplied by small arteries, and are dilated in case of bad venous return, it is hemorrhoidal disease. These pads have a role in fine anal continence: at rest, they complete the closure of the rectum; during defecation, these pads are flattened and erase to allow passage of stool.

Hemorrhoids are therefore normal anatomical structures. They only cause symptoms in case of dilation and significant enlargement, that’s when we talk about hemorrhoidal disease .

We differentiate the internal hemorrhoids located inside the anal canal which are rather responsible for bleeding and the external hemorrhoids , visible on the level of the anus, responsible for pains and oozing.

Favoring factors of hemorrhoids

Apart from heredity, there are multiple causes of enlarged hemorrhoids  : excessive pushing efforts during defecation (especially in constipation), lifestyle (sedentary, spicy food, alcohol), pregnancy and childbirth and finally the relaxation of tissues linked to age.

Symptoms of hemorrhoids

The three most common symptoms are bleeding (or rectal bleeding), the existence of a lump (or prolapse) in the anus and pain.

  • The rectal bleeding are bleeding red blood, usually small accompanying stool (end of defecation splash). Sometimes the bleeding is minimal (blood stains on the toilet paper). When this blood loss is large and repeated, it can be responsible for anemia. The presence of rectal bleeding can sometimes justify an additional colonoscopy, so as not to overlook another cause of digestive bleeding.
  • HEMORROID PROLAPSUS . In hemorrhoidal disease, the hemorrhoidal pads slide down toward the anus. We talk about hemorrhoidal prolapse. This prolapse can be classified into 4 grades:
    • Grade I: Hemorrhoids protrude into the anal canal in pushing but without externalizing.
    • Grade II: Hemorrhoids prolapse on exertion but spontaneously enter the anal canal
    • Grade III: The pads come out on exertion and must be manually reintegrated into the anal canal.
    • Grade IV: Permanent hemorrhoidal prolapse.
  • PAIN:  The enlarged hemorrhoids are responsible for a type of anal pain gravity. Sometimes this pain is intense, especially in case of hemorrhoidal thrombosis corresponding to a venous clot located at the level of the anal canal or in case of hemorrhoidal attack, i.e. bulky inflammatory and painful grade IV hemorrhoid.
  • Sometimes be responsible for disabling itching (pruritus). This symptom occurs in cases of hemorrhoidal anitis (inflammation of the mucosa covering the hemorrhoidal pad.
  • MARISQUES  are excess skin on the anal margin that persists after a hemorrhoidal attack. This excess skin can disappear in a few weeks after the attack, or persist. Marisques can cause a certain degree of discomfort, especially for intimate hygiene.

See more:What are hemorrhoids with blood clots

THE DIFFERENT SURGICAL METHODS

They are usually performed under general or locoregional anesthesia by epidural.

How hemorrhoids are treated with Hemorrhoids removal or Milligan Morgan intervention

Principle

It consists in performing surgical excision of the hemorrhoidal packages , generally 3 in number, from the external hemorrhoids located at the level of the skin of the anus to the internal hemorrhoid as well as its internal extension at the level of the anal canal. The wounds after hemorrhoidectomy are not closed and generally leave 3 clover-shaped scars at the level of the anus. It is left in place on both sides of the hemorrhoidal excesses of the “bridge”, skin and mucous membrane areas in order to promote subsequent healing.

Advantages disadvantages

It is the most radical treatment, with almost no risk of recurrence. Postoperative complications are rare. On the other hand, wounds in the anus are sensitive and responsible for pain, constipation, and oozing, causing convalescence between 4 and 6 weeks.

How hemorrhoids are treated with HAL-RAR or Hemorrhoidal Artery Ligation using Doppler, associated with mucopexy

Principle

Thanks to an anoscope, positioned at the level of the lower rectum, equipped with a doppler , the arteries of hemorrhoidal origin are identified at the level of the lower part of the rectum. The detected arteries are thus ligated in order to reduce the blood flow to the hemorrhoids. It is thus made between 6 and 10 knots at the level of the lower rectum in order to reduce the pressure at the level of the hemorrhoidal vessels. This mucopexy is often associated with this technique , which consists in suturing the hemorrhoidal bundle which tends to prolapse (out of the anus), at the level of the lower rectum. This gesture prevents recurrence of the prolapse.

Advantages disadvantages

It is an effective treatment, especially on bleeding, and less painful than hemorrhoidectomy. The recidivism rate is around 5%. In the event of recurrence it is always possible to intervene again with the same technique or another. This technique cannot always be offered, especially in cases of advanced hemorrhoidal prolapse on several packs.

How hemorrhoids are treated with radiofrequency 

Principle 

Thanks to an anoscope located at the level of the lower rectum, a radiofrequency probe is positioned in the base of the hemorrhoids. The energy delivered will cause blood to clot in the healthy hemorrhoid and destroy the venous wall. In a few weeks the hemorrhoid atrophies and is replaced by a scar (fibrous remainder).

Advantages disadvantages

It is the fastest and least painful surgical treatment. The recidivism rate is 5 to 10%. During the healing phase, there is frequent bleeding, usually mild.

HOW IS THE INTERVENTION? 

Your intervention and the conditions of hospitalization  Ch

The intervention is carried out under general anesthesia, most often. The duration is approximately 20 minutes for radiofrequency treatment, and 30 minutes for other interventions. At the end of the intervention, the surgeon performs additional local anesthesia to reduce pain in the hours after waking up. Whatever the technique envisaged, the intervention can be carried out within the framework of an outpatient hospitalization, that is to say on a hospitalization lasting only one day. For this, certain conditions are absolutely essential and must be discussed with the surgeon and the anesthesiologist before hospitalization.

The day before the intervention

No special preparation is required. Depilation and digestive preparation (purging) previously performed are no longer necessary today.

The day of the intervention 

The patient takes a shower with soap or conventional shower gel before coming to the clinic. A small rectal enema is performed at home, the prescription for this enema being given to the preoperative consultation.

The hours following the operation 

The purpose of this phase is to monitor the absence of complications for a return to a normal state. The first phase takes place in the recovery room: when the intervention is finished, you are transferred to the recovery room for approximately 2 hours. Your state of consciousness, your pulse, your oxygen saturation, your breathing will be monitored. Then you will be taken to a room in the outpatient hospital department, where you will be up and served a snack. If there is no anomaly during monitoring, you will be allowed to return to your home, if you are accompanied.

During the convalescence phase 

This phase is more or less long depending on the type of intervention. The prescribed treatments must be taken systematically the first week to limit the unpleasant symptoms. In case of problems, you can reach the digestive surgery office during the week from 8 a.m. to 7 p.m. and on Saturday morning from 8 a.m. to 12 p.m. Outside of these hours, if you feel that you cannot wait until the secretariat opens, you can contact the emergency services of the Clinique de la Garde.

RISKS AND COMPLICATIONS OF HEMORRHOIDAL SURGERY 

Postoperative pain is a mandatory effect of proctologic surgery, but is well managed by prescribed painkillers. Several treatments are available on the prescription to treat different aspects of pain. In case of incomplete effectiveness, a stronger pain-relieving treatment may be offered to you.

Bleeding is usually minor, but can last up to a month. Heavy bleeding is rare, but can sometimes require reoperation. This risk is increased when taking anticoagulant or antiaggregant drugs.

The oozing is generally unimportant and is linked to the presence of scars not covered by bandages. Adequate hygiene is necessary: ​​a shower with soap a day, rinsing with the hand shower at least once a day, and after each bowel movement.

Constipation is a reflex to pain. Laxative therapy is routinely prescribed to prevent this.

Stenosis (narrowing) of the anus is an exceptional complication of hemorrhoidectomy. It can occur in the event of repeated surgery, or in the presence of bulky hemorrhoidal prolapse of the three packages.

Recurrence of hemorrhoidal disease is rare: 1 to 10% depending on the intervention performed. In case of doubt about a recurrence, only a proctological examination can confirm the diagnosis. A new treatment, medical or surgical, can be proposed.  

In some cases, home treatments will not be enough. You will then need to call a specialist. It is best to consult your doctor who, knowing your clinical history, can provide you with a complete list of treatments that may help you. If you want to avoid taking conventional medicines, your doctor may suggest herbal medicines that will have fewer side effects and can help you.

Generally, with natural remedies or drugs, thrombosis will subside and you will find good health. However, in some cases, surgery remains the only option if the crisis is severe. Procedures such as sclerotherapy, hemorrhoidectomy or ligation are some possible suggestions. In general, this type of intervention will mean having to stay in the hospital and make several follow-up visits, before getting a full recovery.

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