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Open Surgery with Hemorrhoids

Open Surgery with Hemorrhoids

Hemorrhoids is not a vein enlargement, varicose disease as we used to know. They are vascular cushions consisting of muscle, veins and connective tissue in three different parts of the anal canal (right upper, lower right and middle left). So it is a connective tissue disease. Hemorrhoidal diseases are of three types.

1.External hemorrhoids (Located in the first 2 cm from the anus and visible externally)

2. Internal hemorrhoids (located 2 cm above the anus)
3. Mixed hemorrhoids (Conditions where both Internal and External  hemorrhoids are together.)

For various reasons, these pads grow, hang out of the anus, diarrhea, chronic constipation, inactivity, sedentary life, obesity and childbirth are the reasons that increase hemorrhoid disease.

What Are the Symptoms of Hemorrhoids?

Bleeding; It usually happens after using a bright red toilet and increases with straining.

Pain; Other symptoms are hemorrhoidal breasts protruding beyond the anus, itching in the anus area.

External hemorrhoids often do not require treatment. Rarely, if thrombosis (blood filling) occurs, surgery is performed.

Internal hemorrhoids are the diseases that cause the most complaints and some of them require surgery. It is analyzed in 4 degrees.

1st degree internal homorids; Sometimes it causes pain and bleeding and most of the time it does not require surgery.

grade internal hemorrhoids; After defecation, it bleeds out of the anus with straining and goes back into it on its own. If bleeding is excessive, surgery is required.

3rd degree internal hemorrhoids; After straining, it comes out of the anus, hangs from the anus, the patient pushes it in with his hand, its treatment is surgical.

Grade 4 internal hemorrhoids; It is the last stage, the internal hemorrhoids that protrude from the anus do not go in with a manual push, and the treatment is surgery.

and Grade 4 internal hemorrhoids; must be operated on. It does not go away with medical treatment.

Diagnostic Methods:

Visual and manual inspection is done. Rectoscopy is required for the diagnosis of internal hemorrhoids. In medical treatment, it is recommended that the patient consumes plenty of fluids, consumes plenty of vegetables, eats pulpy foods, loses weight, prevents constipation, does not sit on the toilet for a long time, and sits in hot water. In addition, various pomades and suppositories can be used as drug therapy.

Hemorrhoids Treatment

  1. With the help of sclerotherapy rectoscope, vasoconstrictor and astringent drugs can be injected into the base of the hemorrhoidal pouches, it is not a commonly used method.
  2. Rubber band libation (Rubberband) is based on strangling the internal hemorrhoidal pouch with the help of a tool. The suffocated hemorrhoid pack falls off spontaneously within 5-6 days, it is usually applied in 1st or 2nd degree internal hemorrhoids that bleed. The patient returns to work on the same day, does not require anesthesia, usually results are good.
  3. Infrared coagulator application; It does not require anesthesia, it is effective in 1st and 2nd degree bleeding hemorrhoids. It is easy to apply. The patient can return to work on the same day.

Which Methods Are Used in Surgical Treatment?

  1. Under closed technique (Ferguson) anesthesia, the hemorrhoidal pouches are surgically removed. Hemorrhoid beds are closed by suturing.
  2. With open technique (Milligan morgan) general anesthesia, the hemorrhoidal pouches are removed and the hemorrhoidal beds are left open.
  3. Stapler hemorrhoidopexy (Longo method) is based on the principle of removing the entire intestinal mucosa with a width of 3 cm all around, 5-6 cm above the anus, with a special tool called a circular stapler, and suturing it again with the help of this instrument. In this method, hemorrhoidal pouches are not removed, since this procedure is performed 3 cm above the hemorrhoidal pouches, the postoperative period is very painful. 1 day after the operation, the patient can take normal food. There is no need for applications such as additional dressing, sitting in water. The recurrence rate is extremely low. This is the modern surgical method used today. At the end of this surgery, the patient’s internal hemorrhoidal pouches shrink, become inactive and do not harm the patient. Since the intestine is shortened by 3 cm, it is not seen in prolapse from the anus.
  4. Laser therapy; This method can be applied in 2nd and 3rd degree internal hemorrhoids disease. It can be done with general or local anesthesia. The patient returns to work on the same day, does not require additional dressing treatment. In this method, a laser probe is inserted into the hemorrhoidal pouch, several firings are made, and the hemorrhoidal pouch shrinks and shrinks. In this procedure, the hemorrhoid pack is not removed. It is a very less painful procedure. After the procedure, the patient can be discharged on the same day and continue to work.