Hemorrhoidectomy - what is it? Look for the answer here!

In the early stages, hemorrhoids can be successfully treated with conservative methods, but in some cases the disease continues to progress even with the use of medications. If the manifestations of pathology persist, patients undergo a surgical intervention called hemorrhoidectomy, which allows you to get rid of nodes and other symptoms once and for all. In what cases is surgical treatment of the disease recommended, and what do patients need to know about the preparation and postoperative period?

Hemorrhoidectomy - what is it?

Hemorrhoids are one of the most common diseases among adults, manifested by constipation, pain and the appearance of hemorrhoids. These are neoplasms located in the area of ​​the rectal opening and rectum, which forms from the affected vessels. With hemorrhoids in the vascular walls, blood circulation is disturbed, they lose elasticity and tone, begin to increase in size and protrude. The appearance of nodes and bumps indicates that the disease has passed into the last stages, at which conservative treatments, as a rule, are able to eliminate only the symptoms of the disease.

Hemorrhoidectomy involves the removal or resection of hemorrhoidal cones, which can significantly improve the patient's condition and quality of life. In proctology, the operation ranks first in terms of frequency among all surgical interventions, but it is carried out exclusively if there are appropriate indications.

For reference: hemorrhoidectomy is performed in the traditional way, therefore, many clinics offer minimally invasive surgical methods that have a minimum number of complications.

Advantages and disadvantages

Like any other treatment, hemorrhoidectomy has pros and cons that should be considered when prescribing an operation. The main advantage is the high efficiency of treatment compared to conservative methods. With proper implementation and sufficient qualifications of the doctor, it allows you to completely relieve the patient of unpleasant sensations, hemorrhoids and other manifestations of the disease.

If we talk about the shortcomings, then these include a fairly long rehabilitation period, during which a person may feel discomfort and pain, as well as a considerable cost of the procedure. Despite this, for most patients, hemorrhoidectomy is the only chance to get rid of the painful manifestations of hemorrhoids.

Indications and contraindications

Many patients believe that the removal of nodes is the easiest way to get rid of the manifestations of the disease, but surgical treatment is carried out only if there are strict indications. These include:

• hemorrhoids of the 3-4th stage, accompanied by the formation of large nodes;
• hemorrhoidal veins fall out with every trip to the toilet or with physical exertion;
• lack of effect from conservative treatment;
• anemia that develops due to frequent bleeding;
• infected cracks, erosion;
• a significant decrease in working capacity due to manifestations of pathology.

In addition, when prescribing an operation, one should take into account the frequency of exacerbation of hemorrhoids, the general condition and age of the patient - most often surgical intervention is used at a young and middle age, much less often in the elderly (subject to a normal general condition organism).

Contraindications to hemorrhoid eetomy include pathologies of the large intestine, cancerous neoplasms, severe dysfunction of internal organs, acute infections, hematopoietic disorders and hemostasis. The operation is also not performed during the period of gestation and breastfeeding.

Attention: many contraindications for performing hemorrhoidectomy are relative - the operation can be performed after childbirth or treatment of acute diseases.

Varieties of hemorrhoidectomy

There are two main ways to perform hemorrhoidectomy surgery, and the doctor chooses a specific option based on the clinical course of the disease and the general condition of the patient's body.

Table. Varieties of surgical intervention.

A kind of surgical intervention	Features of the	Recovery period
Open hemorrhoidectomy	During the operation, the surgeon expands the rectal canal and rectum, clamps the nodes with special devices, ligates the vessels going to them and excises the affected veins. The wounds that remain after the intervention are not sutured	7-20 days
Closed hemorrhoidectomy	The technique of the operation is similar to that used for open hemorrhoidectomy, but sutures are applied to the operating incisions	7-14 days

Each of the methods of performing the operation has its own disadvantages and advantages: in the absence of stitches, the patient experiences less pain, but the wounds heal for a long time. If the operation is performed in a closed way, the rehabilitation period is shortened, but in the postoperative period, serious discomfort is possible.

In addition to open and closed hemorrhoidectomy, in recent years, surgeons have been practicing an operation called resection of the intestinal mucosa. It is low-traumatic, does not require general anesthesia and is performed in 15-20 minutes, but is not suitable for removing external hemorrhoids.

Preparing for the procedure

Hemorrhoidectomy is not an abdominal operation, but requires proper preparation for the procedure. Before conducting it, the patient will have to undergo a series of examinations:

• clinical analyzes of blood and urine;
• research for serious infections (HIV, hepatitis, syphilis);
• blood clotting test;
• examination and palpation of the rectum, anoscopy, rectromanoscopy;
• Ultrasound of the pelvic organs according to indications.

In addition to medical research, preparation includes a special diet - 7-10 days before the operation, it is necessary follow a diet that excludes the use of foods that contribute to gas formation and the formation of excess feces masses. Foods that need to be discarded include legumes, rice, black bread, cabbage, baked goods, and carbonated drinks. Preference should be given to first courses cooked in light broth, lean fish and meat, fermented milk products, wheat bread. In addition, it is recommended to consume at least 1.5-2 liters of water per day. If a person is taking hormonal or blood thinning medications, they should be stopped a few days before surgery.

On the eve of the operation, you need to starve a little (the last meal should be no later than 12 hours), take a bath or shower, and put on clean linen. On the evening before, you should do a cleansing enema or use drugs like Fortrans or Microlax.

Important: it is not recommended to use most laxatives to cleanse the intestines, as they cause increased gas formation.

How is the operation performed?

Carrying out hemorrhoidectomy requires hospitalization of the patient for a period of several days to two weeks. The procedure is performed under local, epidural (anesthesia is introduced into the epidural space of the spine) or general anesthesia. The patient is placed on his back or stomach with bent legs, after which the surgeon performs the necessary manipulations. At the end of the resection, the incisions are sutured or left open, after which a tampon is inserted into the anus, soaked with Levomekol or Levosan ointment, as well as a gas outlet tube that prevents accumulation gases. Depending on the concomitant pathologies, the patient may undergo additional procedures - for example, a sphincterotomy to relieve muscle spasm and create a favorable environment for healing fabrics.

Food can be taken the next day after the operation - nutrition should be started with light broths with crackers, and then switch to semi-liquid dishes, boiled vegetables and cereals, steamed meat and fish, baked fruits. If the healing process proceeds normally, the stitches are removed after a few days, the doctor examines the rectum and, in the absence of complications, the patient is discharged home. A follow-up examination is carried out after one, and then three weeks later.

Attention: The most difficult operation to remove hemorrhoids takes place in elderly people with concomitant diseases - in other cases, the procedure does not cause complications.

How to behave during the rehabilitation period?

It takes an average of 5-6 weeks to fully restore bowel function after removing hemorrhoids. The period after hemorrhoidectomy can be quite painful for the patient, and in order to improve the condition and accelerate the healing process, a number of rules and recommendations must be followed.

1. To reduce pain, you can lubricate the places using creams and ointments containing local analgesics, as well as local remedies with a regenerating effect. In addition to painkillers, in the postoperative period, patients are prescribed anti-inflammatory and antimicrobial agents that prevent infection of wounds and the development of inflammatory processes.
   

   Wounds after hemorrhoidectomy

2. To eliminate swelling, you can take sitz baths with herbal infusions (chamomile, calendula, burdock root, etc.), and the water should be warm, not hot.
3. To improve blood circulation at the site of surgery and cleanse the body of toxins, you should drink as much non-carbonated mineral water or weak tea as possible.
4. During a certain period, the patient may experience constipation - laxatives like "Dufalaka", but they should be taken only after consulting a doctor, otherwise the condition can significantly will get worse.
   

   "Dufalak"

5. In the postoperative period, it is important to avoid heavy exertion and strong straining during bowel movements, but physiotherapy exercises and walks in the fresh air are useful for restoring the body.
6. In the first week after hemorrhoidectomy, bloody discharge from the rectum is possible, so the patient needs strictly observe the rules of personal hygiene and often change linen, and first it must be ironed hot iron.

The diet after surgery should consist of light, but enough high-calorie meals - you need to eat in small portions, be sure to use fermented milk products, boiled and steamed vegetables, lean meat.

Important: within 7-10 days, there may be an abundant sacral discharge - they are normal and do not require medical intervention.

Possible complications

Sometimes hemorrhoidectomy can cause postoperative complications, which include:

• bleeding due to divergence of sutures or injury to healing tissues by feces;
• insufficiency of the sphincter muscles, as a rule, becomes the result of insufficient qualifications of the surgeon;
• infection of incisions, the appearance of fistulas and cracks;
• a decrease in the lumen of the rectal opening, deformation of the anal canal by scar tissue;
• prolapse of the rectum;
• retention of urine (observed mainly in men).

Surgical intervention does not provide a 100% guarantee of absolute recovery, and relapses of the disease are observed in a small number of patients.

Attention: if bleeding or other serious complications develop after surgery, you should consult a doctor as soon as possible - some complications require immediate medical attention.

Is it possible to do without surgery?

If the effect of conservative treatment is absent for a long time, and hemorrhoids significantly reduce the quality the patient's life, surgical intervention is necessary - in this case, the benefits of the operation outweigh the possible risk complications. In addition to the traditional method, minimally invasive techniques can be used to remove hemorrhoids, which include:

• laser therapy;
• radio wave operation;
• ligation with latex rings;
• sclerotherapy;
• thrombectomy;
• electrocoagulation;
• cryodestruction;
• sclerotherapy;
• dearterization.

The above methods of surgical treatment practically do not cause complications and painful sensations, but each of they have their own indications, contraindications and features, therefore, the decision on the choice of a particular operation must be made doctor.

Hemorrhoids are common and often painful and can cause serious complications. To avoid unpleasant consequences, if you have one, you should not refuse the operation if there are appropriate indications - in some cases it is the only chance for a full life.

Video - Hemorrhoidectomy