Brisanje vanjske hemoroide - kirurgije tehnike

Hemorrhoids - a disease of the rectum, developing due to the expansion of veins.The result of the expansion of the veins is the accumulation of blood in the tissues of the rectum and the formation of hemorrhoids.Before it grows into a chronic form of the current, the hemorrhoids "pass" 4 stages of progression.And if in the initial stages of treatment the therapeutic is used, and it is successful, then the last stages of the disease involve surgical intervention.

Operations to remove nodes of external hemorrhoids are carried out only if the previous conservative treatment has not yielded positive results.And one more nuance - surgical intervention is indicated in diagnosing thrombosis of hemorrhoids.Indications for the operation can also serve as dropping, bleeding hemorrhoidal nodes.

Operations are performed during the remission period( outside exacerbations), but may be contraindicated with pronounced inflammatory processes in the rectum.If earlier removal of the nodes of external hemorrhoids meant a long rehabilitation period, and the operation itself was painful enough, modern methods of surgical treatment allow such operations to be carried out quickly, safely and painlessly.

Table of contents: Medical indications for surgery Contraindications for surgery Types of operations for external hemorrhoids

Medical indications for operation

Doctors, of course, avoid surgical intervention as much as possible and first conduct therapeutic treatment of external hemorrhoids( link to article MedicinalPreparations from external hemorrhoids) .I must say that in most cases( if the patient has turned in time for help to a proctologist and accurately fulfills all his purposes), surgical intervention can be avoided, but there are clear medical indications for the operation.

First, an urgent operation is indicated to those people who have rectal prolapse and bleeding.Moreover, immediate surgical intervention is shown only at a young age!A timely operation will prevent the development of heavy bleeding and anemia.

Secondly, if the hemorrhoids are diagnosed in a middle-aged person, then before conducting an operation, the doctors will conduct a full examination of the body.Most often, such patients are first assigned to invasive procedures, which often helps prevent rectal prolapse and bleeding.

Third, surgical intervention for external hemorrhoids in the elderly is carried out only in exceptional cases.Even the prolapse of the rectum can be treated with pills, ointments and suppositories, it is often in the old age to stop the progression of external hemorrhoids with the help of folk remedies.

Contraindications to the operation

The operation to remove hemorrhoids implies the use of anesthesia, so there are clear contraindications to the type of external hemorrhoid treatment under consideration:

• , the presence of severe concomitant pathologies of a general nature;
• heart failure;
• oncological diseases of different localization and severity;
• diabetes mellitus( due to poor wound healing);
• abnormalities of the intestine, which are associated with the formation of ulcers or acute inflammatory processes;
• immunodeficiency states.

Note: pregnancy also refers to contraindications in this case, but is conditional.The fact is that the removal of the nodes of the external hemorrhoids during the period of gestation is usually accompanied by relapses, but during the birth the hemorrhoids may simply disappear.

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Types of operations for external hemorrhoids

Surgical treatment of external hemorrhoids is carried out in 50% of cases of treatment of patients to the doctor, because they do it already at the last stages of the disease development.Modern surgery can offer various types of surgical treatment of the disease under consideration: minimally invasive, classical surgery and removal of hemorrhoids by laser.

Minimally invasive methods

The feature of minimally invasive methods is that the surgeon does not use a scalpel during the operation.Instead, punctures are made in the internal tissues, through which the necessary manipulations are carried out.The main advantage of this method of treatment of external hemorrhoids is the absence of contraindications and a small rehabilitation period.Such minimally invasive methods for treatment of external hemorrhoids include:

Sclerotherapy

It is used to treat the 1-3 stages of external hemorrhoids and to stop bleeding.Implies the introduction of hemorrhoidal nodes of specific sclerosing drugs that cause the transformation of blood vessels into connective tissue.Bleeding stops quickly, with time, the hemorrhoidal node can significantly diminish in size.

Infrared coagulation

For this treatment doctors use a special device - a photocoagulator.With the help of an anoscope, the surgeon brings the light guide tip of the apparatus directly to the "legs" of the nodes of the external hemorrhoids.The heat flux that passes through the light guide acts on the principle of laser beams.It is worth knowing that using infrared coagulation to remove the hemorrhoidal node is impossible, this minimally invasive method of treatment of the disease in question is most often used to stop bleeding.

Latex ring ligation

The essence of this operation is to put on the external nodes of hemorrhoids special latex rings.During the procedure, the surgeon will use a mechanical and / or vacuum ligator.The hem of the hemorrhoids disappears with the ring put on, and the stump of the connective tissue remains on the site of rejection.In this way, 90% of patients get rid of external hemorrhoids, especially since waiting for the completion of the procedure( when the node falls off) needs only 2 weeks.

Cryotherapy

During this minimally invasive procedure, the hemorrhoids are frozen with liquid nitrogen.After thawing, the node dies off, and the formed wound is treated with special, wound-healing preparations.The entire procedure for freezing hemorrhoids lasts a maximum of 4 minutes.

Classical surgical methods

In some cases, the removal of external hemorrhoids involves the patient in the hospital, careful preparation for surgery and the use of general anesthesia. Surgical removal of hemorrhoids is also carried out by several methods:

• is the usual operation to remove nodes;
• removal of drop-down nodes by radio waves;
• hemorrhoidectomy;
• desarterization.

All of the above methods of surgical removal of external hemorrhoids have some advantages:

• relapses are extremely rare;
• after the operation there are no open wounds;
• cases of infection and extensive bleeding are rare;
• rehabilitation period reduced to 4-5 days.

Removal of hemorrhoids by laser

The main advantage of this method of surgical treatment of external hemorrhoids is the absence of painful sensations.During the procedure, the patient generally does not feel any discomfort and pain, which allows you to give up the prescription of pain medications.In addition, only after removal of hemorrhoids with a laser, the patient is immediately allowed to walk.It should be noted one more positive point - during the removal of nodes of external hemorrhoids by laser, the risk of traumatization of the anus and surrounding tissues is minimized.

Removal of hemorrhoids with a laser is performed both at the initial stage of the disease, and with visible progression of the pathology.The external nodes are simply cut off by the laser beam, and the resulting wounds immediately "solder", which implies a complete absence of bleeding.

Advantages of removal of hemorrhoidal nodes( external) by laser

To understand why doctors prefer to remove external hemorrhoids with laser, you need to familiarize yourself with the advantages of this method of treatment:

1. Removal of external hemorrhoids passes absolutely painlessly - the patient feels only heat waves.If the pain threshold for a person is low, the operation can be performed under local anesthesia.
2. The procedure for removal of external hemorrhoids is performed on an outpatient basis, its duration is 10-15 minutes.
3. There is no need for any specific preparation before the operation.
4. Immediately after removing the nodes with a laser, the patient can go home, and the next day - return to the usual way of life, including work.
5. Since the laser immediately cauterizes the wound, the risk of bleeding is almost completely absent.
6. External laser hemorrhoids can be removed by laser with acute inflammatory processes, diagnosed fistula and fissures of the anal opening.

It is worth knowing about some disadvantages of this method of removing hemorrhoids.First, too large nodes are not completely removed by the laser beam, so relapse of the disease may occur.Secondly, this procedure is quite expensive.

Possible complications after surgical treatment

The most unpleasant consequence of surgical treatment of external hemorrhoids is a relapse of the disease.Agree, the emergence of new nodes, and the need for a repeat operation is unlikely to please anyone. But besides this, there are a number of complications / adverse effects that accompany the surgical treatment of external hemorrhoids:

1. Severe pain.Due to the presence in the anorectal area of ​​a variety of nerve fibers.It is possible to get rid of pain only by anesthetics( appoints the attending physician).
2. Psychological barrier.Occurs if the patient during the operation, or visiting the toilet, experienced severe pain.He will restrain the urge to go to the toilet, which only aggravates the situation.Cope with this phenomenon can be through the appointment of laxatives.
3. Urine retention.This unpleasant syndrome lasts no more than 24 hours after an operation to remove external hemorrhoids.If necessary, the doctor will conduct a catheterization of the bladder.
4. The bleeding that has opened.The cause of this can be either an improperly incinerated vessel or an injury to the rectal mucosa.The patient is assigned a hemostatic sponge, or a suturing of the vessel is performed.

Surgical treatment of external hemorrhoids is a necessity often encountered by both physicians and patients.To be afraid of operations concerning an external hemorrhoids it is not necessary - the modern medicine conducts them quickly, practically painlessly and with the minimal risk of development of complications.But in time removed external hemorrhoids will avoid serious consequences of the progression of this disease.

Tsygankova Yana Aleksandrovna, medical reviewer, therapeutist of the highest qualification category