For a long time, hemorrhoids were considered a disease of the ordinary veins of the rectum – their varicose veins, however, this could not explain the arterial bleeding that occurs in most patients with hemorrhoids. Morphological studies have shown that hemorrhoids consist mainly of cavernous tissue with a large number of arteriovenous anastomoses.
Under unfavorable conditions or pathological conditions (constipation, a sedentary lifestyle, pregnancy, straining during childbirth, etc.), microcirculation is disturbed in the cavernous structures of the rectum (the number of arterial anastomoses increases, the lumen of anastomoses expands, and the caliber of the discharge veins narrows), which leads to the formation of hemorrhoids. At the same time, in most cases, three main internal hemorrhoids are formed from three embryonically laid cavernous bodies – on the left lateral, right anterolateral, and right posterolateral walls of the anal canal.
Asymptomatic hemorrhoids occur in 10 – 12% of practically healthy people who do not complain of intestinal discomfort. During examination (rectoscopy, colonoscopy) on the walls of the anal canal, at typical points, vascular formations of a delicate purple color are determined. Asymptomatic hemorrhoids do not require treatment, but their timely detection is important, since in this case preventive measures, such as changing the work schedule, physical activity, combating constipation, and a dietary regime, will be effective.
Sometimes, people get confused with hemorrhoid skin tags. People things that anal skin tags are a symptom of hemorrhoid. But that is not true. You can easily shrink hemorrhoid skin tags naturally at home.
Classic complaints of patients with chronic hemorrhoids:
- pain in the anus, arising mainly from prolonged sitting;
- during and after bowel movements;
- minor bleeding, usually associated with bowel movements;
- loss of nodes from the anal canal when straining, coughing, sneezing, walking;
- these symptoms are often joined by anal itching, a burning sensation in the anal area.
To date, there are two forms of the disease:
- sharp,
- chronic (depending on the duration of the disease).
Both are manifested by thrombosis, bleeding, inflammation, and prolapse of nodes. Treatment tactics are determined by the stage of the disease. Traditionally, drug treatment is aimed at combating exacerbations. However, in the chronic form, any drugs used can only achieve a temporary effect.
Methods of surgical treatment of hemorrhoids
- sclerotherapy,
- infrared photocoagulation,
- ligation of enlarged knots with latex rings,
- submucous laser destruction of hemorrhoids,
- ligation (ligation) of hemorrhoidal arteries under the control of Doppler ultrasound,
- hemorrhoidectomy in various modifications.
The choice of the necessary operation depends on the stage of the disease and the complications that have appeared. The first three methods are outpatient procedures and are used in the initial stages of the disease (1 st).
Submucous laser destruction (LHP)
Submucous laser destruction is also an outpatient method of treatment, but it can be used for both stages 1 and 2-3 of the disease.
The essence of the technique is vaporization (evaporation) of cavernous hemorrhoidal tissue from the inside without damaging the mucous membrane using laser radiation. Subsequently, the node collapses and scarring.
The advantages of this technique are a short operation time – 15-20 minutes, the possibility of performing on an outpatient basis (a few hours after the operation, the patient can go home), a painless postoperative period, the possibility of treatment for combined pathology of the anal canal (fistulas, fissures, anal polyps).
Inpatient treatment
Treatment in a hospital is indicated for patients with stages 3-4 of the disease or its complications. The main method of surgical treatment at these stages of the disease is hemorrhoidectomy (Milligan-Morgan operation or its modification), which consists of the complete removal of hemorrhoids. However, many patients refrain from such treatment, fearing postoperative pain and long-term rehabilitation. The recovery period after traditional hemorrhoidectomy is usually more than a month.
Hemorrhoidectomy with LigaSure
In our clinic, hemorrhoidectomy is performed using the “LigaSure” apparatus. It makes it possible to remove hemorrhoids using rapid bipolar electrocoagulation without suturing the vessels feeding them. At the same time, the intensity of postoperative pain decreases, and the period of functional recovery decreases. The operation with the “LigaSure” apparatus is much faster than the traditional one, from 10-20 minutes. After it, hospitalization is necessary for 1-3 days (instead of 4-7), and the period of full recovery is reduced to 3-4 weeks.
Ultrasound Guided Hemorrhoidal Artery Ligation (HAL-RAR)
In recent years, an alternative type of treatment has appeared: ligation of hemorrhoidal arteries under ultrasound Doppler control, which we recommend to perform in patients with stage 3 of the disease and after previous hemorrhoidal bleeding. In our clinic, we have the A.M. IHAL-RAR System apparatus, which allows us to perform this modern high-tech operation. It was first described in 1996 by the Japanese scientist Morinaga as transanal Doppler-controlled dearterization of internal hemorrhoids with mucopexy of the mucous membrane (HAL-RAR operation). This has become a new approach to the treatment of hemorrhoidal disease in accordance with modern ideas about its anatomical and pathogenetic aspects. The meaning of the technique is to suture the terminal branches of the superior rectal artery,
Even in comparison with hemorrhoidectomy by the “LigaSure” apparatus, this operation has significant advantages:
- the main cause of the disease is eliminated – the pathological flow of arterial blood to the hemorrhoids;
- the nodes are fixed in a physiological position, which prevents them from falling out;
- there are no postoperative wounds in the anal canal;
- this procedure can be performed simultaneously with other interventions in this area (polyp of the anal canal, fissure, fistula);
- slightly painful or painless postoperative period;
- the period of hospitalization is reduced to 1-2 days;
- the ability to start working in 5-7 days after treatment.
