Proctology

What is hemorrhoid surgery

Hemorrhoid surgery involves the removal of internal and/or external hemorrhoids which are swollen veins in the anus. They are caused by weakness of vein walls in the area which results from genetic, inborn and hereditary factors. In women, the main cause is usually pregnancy. Chronic constipation is a very common cause of the disease. These changes result in repeated bleeding of different intensity during and after bowel movements, common inflammation and painful hardening of varicose veins.

Degrees of internal hemorrhoids:

1. A first-degree internal hemorrhoid bulges slightly into the anal canal;

2. A second-degree internal hemorrhoidal cushions bulge from the anus during pressure, then go back inside by itself;

3. A third-degree internal hemorrhoid bulges from the anus during bowel movement and must be pushed back in with a finger;

4. A fourth-degree internal hemorrhoid protrudes from the anus all the time and can´t be pushed back in.

Who should undergo the surgery

Currently, hemorrhoids are the most common condition dealt with by gastroenterologists and surgeons. The patients suffering from the diseases have several different complaints ranging from discomfort like itching, burning and pain in the anus to bleeding, mucosal prolapse or ulcers.  Patients collapsing in restrooms suffering from acute large blood losses have been reported. Last but not least, patients are confronted with the hygienic consequences of the disease: stained underwear, common persistent itching, anal cleansing difficult to achieve, and occasional incontinence in very advanced stages. Global statistics show that a complicated course of the disease that hasn´t been treated for a long time may in some cases lead to the development of anal cancer. And vice versa - hemorrhoids may be symptoms of anal cancer.

Therefore, it is important that the disease is properly dealt with - by means of assessment and treatment. Due to natural shame, patients often downplay or conceal their complaints. On the other hand, physicians tend to skip a very important rectal examination. Both are incorrect and often lead to tragic complications in the most advanced stages of the disease.

Before the procedure

In addition to taking a patient´s, history and performing an overall assessment, a rectal examination and anorectoscopy are performed. Before indicating our patients for surgery, a colonoscopy could be required.

The physician will explain the procedure and anesthesia to you and inform you about any possible risks. You may ask any questions, in particular, questions related to the procedure, your expectations and concerns, during the discussion.

When making a binding appointment for hemorrhoid removal, you will be provided with an information sheet on how to prepare for the surgery, including information on eating, drinking, smoking and taking or discontinuing some medicines, which will be explained to you. Complying with all the recommendations is necessary for the surgery to run smoothly and for event-free healing.

What does the treatment involve

Hemorrhoid treatment of initial stages (first-degree hemorrhoids) is first conservative (non-surgical) - medicines, diet and regimen changes are used. More advanced stages (2-4-degree hemorrhoids) usually require an out-patient or surgical procedure.

In the case of hemorrhoid removal, the physician will diagnose the stage of the disease and offer the most suitable treatment option.

The HAL-RAR method is the most common procedure used to remove hemorrhoids in the GHC.

Out-patient procedure

So-called Barron ligatures or rubber band ligation (RBL)

The internal hemorrhoid is placed into a suction ligator and a rubber band is placed around it base stopping the blood supply. The hemorrhoid will shrink and die within a few days with shriveled hemorrhoidal tissue falling off during normal bowel movements. It can be accompanied by minor bleeding that quickly stops by itself. The treatment is painless. The patient may experience some discomfort in the anal area for several days which can be treated by common pain-killers (Brufen, Ibalgin etc.).

Surgical treatment

Surgical procedure is only performed under general anesthesia.

Stapled hemorrhoidectomy

It is performed by a surgeon using a circular stapler to cut a mucous cuff from the area above hemorrhoids. At the same time, the defect is closed by the stapler, together with vessels supplying blood to the hemorrhoids. This technique is safe when used by an experienced surgeon and the client may be discharge to home care after 24 hours of hospital stay.

HAL-RAR method

This minimally-invasive method provides safe and first of all effective relief from all stages of the disease. HAL-RAR surgery lasts several dozens of minutes. A Doppler ultrasound device is introduced into the anal opening which pinpoints the exact location of the arteries supplying blood to the hemorrhoids. Their exact location is confirmed by an audible signal. It means that only the locations with hemorrhoids are treated and no surgical wound is made.

HAL - the surgeon puts a ligation on each artery by placing a double stitch around it, hence cutting the blood supply to the hemorrhoid. The pressure in the hemorrhoids is almost immediately decreased and they start to shrink away. The surgeon checks the results of the treatment by the ultrasound device.

RAR - an addition part of the procedure following HAL (for third- and fourth-degree hemorrhoids) used for hemorrhoids prolapsing out of the anus. These have to be lifted up. It may be accompanied by temporary pain immediately after the procedure.

The client may be discharged to home care after he/she completely wakes up from anesthesia. Most patients only feel some pressure in the anus after the surgery and can soon get back to work depending on their profession. Usually, a one-week sick leave is recommended.

The Milligan-Morgan technique

For highly advanced stages of the disease and its acute stage (e.g. hemorrhoidal thrombosis), a radical surgical treatment may be the most suitable option for the patient. It is a classical surgical procedure used to remove internal and external hemorrhoids and to ligate the supplying vessels. It is a radical method involving certain discomfort during the healing of skin and mucosal defects. The overall treatment time may exceed 5-6 weeks.

After the surgery

An integral and very important part of the treatment is the involvement of the patient: regimen changes, diet, active way of life, strengthening of pelvic floor muscles, local hygiene. Regular follow-up visits in the surgical out-patient department of the GHC Clinic Prague are also a precondition of achieving good treatment results.

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