Operative methods and
hemorrhoids
Operative methods are:
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hemorrhoidectomy
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stapled hemorrhoidopexy
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These methods are used for treating grade 4
haemorrhoids, and for grade 2 and 3 haemorrhoids not
successfully treated by banding or other methods. This is done
under general anaesthetic.
Hemorrhoidectomy and
hemorrhoids
Hemorrhoidectomy is currently the ultimate treatment for
advanced or severe hemorrhoids. The most popular techniques are
Milligan-Morgan open procedure and the Ferguson closed
procedures.
The main advantages of
Hemorrhoidectomy are:
90% success rate for third and fourth degree hemorrhoids
- minimum complications
The disadvantages of
Hemorrhoidectomy are:
significant
postoperative pain reported by patient
Stapled hemorrhoidopexy and
hemorrhoids
Stapled hemorrhoidopexy is a new alternative available for
individuals with significant hemorrhoidal Prolapse introduced
by Longo in 1997. During Stapled hemorrhoidopexy circular
stapling device is inserted into the rectum, pushing the
hemorrhoids and the tissue surrounding them up into the anal
canal.
The stapler then is fired, stapling the hemorrhoids and
surrounding tissue to tissue higher up in the anal canal .
In this way stapled hemorrhoidopexy reduces blood flow to
the internal hemorrhoids. These internal hemorrhoids then
typically shrink within four to six weeks.
The main advantages of this
method are:
- average 90% success rate can be achieved;
- hemorrhoids are not excised;
- prolapsed anorectal mucosa is returned to its original
anatomical position by means of removing and stapling
redundant mucosa;
- after surgery the blood flow in hemorrhoidal vessels
decreases;
- it is observed substantial reduction of postoperative
pain;
- less analgesics are required after surgery
- earlier discharge from hospital in comparison to
Hemorrhoidectomy
Disadvantages:
- If too much muscle tissue is drawn into the device
during the procedure, it can result in damage to the rectal
wall.
- The internal muscles of the sphincter may stretch,
resulting in short-term or long-term dysfunction which may
lead to temporary incontinence disturbance
- Stapled hemorrhoidopexy promotes higher risk of
recurrence and prolapse (protrusion outside the anus) than
conventional hemorrhoid surgery
- new procedure – there is no statistically significant
results for the long-term benefits of this treatment.
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