Surgical treatment of hemorrhoids (hemorrhoidectomy)

In the early stages, hemorrhoids can be treated with conservative methods, but most patients consult a proctologist later. When the size or number of nodes increases, surgical treatment becomes necessary. At Oxford Medical, this is performed using modern minimally invasive techniques:

• ligation of hemorrhoidal nodes with latex rings;
• Doppler-guided HAL-RAR dearterialization;
• infrared photocoagulation;
• laser hemorrhoidoplasty;
• radiofrequency ablation.

These methods allow the removal of hemorrhoidal nodes in one procedure (several sessions may be needed for latex ring ligation), often without the need for hospitalization.

Hemorrhoidectomy — radical excision of hemorrhoidal nodes with a scalpel — is prescribed only in the most severe cases when other techniques are ineffective. About 10% of patients require such surgery.

Hemorrhoids occur due to varicose enlargement of the veins in the hemorrhoidal plexus of the anal canal and are accompanied by the formation of venous nodes. They may be located inside the rectum or outside the anus, and in combined hemorrhoids — on both sides.

At an early stage, the disease is almost asymptomatic, so many patients delay seeing a doctor. Symptoms appear when the nodes enlarge. In such cases, surgical treatment is usually required. The choice of technique depends on the stage of hemorrhoids and the patient’s individual characteristics.

Minimally invasive techniques are used for uncomplicated stage 1–3 hemorrhoids.

Indications for hemorrhoidectomy include:

• Prolapse of internal hemorrhoidal nodes;

• Strangulation of one or more nodes;

• Thrombosis of the node;

• Frequent bleeding;

• Combination of hemorrhoids with anal fissures or rectal fistula;

• Insufficient effect from conservative or minimally invasive methods.

Minimally invasive treatment of hemorrhoids usually does not require hospitalization and is performed on an outpatient basis. In many cases, the patient can return to their normal rhythm of life within a few days, however recovery time depends on the selected treatment method, the stage of the disease, and the individual characteristics of the body.

The procedures are performed as follows:

1. Ligation of hemorrhoidal nodes with latex rings – using a special ligator, a latex ring is placed on the base of the internal hemorrhoidal node, which stops its blood supply. As a result, the node gradually becomes necrotic and falls off after a few days, and connective tissue forms in its place, which helps fix the mucous membrane.
2. Doppler-guided dearterialization HAL-RAR – an anoscope with a Doppler sensor is inserted into the lumen of the rectum, which allows the arteries supplying the hemorrhoidal nodes to be detected. After that, the doctor sutures and ligates these vessels, reducing blood flow to the nodes. If prolapse is present, mucosal lifting and fixation of the rectal mucosa (mucopexy) is additionally performed. As a result, the hemorrhoidal nodes gradually decrease in size.
3. Laser hemorrhoidoplasty – laser treatment of hemorrhoids, which involves controlled thermal exposure of laser energy to the tissues of the hemorrhoidal node. The laser coagulates the vessels feeding the node, as a result of which it gradually decreases and is replaced by connective tissue.
4. Infrared photocoagulation – a method in which infrared radiation causes coagulation of tissues in the area of the internal hemorrhoidal node. This leads to a decrease in blood filling of the node and the formation of fibrous tissue, which contributes to fixation of the mucosa.
5. Radiofrequency ablation – a treatment method in which the tissues of the hemorrhoidal node are exposed to radiofrequency energy. Under the influence of the thermal effect, coagulation of the vessels occurs and the node gradually decreases.

Most minimally invasive procedures are performed using local anesthesia or sedation to ensure patient comfort.

If the disease has an advanced stage or minimally invasive methods do not provide the required result, surgical treatment may be used. The radical surgery – hemorrhoidectomy – involves hospitalization of the patient, preoperative preparation, anesthesia, and adherence to recommendations during the postoperative period.

At the «Oxford Medical» clinic, hemorrhoidectomy is performed using the Milligan-Morgan method. During the operation, the surgeon removes internal and external hemorrhoidal nodes together with areas of altered vessels. This approach allows the source of the disease to be eliminated and significantly reduces the risk of recurrent hemorrhoids.

The Milligan-Morgan method is mainly used for combined hemorrhoids or in the late stages of the disease, when other treatment methods may be insufficiently effective.

Oxford Medical operates a high-tech surgical inpatient facility equipped with expert-level devices. This enables both minimally invasive and classical surgical hemorrhoid treatments.

When a patient comes to the clinic, a comprehensive diagnosis is first performed. Based on the results, proctologists and surgeons select the most appropriate treatment method.

Advantages of treatment at Oxford Medical include:

• Use of minimally invasive techniques that do not require hospitalization or anesthesia;

• Longo hemorrhoidectomy for complex cases;

• High professionalism of proctologist-surgeons;

• Advanced equipment from leading European and American manufacturers (for laser and radio wave therapy, infrared photocoagulation, HAL-RAR, etc.);

• Comfortable single and double patient rooms.