Haemorrhoids
Diagnostics
Haemorrhoids are diagnosed during an endoscopy of the anal canal (proctoscopy) and of the rectum (rctoscopy). If bleeding occurs, a coloscopy (endoscopy of the colon) is necessary to exclude a malignant tumor of the colon.
Surgery
The aim of the treatment is to reduce the haemorrhoids of the anal canal, which can be done with operative and non-operative measures.
There are four stages of haemorrhoids:
- Slight sweeling of the cavernous body, only visible by proctoscopy.
- Prolaps during bowel movement (dejection) which afterwards will withdraw spontaneously into the anal canal.
- Prolaps during dejection, nodes are not able to withdraw into the anal canal, they have to be pushed back by hand.
- Lasting haemorrhoidal prolaps during which the mucosa of the canal is turned outward several centimeters.
Conservative methods are the reduction of weight, the avoidance of gas-forming food and a high bulkage nutrition. Slight disorders can in many cases be treated successfully with so-called haemorrhoidal ointment or suppository.
Stage II haemorrhoids can be obliterated with sclerosant, or be tied off (ligated) with an elastic ligation (Barron operation). An elastic ligation is clearly to be prefered, because haemorrhoids will drop off after 7-10 days without the patient noticing.
Stage III and IV haemorrhoids usually have to be operated on.
Surgical Methods
Conventional Methods:
Singular nodes can be cut off by leaving an open wound (method according to Milligan- Morgan) or by sewing the mucosa (method according to Parks, Ferguson or Fansler- Arnold).
New Surgical Methods
In Germany, since the end of the nineties, a surgical method using a stapling device (LONGO-operation) has been performed increasingly on stage III-IV haemorrhoids).
Surgical Risks
The use of an elastic ligature can lead to severe bleeding in 1% of all patients, so that a reappearance in hospital is necessary. The Longo operation method leaves the patient free ofpain and enables him/ her to be fit to work in short time. A so-called dumping of the bowels after Longo operation is only temporary and will normalize in most cases after a few month.
Fundamental complications of a haemorrhoid operation, no matter if conventional method or new method is used, are: bleeding, pain, inflammation and stenosis of the anal canal. Up to 4% of all aptients suffer from postoperative bleeding, the majority of them can be treated without further surgery. Further complications are very rare, and with our patients no violation of the sphincter resulting in incontinence has occured so far.
Both surgical methods contain a risk of 1,5-3% that new haemorrhoids can develop, which in most cases can be treated with an elastic ligation.
Special Questions
- The surgical method that suits you best will be chosen after a detailed examination and will be discussed with you.
- The Longo method in comparison to the sclerosing method offers better results and can be performed ambulatory.
- Sitting baths will be performed according to the conventional methods which leave an open wound. According to this, a medicamentous regulation of the stool will be administered to avoid straining during bowel movement. A sufficient pain therapy is self-evident.
- Your stay in hospital will take 3-4 days.
- A final proctologic examination will be performed 4 weeks after surgery to judge the final outcome of the operation.
