Surgical treatment of external hemorrhoids

Hemorrhoids is a disease that brings a lot of unpleasant moments and discomfort, especially for those who have to sit for a long time. This is pain, itching, a feeling of heaviness, burning in the anus. The urge to empty the bowels is perceived with a shudder, since it is often accompanied by bleeding, severe pain syndrome. Symptoms depend on the severity of the pathology, whether it is internal or external. At the initial stages, conservative treatment is used. [1]If this does not lead to success, hemorrhoids continue to progress, during bowel movements, internal nodes constantly fall out, efficiency decreases, then they resort to surgical treatment. [2]

Surgical treatment of external hemorrhoids

Hemorrhoids are triggered by poor circulation in the lower intestines. Hemorrhoids increase in size and against the background of increasing degenerative processes in the sphincter, fall out of the anus. Around it, dense painful seals are found, inflammatory complications are possible that cause fever, fever.

The need to remove external hemorrhoids arises at stage 3-4 of the disease, when drug therapy was ineffective.

The third stage corresponds to a state when the nodes fall out even from a slight physical stress and are adjusted manually. On the fourth last, this happens constantly, the nodes cannot be returned to the anal canal, heavy bleeding leads to anemia.  [3]

There are various methods of hemorrhoidectomy, for example, according to Milligan-Morgan, Whitehen and others. The operation is performed under general anesthesia, the nodes are excised with a scalpel in a certain way, the wounds are sutured with absorbable threads. Although surgical treatment often entails complications leading to insufficiency of the anal sphincter, formation of canal strictures, and a long period of rehabilitation, this approach is still relevant in difficult cases. Along with it, minimally invasive techniques are used that do not require general anesthesia. [4]

Removal of external hemorrhoids under local anesthesia

A number of operations are performed under local anesthesia to remove external hemorrhoids without a scalpel. Depending on the stage of the disease, this can be:

• infrared photocoagulation (exposure of the node to high temperature, after which it dies);
• sclerotherapy (a sclerosing substance injected inside the node leads to its atrophy);
• transanal dearterization of hemorrhoidal arteries under Doppler control (ultrasound decreases blood flow to the hemorrhoidal node, after which it dries up);
• electrocoagulation (with the help of alternating current supplied to the electrodes, between which the base of the node is clamped, tissue denaturation occurs). [5]

Ligation for external hemorrhoids

The ligation procedure involves putting a latex ring on the hemorrhoid using a ligator. At this stage, 2 types of it are used:

• vacuum, when a unit is sucked into a special cylinder with the help of a vacuum and a ring is dropped onto its surface;
• mechanical - the same procedure, but carried out manually with special forceps.

The technique is used at the 2,3 stages of hemorrhoids. No more than 2 nodes are removed per session. Prevention of possible complications is carried out with antibiotics. [6]

Laser treatment of external hemorrhoids

Another operation carried out under local anesthesia, laser coagulation, is relatively painless and less traumatic than hemorrhoidectomy. Its essence is that the beam focused on the external hemorrhoidal node cuts it off and after healing there are no scars. [7]

The advantages of this procedure are that no hospitalization is required, a short postoperative period, and a low risk of recurrence.