Hemorrhoidectomy
In surgery, hemorrhoidectomy is the surgical removal of greatly enlarged hemorrhoids . However, there is no standard procedure. Rather, a distinction is made between several different techniques, each named after their inventor. Today, however, more modern, minimally invasive treatment methods are preferred whenever possible.
course
The operations are performed under general or spinal anesthesia and require a long inpatient stay in hospital. Usually between five and ten days. This time is especially necessary for the subsequent observation. If there are complications after the operation, for example, very heavy bleeding may occur.
The healing time is long and very painful, so the use of painkillers is necessary. Healing takes several weeks, especially with the open procedures (especially according to Milligan-Morgan), and the wounds must be cleaned and cared for daily with Sitz baths (e.g. chamomile ). In any case, the patient remains unable to work for several weeks.
Procedure
Milligan-Morgan ( Open Hemorrhoidectomy )
Application area (indication):
In the case of significant complaints with hemorrhoids of the 3rd, less often the 4th degree.
History:
Developed around 1935 by doctors ETC Milligan and C. Naughton Morgan in Great Britain , this surgical technique is (still) the standard procedure in the country of origin, but also in Germany.
Technology:
During the procedure, the three hemorrhoidal nodes are pulled out through the anus with a clamp and dissected there. This is why this surgical technique is sometimes referred to as the 'three-lobe method'. However, the procedure does not have to be used for all nodes at the same time. It is just as suitable for treating only individual segments.
The surgeon decides where to preserve skin bridges and separates the hemorrhoid tissue from the underlying sphincter . After the knot is pierced, the supply artery is usually tied off. This can prevent later bleeding. Finally, the knot is removed with a scalpel .
Specialty:
The triangular wounds that remain between intact bridges of skin and anal mucosa, which are at least 2 cm wide, are not sutured, but have to heal open. Hence the designation as an open procedure .
Parks ( Submucosal Hemorrhoidectomy )
Application area (indication):
In the case of significant complaints with hemorrhoids from 3rd, but especially 4th degree.
History:
The London surgeon AG Parks was of the opinion that only the insensitivity of the anal canal to infections was the reason for the development and success of open procedures. Therefore he developed his own method (around 1956) with which he tried to keep the anal skin largely intact. The technique is still used regularly, especially in Europe.
Technology:
For this purpose, a Y-shaped incision is made in the anal mucosa for each lump and the hemorrhoidal pad underneath is exposed. Then the supply vessels are tied off, the upholstery tissue under the mucous membrane is removed and the wound edges are sutured in a T-shape. A smaller area remains open only in the lower part of this T in the direction of the anus. The procedure has a clearer preparation, but is technically more complex compared to Milligan-Morgan. Greater experience of the surgeon is required.
Specialty:
The procedure is preferred because of the faster and less painful healing. However, critics argue that there is a risk of suture complications. This could loosen and lead to a wide defect zone in the anal canal or, in the case of severe scarring, more to a bowel than the Milligan-Morgan procedure.
Ferguson ( Closed Hemorrhoidectomy )
Application area (indication):
In the case of significant complaints with 3rd or 4th degree hemorrhoids.
History:
This technique was developed as a modification to Milligan-Morgan around 1952 by Ferguson in the United States and is still preferred there today.
Technology:
As with Milligan-Morgan the tissue is grasped with forceps, with a scalpel from the sphincter muscle ( sphincter dissolved), and then separated. However, the wound is then closed from the top down to the anoderm with a continuous longitudinal suture.
Specialty:
Expect less pain and faster healing compared to Milligan-Morgan. Closing the wound can increase complications from bruising. As with Parks, the seam creates another risk of complications.
Fansler-Arnold ( reconstructive hemorrhoidectomy )
Application area (indication):
In the case of significant complaints with 4th degree hemorrhoids. Especially if it is fixed on the outside and the anal canal is deformed to such an extent that it has to be restored during the operation (anal plasty ).
Technology:
Here the outwardly displaced anal skin is first removed from the inside. After cutting out the underlying hemorrhoids, the lobe of the mucous membrane is sutured back to its natural position inside the anus.
Specialty:
The disadvantage of the method is the extremely high cost of the operation.
Whitehead ( supra-anodermal hemorrhoidectomy )
History:
This technique, which was described by Whitehead as early as 1882, is now considered a " malpractice " and is only rarely used when further developments are taken into account. She was quickly suspected of causing a particularly high risk of complications, especially stenoses .
Technology:
Whitehead preferred the circular cutting out of the hemorrhoid pads, which, however, usually involves the complete destruction of the anal skin, the anoderm .
Risks and Complications
With all techniques, there is a risk that bleeding will subsequently occur, some of which can be very severe and require emergency treatment. It can also abscesses , fistulas and stenosis occur. In unfavorable cases, the operation can result in tightness of the anus and lead to temporary, rarely even life-long weakness in the wind and stool ( faecal incontinence ).
As with all interventions, there is a low risk of infection or possibly an injury due to the surgeon's carelessness.
Relapse
As a rule, the recurrence rate is very low. However, a recurrence of hemorrhoids cannot be ruled out. In younger patients (under 40 years of age) it is therefore occasionally recommended to postpone the operation.
See also
Individual evidence
- ↑ F. Stelzner : Errwege der Proktologie and its consequences. In: Coloproctology . Volume 23, 2001, pp. 73-80. doi : 10.1007 / s00053-001-5043-z
Web links
- Milligan-Morgan - Operation description (in English) of the forum "Hemmorrhoids in plain English"
- Ferguson - Operation description (in English) of the forum "Hemmorrhoids in plain English"
