Disease characterized by insufficiency of the venous plexus (network) of the anus. Anatomically, these veins are located in the submucosal layer of the anal canal, but it includes arteriovenous anastomoses with pure arterial blood, mainly in the internal venous plexus. According to an anatomical border of the anal canal, the dentate gyrus, hemorrhoids are divided into two groups: 1) those that are above the dentate gyrus and are called internal and 2) those that are below the dentate gyrus and are called external. The hemorrhoidal mesh completes the closure of the anal canal and contributes to the mechanism of gas and fecal restraint. The decade with the highest incidence of hemorrhoids is 40-50 years. Hemorrhoids are three times more common in men than in women. In patients with hemorrhoids, hypertension of the internal sphincter is observed, which prevents the return of blood from the hemorrhoids to the heart. Others believe that hypertension and the external sphincter coexist and this explains why paraplegics do not show hemorrhoids. Other secondary causes are: 1) dysfunction of arteriovenous anastomoses, 2) stagnation of blood, 3) increased intra-abdominal pressure and compression of the veins of the lower abdomen (such as during constipation, prostatic hypertrophy and pregnancy). Other conditions such as sedentary lifestyle, specific occupations (such as taxi drivers, motorists in general, pilots, etc.), alcohol and spices negatively affect the proper functioning of hemorrhoids. The symptoms of the disease are proctalgia, mucosal prolapse, bleeding and itching of the ring. Hemorrhoids according to their severity are divided into four degrees: 1st degree finding swelling of the vessels during the finger examination, 2nd degree prolapsed hemorrhoids during defecation but which are automatically rearranged at the end of it, 3rd degree prolapsed hemorrhoids with only with the help of the hand and the 4th degree the reduction of hemorrhoids is impossible.
The hygiene of the anus and the anal area is done by washing with plain water without the use of soap (soap irritates) and stop using the toilet paper (the paper hurts). Baby wipes and the use of paraffin oil are recommended to achieve soft stools resulting in quick and easy defecation. The use of ointments with topical analgesics (xylocaine) or with a mixture of cortisone (proctosynalar). In advanced conditions oral flavonoids (daflon) are used.
1. HEMORROIDECTOMY AGAINST MILLIGAN - MORGAN (OPEN METHOD). Three incisions for the removal of hemorrhoids during the 3rd - 7th - and 11th hour of the anal area which remain open and heal over time.
2. FERGUSSON HEMORROIDECTOME (CLOSED METHOD). It is very similar to the above method but the wounds at the end of the operation are sutured. This speeds up the healing of wounds and the discomfort is controlled.
3. HALL - THD. Methods of reduction of hemorrhoids and at the same time correction of a slight form of mucosal prolapse of the rectum without tissue removal and special injury of the rectal area. They are not recommended in severe forms of hemorrhoids.
4. LOGO METHOD.
5. CLOSED HEMORROIDECTOMY USING HARMONIC. Method of micro-invasive surgery with very good results and with slight postoperative discomfort.
6. LASER. Promising method with unknown long-term results due to the few years it is applied.
All of the above methods are performed under general or dorsal anesthesia. The general instruction is to analyze each method in the patient, a candidate for surgery, so that he knows what to expect mainly postoperatively. Of course the patient must have given his written consent to the surgeon in order to proceed to the most appropriate invasive method to solve his problem.
The choice of the method to be applied (final decision) is up to the surgeon at the time of surgery because only then does he have a complete picture of the size of the problem. So that he can apply the most appropriate method in order to have the best postoperative result in the long run.
The patient should be aware that there is no perfect method. All methods have their pros and cons. There are no painless methods as presented mainly from the internet. There are the least painful methods. Depending on the severity of the problem, a surgeon specializing in anal disease will decide which treatment to follow to resolve the problem.