Most operation techniques for hemorrhoid treatment are painless due to the fact that the majority of them are performed above dentate line, where there are no nerve endings. Surgical resection is more invasive and better chances for complete healing but on the other hand is related with severe postoperative discomfort/pain but with better chances for complete healing. Every procedure has its own particular indications.
Hemorrhoids are considered to be normal structure of the anal canal. If they get bigger or hang down, they will probably bleed. In most of the times, only by correction the toilet habits (prolonged stay at toilet sit, etc.), we can have an important mprovement. The rest of them need to be treated surgically, in either our clinic or the operative room.
American Society of Colon and Rectal Surgeons Guidelines
There are six different ways of treating hemorrhoids.
- In bleeding second-degree haemorrhoids, injection of sclerosant agents may have satisfactory results.
- Rubber band ligation is the simplest way to treat hemorrhoids. A quick, long-term effective and painless treatment, which do not protrude significantly. This treatment is applied in our clinic without any form of anesthesia.
- In more serious cases (including bleeding), HAL or THD are both of them preferred. These methods include localization of hemorrhoidal blood vessels with the use of ultrasound Doppler. Then the blood supply to the hemorrhoids is ligated with sutures. The protruding hemorrhoids are returned to the intra-anal position with another set of intra-anal stitches.
- In the past, ‘’Peter Lord operation’’ (surgical dilation the anal sphincters) was frequently applied. However, there is a real possibility of postoperative fecal incontinence due to significant damage to the anal sphincters.
- Surgeons slowly avoid the ‘’Longo technique’’, due to the frequent relapses or rare serious complications.
- A new promising treatment for third-degree hemorrhoids is Laser Hemorrhoidoplasty Procedure (LHP). This method is quick and atraumatic.
- Finally, in very advanced cases, it becomes necessary to resect hemorrhoids (Milligan-Morgan technique). There is a postoperative traumatic surface and severe postoperative pain. A less traumatic resection and better results can be achieved with Ultracision, Ferguson or Radiofrequency procedures.