6.  Applied Hemorrhoid treatments?

 Depending upon stage and severity, the hemorrhoids are treated with different methods.

First and second degree hemorrhoids

The large part of the hemorrhoidal illness make up this group, whereby each physician has his own experience and preferred methods. Especially first degree hemorrhoids are treated with ointments, suppositories and medicines.

Otherwise, the most commonly used treatment techniques are listed below:

ointment application

Otherwise the mostly following methodes are used:  

- Sklerotical injection treatment: With a tubular instrument (Anoskop), the enlarged hemorrhoids are detected and a liquid astringent medicine is injected into the nodules or into the surrounding tissue with the feeding artery. The medicine causes an inflammation, the swollen nodules shrink and the blood supply is decreased. The hemorrhoids become smaller and the symptoms disappear

Advantages:

•  Relatively simple

•  Short and painless method

•  Economical

Disadvantages:

• Necrosis danger in case of wrong Injection and resultant pain

• High rate of re-occurrence

• Repeated treatments necessary

- Rubber band ligature: With the use of a special instrument, a taut rubber band is put around the tissue supplying blood to the nodules and and the tissue is pinched off. This so-called Barronligature interrupts the blood supply to the enlarged tissue and kills it due to necrosis. The dead tissue is then repelled by the body. The hemorrhoid gets smaller and complaints are reduced.

Advantages:

• Painless execution

• Rapid effect

• Economical

Disadvantages:

• Bleeding and occasional pain

• Sometimes unpleasant tissue repulsion

• Repeat rate is not low

• Often repeated visits and treatment

- Infrared coagulation: With an infra-red device, several spots are heated at the base of the hemorrhoid. The tissue is cauterized by heating. The tissue gets smaller an the complaints get alleviated.

Advantages:

• Painless application

•  Rapid effect

Disadvantages:

• Necrosis formations

• High rate of repetition

- HAL ( Hemorrhoidal Artery Ligation) : This relatively new method was initiated by the Japanese physician Dr. Morinaga and the application is becoming wide spread. Sometimes, it is also used with third degree hemorrhoids. A tubular Proktoskop, which is armed at the top with an ultrasonic sensor, finds the supplying artery of the hemorrhoid, it is then blocked with a surgical stitch. The blood supply is cut off to the tissue, existing bleedings stop rapidly and the hemorrhoidal nodule shrinks and becomes much smaller within 6 weeks.

Advantages:

• Low pain, ambulatory execution

• High success rate

•  Applied only once

Disadvantages:

• Correct technical execution not simple

• Sometimes anesthesia or sedation necessary

• Rare occurrence of small bleeding and feeling of pressure

Third degree hemorrhoids
At this stage, open or closed surgical methods are preferred in addition to the above mentioned Hemorrhoidal Artery Ligation method.

- Open operations: In this method, the hemorrhoidal tissue is cut and removed, so open wounds stay behind. There are different techniques, which are named after the first accomplishing physician.

Milligan-Morgan Hemorrhoidectomy : This technically not difficult method was established in the 1930‘s and still is world-wide most commonly and often applied procedure. The nodules are completely cut off and the supplying arteries are stitched shut. The resulting open wounds will heal within a few weeks.

Ferguson Hemorrhoidectomy : Like the Milligan - Morgan method the nodule will be cut off, but afterwards the anal skin is used to cover over the open wound, so that the wounds are made smaller.

Parks Hemorrhoidectomy : Designed in London by the renowned surgeon Dr. Parks, the hemorrhoidal nodules are cut and removed while the covering anal skin is preserved. This technically challenging, hard and delicate method requires special expertise of the operating surgeon.

Generally, the open surgeries require a few days of hospitalization. It is common to all open surgeries that the highly sensitive anal skin which is called Anoderm, gets damaged. Therefore, the pain management with appropriate medicine is necessary after the operation. Furthermore, bleeding can occur as well as occurrence of tightness after large removals. Also, there is the risk of sphincter muscle injury which can lead to incontinence, thus inability to hold gas and stool.

- Closed operations: As an alternative the open operation procedures, the Stapler Hemorrhoidectomy is developed by the Italian physician Dr. Longo and is being used for some years. A special instrument is inserted and a circular seal in the final intestine will be cut and closed at the same time, so the intestinal mucosa is gathered. Thus the swollen hemorrhoidal pads are lifted to their natural space and shrink with the time. The actual operation takes place in the final intestine which do not have the nerves and the pain receptors and without the injury to the anal skin.

Advantages:

• Less pain

•  Anatomical re-establishment

• Possible in a Day-clinic (out-patient)

Disadvantages:

• Often bleedings from the seal

• Final intestine tightness with increased defecation urge

• Only possible at third degree, still re-locatable hemorrhoids

• High cost

Fourth degree hemorrhoids 
In this final stage the hemorrhoidal nodules are permanently outlocated and cannot be pushed back any more, thus they are fixed. This means, that the closed Stapler operation is technically not possible, so that only open procedures are usable. In addition to the above mentioned open procedures, the Fansler – Arnold Hemorrhoidectomy is favored. This is a very large, hard as well as a delicate method which requires special expertise of the operating surgeon. After cutting the anal skin, the nodules are cleaned underneath without the removal of the skin. After the removal of the nodules, the anal skin is sewed back in place by a plastic technique. By this so-called anal plastic stiching method, the anatomical relations are restored. Since it is technically an open surgery, all the complaints and complications of a typical open surgery applies.                                  

 

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Anal diseases - still a topic with taboo   |   Anatomy of the final intestine   |   What are Hemorrhoids actually?   |   How does the illness of the hemorrhoids developed?   |   How does the hemorrhoidal illness express itself?   |   How is the treatment in the Proktoklinik?   |    Anal fissure   |   Anal fistula / Anal abscess   |   Anal thrombosis   |   Illness of the Linea Dentata   |   Skin folds (Mariscs)   |   Condyloms