7. How do we do the treatment in the Proktoklinik?

We are trained as a non-invasive or minimally invasive treatment specialists. All operations in the Proktoklinik are done with local or regional anesthesia and in out-patient clinic based (no hospital stay and short observation.) . With the combination of well-known procedures and our own techniques, the disadvantages are reduced to a minimum with greatest possible success.

Preparation
There is no special preparation necessary except an empty intestine for all operations. We check for allergies and hemophilia during the preparations which is part of a common pre-surgery patient history interview for all operations we perform. If needed, laboratory tests and radiological controls are also performed or requested.

First and second degree hemorrhoids

Laser obliteration (reduction) and Doppler-ultrasound guided ligation of the arteries: Enlarged hemorrhoidal nodules are internally reduced with the ELVeS Laser, blood vessels which supply blood to the enlarged hemorrhoids are detected with a special doppler-ultrasound guided probe and get stitched shut with a surgical stitch in addition to bundling and tightening of the hemorrhoidal tissue.

With the HAL - technique ( Hemorrhoidal Artery Ligation) only the arteries which supply blood are blocked. The characteristic of our own technique is the use of laser and surgical bundling, lifting and fixing of the enlarged nodules at their original and natural location. This unique combination of methods provide a quick recovery.

Advantages:

• High success rate

•  Painless execution

• Only one visit necessarily

Disadvantages:

• Temporary feeling of pressure

• Rare occurrence of bleeding

• Local anesthesia necessary

Stage three hemorrhoids

- Laser reduction and supraanodermal lifting: Under local anesthesia, the pushed-out but still movable hemorrhoidal nodules are first reduced with the ELVeS Laser and then lifted to their natural position with the help of a special seam technique which also blocks the feeding arteries. Additionally, the remaining arteries are found with an ultrasonic device and blocked with surgical stitch. With this special procedure which is partly developed by us, the advantages of the stapler method are retained without the disadvantages.

hemorrhoid

Advantages:

•     Success rate highly

•     Painless execution

•     No intestine tightness

•     Very economically

Disadvantages:

•     Rarely bleeding

•     Temporary pressure feeling

•     Local anaesthesia necessarily

Stage Four degree hemorrhoids

MİSSH after Dr. Burgard ( Minimal Invasive Submucosal Subanodermal Hemorrhoidoplasty)

This is a brand new procedure and was developed by the German surgeon Dr. Burgard. (Coloproctology 2005, Issue 2 ). It is a revolutionary development for fixed, stage four hemorrhoids. Under regional anesthesia, 1 cm long cuts are made at the less sensitive edge of the hemorrhoid nodules. After the cut is made, the nodules are scooped out from the inside with a special shaver instrument. Afterwards, they are stitched to their natural location, while the feeding artery is blocked. Additionally, the remaining arteries are found with a ultrasonic device and stitched shut.

Shaver
MISSH Operation

So far, this procedure is only performed at three hospitals outside Turkey and only by the Proktoklinik in Turkey.

Advantages:

• No need for large and open surgeries

• No injury to the highly-sensitive anal skin

• Less pain, mostly out-patient execution

• Economical

Disadvantages:

• In rare instances, post-operative bleeding may occur

• Three small open cuts at the edge of the anus

• Short hospital stay may be necessary for older patients in some instances

Post operative care

After the operation, A Rectoscopy (lower intestine reflection) is done to make sure that the end of the large intestine and the surgery area is checked again.

If no contra-indications exist, an anti-inflammatory suppository placed in the rectum after the surgery. Anal tampons or other intra anal Inserts are not used, only a collecting main is placed.

After the MİSSH, a day-long observation of one to two-hour intervals will be done.

Due to the surgical stitches, there can be feeling of pressure for a short time. This feeling can be treated with an anti-inflammatory medicine such as Voltarene.

Small amount of bleeding after the MİSSH is normal. Only intensive and bright red bleeding needs an immediate action.

After the MİSSH, warm sitting-baths with chamomile and washing/douche of the wounds (after defecation) is needed.

Controls by the physician take place after the first week and after the sixth weeks.

It should not be forgotten that regardless of the success of the treatment, if the reasons which cause the hemorrhoids are not eliminated, the potential of the re-occurrence of hemorrhoids is always present.

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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 Hemorrhoids are treated?   |   Anal fissure   |   Anal fistula / Anal abscess   |   Anal thrombosis   |   Illness of the Linea Dentata   |   Skin folds (Mariscs)   |   Condyloms