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Surgery is always indicated when hemorrhoidal disease can not be treated successfully with other methods and when the general condition of a patient allows the intervention.
Various techniques are available for the removal of hemorrhoids. Essentially, efforts are being made today to preserve the particularly sensitive skin of the anal canal. As a result, the pain after surgery was significantly alleviated, so that one can often operate on an outpatient basis.
In the conventional methods, the pathologically enlarged hemorrhoidal tissue is removed, ie, cut away. If the vascular nodes occur individually, the Milligan-Morgan method can be used. In doing so, the single knot is pulled out, then punctured and then removed. The wound area is left open so that the wound secretion can drain, which promotes healing. In some cases, the wound is also sutured, then one speaks of the Parks method. Disadvantages of these conventional methods are the relatively severe pain after the procedure, which results from the only slowly healing wounds in the anal mucosa. These interventions are only carried out on an outpatient basis in individual cases.
If the hemorrhoids can still be pushed back, the gentler operation according to Longo (also called stapler hemorrhoid surgery) is usually used today. An approximately 3 cm wide strip is removed from the painless rectal mucosa by means of an annular stapling suture. This breaks the blood supply to the hemorrhoidal nodules. The prolapsed mucous membrane region is "gathered" upwards and nourished. It uses a finger-shaped device ("stacker"), which automatically connects the mucous membrane by staples. This method (also called "anal lifting") has the advantage that the pain after surgery is very low, as the sensitive inner anal canal is spared. It is therefore particularly well suited for the outpatient sector.
Another method is the Doppler sonographically assisted haemorhoidal artery ligation, HAL for short. By means of ultrasound (so-called Doppler sonography), the doctor detects the vessels in the lower rectum in the hemorrhoidal pillow and ties them with a thread so that they are separated from the blood supply. The hemorrhoids then wither away after a few weeks of their own, without a wound forming. This procedure also causes very little pain and can therefore usually be carried out without problems on an outpatient basis. It is particularly suitable for stage II hemorrhoids, which spontaneously retract into the anus after defecation.
In case of tears in the anal mucous membrane (fissures), it may sometimes be necessary to carefully incise the sphincter under general anesthesia. Fistulas, ie connections between the intestine and the skin, are as completely exposed as possible, and then closed. Your doctor will discuss exactly what is planned with you.