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Hemorrhoids, mucous prolapse, hemorrhoidal prolapse, mucohemorrhoidal prolapse, hemorrhoid elastic ligation

What are hemorrhoids?

The internal hemorrhoids are arteriovenous pads located in the rectum or anus. Hemorrhoidal disease consists of dilatation, especially of the venous component, and mucosal prolapse, more or less marked, of these pads. The main clinical manifestations of hemorrhoidal disease consist of the appearance of soft nodules at the anal margin and the presence of blood, most often on the toilet paper, less frequently in the toilet, after defecation. Rarely (unless the most severe cases of prolapse or the occurrence of hemorrhoidal thrombosis) hemorrhoidal pathology causes pain.

The treatment of hemorrhoids

The treatment of internal hemorrhoids depends on their severity. The most common classification of hemorrhoidal disease recognizes four degrees of severity, from I to IV. In most cases, in addition to providing for general hygiene measures (increased fiber in the diet, abundant hydration, etc.) treatment is based on simple outpatient methods, such as the elastic ligation of hemorrhoids and the hemorrhoidal sclerosis.
classification of hemorrhoids, elastic ligation of hemorrhoidsLe hemorrhoids can be named according to their location. The internal hemorrhoids originate from dilatation of arteriovenous pads located in the rectum. As mentioned above, they do not normally cause particular discomfort, but they can bleed to the point of causing forms of anemia even serious ones. The prolapsed hemorrhoids are the internal hemorrhoids that have become so large that they leak out through the anus, dragging behind the mucosa by which they are covered. They can shrink (i.e., re-enter the rectum reoccupying their original position) spontaneously, but sometimes it may be necessary to push them in manually, and in severe cases they are irreducible. They can be the cause of major defecation disorders, bleed e strangle yourself, causing intense anal pain.
Le external hemorrhoids Are due to dilatation of veins located at the perianal level. They can cause itching o pain, go to meet thrombosis and sometimes break down and bleed.

Hemorrhoidal disease is caused by increased pressure in the veins of the rectum or anus. One of the main causes is defecatory straining, which may be due to constipation or diarrhea; other causes includeobesity and various conditions that cause increased pressure within the abdomen(pregnancy, heavy work, intense physical activity, etc.), which in turn results in increased pressure in the hemorrhoidal veins.
Virtually everyone experiences hemorrhoidal problems during his or her lifetime, but there are factors that make their occurrence easier. For example, hemorrhoidal disease has a familial component, so those who have parents who have suffered from it are more likely to develop it; pregnant women and women who have recently given birth are often affected; people who are overweight or obese, or who stand for long periods of time or perform heavy work show a higher incidence of the condition; and, without a doubt, people who suffer from constipation are prime candidates for developing hemorrhoidal disease.

In all cases of bleeding (also referred to, in this case, as rectorrhagia or hematochezias), whether mild (traces of blood on toilet paper) or more significant (presence of blood in the toilet and stool) one should consult the coloproctologic surgeon, who is able to determine whether the blood loss is due to a benign condition, such as hemorrhoids may be, or more serious (e.g., inflammatory diseases and tumors of the ano-rectum); and, at the same time, indicate and implement the most appropriate treatment.
Hemorrhoidal disease has always been considered an exquisitely surgical condition. The main surgical interventions for the treatment of hemorrhoidal disease includehemorrhoidectomy, transanal dearterization (THD) and mucoprolassectomy (Longo's technique). However, new technologies and advances in medical science have meant that, for years now, the indication for surgery arises, when the pathology is diagnosed early, in only a few selected cases.

Outpatient treatment of internal hemorrhoids can be effectively offered in all cases of grade I and II hemorrhoids, and in many cases of grade III hemorrhoids, even when a mucosal prolapse component is associated. Elastic ligation of hemorrhoids and sclerosis represent the cornerstones of outpatient treatment. These procedures are minimally invasive, rapid, virtually painless, and require no special patient preparation. They can be offered to patients of all ages, even those with conditions that in themselves would contraindicate surgery.

The elastic ligation of hemorrhoids

The elastic ligation of internal hemorrhoids consists of placing, with special equipment, a small elastic band at the base of each hemorrhoid package.
Through an anoscope, a device is introduced that functions, simultaneously, as a suction and an applicator of the elastic band. The hemorrhoid packet is gently suctioned into a small tube, until its base is exposed; at this point, the elastic is "shot," which surrounds and strangles it. After a few days, the strangulated hemorrhoid, which has gone into necrosis, is eliminated with the feces. This procedure is quick and involves minimal discomfort for the patient; it must be repeated for each hemorrhoid packet, with an interval between sessions of at least 15 days. Six sessions of elastic hemorrhoid ligation are usually required to treat all the packets normally present.

 

Sclerosis of hemorrhoids

Since hemorrhoidal pathology is mainly sustained by dilatation of the venous component of the hemorrhoidal pads and slippage (or prolapse) of the mucosa covering them, the same technique that is used for leg varicose veins can be used in its outpatient treatment: the sclerosis, which is the injection of a substance--kinurea in the case of hemorrhoids--that causesinflammation of the vein walls and subsequent closure of the vein itself. Two results are achieved with this technique: treatment of venous dilatations and fixation of the rectal mucosa to the underlying layers of the rectum.

Surgical procedures for hemorrhoids

Hemorrhoidectomy

Hemorrhoidectomy, or surgical excision of the hemorrhoid pads, is the classic surgery for the treatment of hemorrhoidal pathology. It allows for excellent results but, also depending on the technique of its execution, can involve an uncomfortable postoperative for the patient, at least for the first two weeks. In the early post-surgical period, in fact, the wounds may experience bleeding or otherwise exudation, which is exacerbated during defecation, which can be painful.
The patient needs to take appropriate analgesic therapy, and he or she needs to maintain very thorough local hygiene. As the wounds heal, this symptomatology subsides and fades. Normally, the healing process is completed within a month.
Our team performs the hemorrhoidectomy procedure using a technique developed in recent years that involves the use of Ligasure, a technologically advanced radiofrequency scalpel that makes it possible to limit postoperative pain, minimize tissue damage, and accelerate the healing process. Thanks to this, the patient has a recovery with minimal discomfort, even at the time of defecation, and can quickly return to their normal activities.

 

The THD

La THD, or transanal dearterization of internal hemorrhoids, is one of the surgical techniques for the treatment of hemorrhoidal disease that have taken off the most in recent years. To understand how it works, one must briefly recall what internal hemorrhoids are: they are pads consisting of a scaffold of various types of muscle and connective fibers, covered by the mucosa of the rectum, and containing a vascular system consisting of veins (the internal hemorrhoidal plexus) and arteries (branches of the superior rectal artery) joined together. The normal physiological function of hemorrhoids is regulated by the inflow of blood through the arterial vessels and its outflow through the veins.
In the presence of hemorrhoid disease, one of the ways to treat it is to "dearterialize" the hemorrhoid pads, that is, to interrupt their arterial inflow: this decreases the size of the hemorrhoid pads, bleeding and, in general, the patient's "discomfort." In addition to this, the surgery involves "mucopexy," which is the creation of a special suture that reduces the mucosal prolapse, returning the excess mucosa to its normal position in the rectum.
This surgery is indicated in hemorrhoids up to grade III.

Longo's technique

Referred to by this name is the rectal mucoprolassectomy with hemorrhoidopexy. In spite of the complicated definition, conceptually the procedure is quite simple: with a special mechanical circular suture machine of the "cut and sew" type introduced transanally, a cylinder of rectal mucosa is cut, and at the same time the two remaining mucosal slices are sutured with small metal clips.
The removed mucosa partly contains the hemorrhoid pads, the remaining part of which is "lifted" back to its initial position: it is basically a kind of "lifting" of the hemorrhoids, associated with removal of excess rectal mucosa.
The procedure has good functional results, and is indicated especially in grade III hemorrhoids .

 

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Dr. Salvatore Cuccomarino
Painless outpatient treatment of hemorrhoids, proctology, laparoscopic surgery of hernias and diastasis of the rectus, diverticulitis, surgical gastroenterology
61 Amerigo Vespucci Street
Tiorino,TO
EN
Phone 0110438161