Thrombectomy for acute thrombosis of the external haemorrhoidal node

Thrombectomy is the surgical removal of a blood clot from a haemorrhoid, usually an external one. For certain indications, the surgeon may suggest removing the entire thrombosed node; in other cases, conservative care is chosen. The use of a laser does not make the procedure “non-surgical” and does not mean that it treats all cases of grade I–II haemorrhoids. The decision depends on the duration of the thrombosis, the severity of pain and the condition of the tissues. Expected relief, pain relief, possible complications and the risk of recurrent symptoms are discussed before the intervention.

What is thrombectomy and what is it used for

Thrombectomy is the removal of a blood clot (thrombus) that partially or completely blocks the lumen of a vessel. Acute thrombosis of haemorrhoids – the formation of blood clots in the dilated veins of the anus and rectum – is a common complication occurring in a third of patients with chronic haemorrhoids.

Symptoms of thrombosis of grade I-II severity – constant pain (even outside of bowel movements), swelling, inflammation in the area of the affected node. If treatment is not carried out or is ineffective at these stages, the disease progresses to grade III severity. In this case, the inflammatory process spreads to the entire circumference of the anus, the nodes may undergo necrosis, ulcerate. In advanced cases, purulent paraproctitis develops (inflammation of the tissue surrounding the rectum) with the formation of abscesses and pararectal fistulas. Life-threatening complications are possible: severe bleeding, generalization of inflammation – development of sepsis.

The cause of these phenomena is a blood clot, which disrupts blood circulation and releases active substances that provoke an inflammatory process. Medication treatment only reduces the intensity of inflammation and slows further growth of the clot. A more radical method is the removal of the thrombus. The procedure can be carried out using the traditional “cold” method (with a standard scalpel) or using new technologies. In our clinic, a modern highly effective method for treating acute thrombosis of haemorrhoids is used – laser thrombectomy.

Advantages of Laser Thrombectomy

Laser thrombectomy is much faster than medication treatment and eliminates the symptoms of thrombosis. Pain completely disappears by the 2nd-3rd day after the procedure, whereas with pharmacotherapy it only starts to subside by the third day.

Advantages of the laser method over the traditional method:

• Bloodlessness – the laser reliably seals damaged blood vessels.
• Reduction in the likelihood of recurrence – the cavern capsule in the area of thrombosis is destroyed by laser radiation, which prevents the formation of new clots in this area.
• Infection control. Laser exposure does not guarantee wound sterility and does not replace the rules of asepsis, care, and monitoring; signs of infection require consulting a doctor.
• Fast patient recovery – you can return to usual activities on the day of the procedure or the next day.
• No need for general anesthesia, which reduces anesthetic risks and lowers the number of contraindications.

Laser thrombectomy is easily tolerated by patients, does not require sutures, or the use of painkillers after the procedure.

Indications and contraindications

Laser thrombectomy is performed for acute external or internal haemorrhoids and is recommended in the following cases:

• Acute thrombosis of I-II degree.
• Presence of single thrombi.
• Ineffectiveness of medication treatment, frequent recurrence of thrombosis.

Main contraindications:

• Thrombosis of III degree.
• Multiple thrombi.
• Severe bleeding.

In these cases, stitching or surgical removal of the affected node – haemorrhoidectomy – is indicated.

Preparation

Before the procedure, the following examinations are necessary:

• Examination by a proctologist with endoscopic study of the rectum – anoscopy, sigmoidoscopy.
• Examination by a therapist.
• Electrocardiography (ECG).
• A set of laboratory tests – complete blood and urine tests, blood biochemistry, tests for socially significant infections (HIV, syphilis, hepatitis), determination of blood group.

How the Procedure is Performed

The procedure is performed on an outpatient basis or in a day hospital. Before thrombectomy, anesthesia is administered – local injection of anesthetic or spinal-epidural anesthesia. The intervention is carried out with individually selected anesthesia, while the patient remains conscious and breathes independently.

The procedure includes the following stages:

1. The patient is placed on a gynecological chair or in the knee-elbow position on the table.
2. An antibiotic is injected into the tissue surrounding the anus to prevent infectious complications.
3. The node is punctured with a thick needle, through which the thrombus is evacuated.
4. The laser fiber is inserted through the needle and the cavern in the area of the former thrombosis is destroyed with high-temperature directed radiation.
5. The needle is removed.

Removal of a single thrombus takes 10-15 minutes. If local anesthesia was performed, the patient is discharged home immediately; after epidural anesthesia – after several hours of observation in the clinic.

Result

Laser thrombectomy immediately after the procedure provides the following positive effects:

• Pain relief, ability to defecate without discomfort.
• Disappearance of unsightly nodes, natural appearance of the anus.
• Ultimately – increased self-confidence, the ability to engage in favorite activities without being distracted by the “embarrassing” problem.

After the procedure, it is not necessary to follow a special diet or severe physical activity restrictions. For a week, there may be mild spotting of blood after defecation, which goes away on its own without treatment.

After the thrombectomy, the pain may decrease; however, recurrent thrombosis is possible. The outcome depends on the extent of the procedure and the further course of the disease; simple removal of the thrombus and excision of the thrombosed node are different options. In case of recurring complaints, an examination is required. HAL-RAR is mainly used for internal haemorrhoids and is not a universal treatment for recurrent thrombosis of the external node; subsequent management is chosen according to the established diagnosis.

Failure to follow the technology can cause laser thrombectomy to result in burns, suppuration, and bleeding. The high qualification and many years of experience of our proctologists allow us to avoid these severe negative consequences.