Treatment of haemorrhoids stage 4 – Longo operation

The Longo procedure, or stapled haemorrhoidopexy, lifts prolapsed internal haemorrhoidal tissue by removing a ring of mucosa above the dentate line and fastening the edges with staples. It is not considered a universal “gold standard” for late stages and does not eliminate external nodes. In the ASCRS guidelines, it is not routinely recommended as the first surgical option due to limitations in effectiveness and risk profile. Postoperative pain and other complications are possible; benefits and alternatives are discussed before choosing the method.

The essence of the operation

Under the mucous membrane of the rectum there are anal ridges that protrude into its lumen and hermetically close the walls of the anal canal when the sphincters contract. These rollers are attached to the intestinal walls using thin ligaments. But if more blood begins to flow into the cavernous veins of the upper plexus of the rectum under the influence of external factors and a number of diseases, then the anal ridges enlarge, and the ligaments that fix them are destroyed. After this, the ridges move down and become haemorrhoids, which fall out of the anus and cause pain.

With stapled haemorrhoidopexy, the internal prolapsed tissues are moved higher, and their blood supply changes. The staple line is located inside the rectum, so the external wound usually differs from the wound after excision of the haemorrhoids. This does not mean there is a complete absence of tissue damage or the need for subsequent monitoring. After discharge, the patient receives recommendations regarding bowel movements, pain relief, and follow-up examinations; severe pain, fever, and significant bleeding require urgent medical attention.

Possibility of replacement with conservative treatment

Stage 4 haemorrhoids are an already advanced pathology that occurs due to missing or improper treatment, especially with folk remedies. This condition is equally common in men and women and occurs at any age. Stage 4 haemorrhoids are accompanied by tissue atrophy, so haemorrhoids can fall out even from sneezing, and they can no longer be straightened by hand, and defecation can be spontaneous.

By location, haemorrhoids are internal, external and combined. Appearance is characterized by the location of nodules around the anus. With internal haemorrhoids, they remain in the rectum, but cause many unpleasant sensations: pain, itching, etc. In the case of combined haemorrhoids, the nodes are located both inside the intestine and outside.

4th degree of the disease is the last and threatens not only the health, but also the life of the patient. Complications of this stage of haemorrhoids may include bleeding and pinching of the anal muscles along with blood vessels, as well as necrosis, thrombosis, paraproctitis.

With pronounced irreducible prolapse, surgical evaluation is often required, but medications do not automatically become “strictly contraindicated.” Stool correction and symptomatic relief can be part of preparation and recovery. Pain relievers are chosen taking into account bleeding, stomach and kidney conditions, and other medications. Antibiotics are not prescribed to everyone for the treatment of ordinary haemorrhoids: they are needed in certain infectious and perioperative indications. The specific regimen is determined by the doctor after examination.

Advantages of surgery using the Longo technique

The main difference between the Longo operation and other surgical methods is that the haemorrhoids remain in the body, but by moving upward and suturing the vessels, their blood supply stops and they dry out. In addition, the rectal mucosa is pulled back to its original position and its functionality is automatically restored.

But the advantages of Longo’s technique do not end there. It is minimally invasive and, accordingly, low-traumatic, and also has the following list of advantages:

• short duration of the operation – from 20 to 40 minutes;
• no need for general anesthesia – local anesthesia is sufficient;
• no blood loss and minimal tissue trauma;
• use of disposable tools;
• minimized risk of complications and relapses;
• fast recovery period;
• lack of dressings, physiotherapy, etc.

The length of stay after surgery depends on overall well-being, pain control, urination, and the absence of early complications. Some patients require only a short observation period, while others need more time. It is not possible to claim that pain occurs in only a fixed 10% without specific research. Discharge does not equate to full recovery: activity restrictions and follow-up examinations are determined individually.

Disadvantages of Longo’s operation

The Longo procedure does not eliminate external haemorrhoids and is not suitable for every patient with internal nodes. Compared to node excision, there may be differences in pain and recovery, but the risk of recurrence and rare serious complications requires separate discussion. In cases of tumors, active infection, and other diseases, the approach is determined individually. The cost of equipment affects the estimate; however, information about a foreign MHI policy does not describe payment for treatment in Kiev. The method cannot be considered preferable solely because it is technically available. More on the topic: external haemorrhoids.

Operation progress

Operation Longo is a stapled haemorrhoidopexy. It received this name due to the fact that titanium staples are applied clockwise around the wound inside the intestine. The procedure is performed in stages:

1. The patient is placed on a chair resembling a gynecological one, and his legs are fixed, simplifying access to the operated area.
2. The anal area is anesthetized and the anus is pulled apart using special clamps.
3. The rectal dilator is inserted and fixed, and then the anoscope with obturator.
4. Circular purse-string sutures are applied to the intestinal mucosa above the dentate line, checking the distance between the gaps.
5. The suture is tightened, and the ends of the threads are brought out through the rectal canal into a Longo stapler inserted into the rectum.
6. Part of the intestinal lining is excised and staples are placed around the wound.
7. The stapler, anoscope and dilator are removed from the anus.
8. A turunda with medicinal anesthetic ointment is inserted into the anus and a gas outlet is installed for a day.

During the rehabilitation period, the patient is prohibited from lifting weights and is required to take frequent walks, carefully monitor hygiene, and temporarily switch to gentle dietary foods.

Our clinic is equipped with modern endoscopic equipment and treats haemorrhoids using high-tech minimally invasive interventions. Operation Longo is one of our main areas, so we invite everyone with stage 3-4 haemorrhoids for a consultation and subsequent return to normal life without pain and discomfort!