Haemorrhoidectomy by Milligan-Morgan

Surgical treatment of haemorrhoids is optimal in the late stages of the disease, when other methods – diet, medication, minimally invasive techniques – do not bring results.

Advanced forms manifest clearly: itching, pain in the anal area become unbearable, dense nodes prolapse with every act of defecation, do not retract, and bleed.
The Milligan-Morgan haemorrhoidectomy is a classic surgical method, named after the authors who proposed it a hundred years ago. Despite the introduction of minimally invasive technologies, the operation is still considered the benchmark in proctology.

Advantages

The main advantage of the method is absolute radicalism:

• the nodes causing symptoms are removed, although individual predisposition and risk of recurrence are not completely eliminated;
• The effect is long-lasting – more than 10 years, relapses are extremely rare;
• The function of the rectum is not affected.

The professionalism of the doctor directly affects the final result. Despite the relative simplicity of the method, there are a number of nuances and technological features that only a surgeon with a wealth of skills can handle.

Possible complications – narrowing, deformation of the anal canal – occur when the medical process is grossly violated by unprepared personnel, or when a patient ignores the doctor’s recommendations.

Indications

There are specific reasons for radical surgical treatment of haemorrhoidal disease:

• No effect from long-term conservative therapy;
• Recurrence of the disease, complications after minimally invasive interventions;
• Haemorrhoids III– Stage IV;
• thrombosis, inflammation, necrosis of nodes;
• intense bleeding leading to severe anemia;
• impossibility of performing conservative surgeries – merging of nodes, paraproctitis, anal fissure.

Contraindications

Milligan-Morgan haemorrhoidectomy is not performed in acute inflammatory or oncological processes, uncompensated somatic pathology, or blood formation disorders. It is recommended for pregnant women to undergo surgery after childbirth.

Preparation

A mandatory condition for surgical treatment is the informed consent of the patient. If Proctologist reasonably recommends haemorrhoidectomy, there is nothing to fear.
Once the decision is made, a standard examination protocol is assigned:

• Blood tests – complete blood count, biochemical, coagulation, blood type and Rh factor, viral hepatitis, HIV;
• Chest X-ray;
• Electrocardiogram;
• Urinalysis;
• Examination by a therapist, anesthesiologist, for women – a gynecologist.

If necessary, additional laboratory and instrumental diagnostics are carried out. 

Two to three days before surgery, the patient avoids foods that cause indigestion, as well as medications that affect blood clotting. The day before, the intestines are cleaned using an enema or special preparations (Fortrans).

Pain Relief

Accessing the anal canal is complex and painful, so successful surgery is impossible without proper anesthesia.

For haemorrhoidectomy, spinal-epidural anesthesia is used: the drug is injected into the spinal area at the level of the lumbar vertebrae. Modern anesthetics are safe, act quickly – within 5 minutes, sensation below the waist disappears. The operation goes smoothly – the patient does not experience psychological or physical discomfort.

To minimize postoperative pain, an epidural catheter is installed – a thin flexible tube through which pain-relieving medication is administered.

Procedure

During the surgical intervention, the surgeon clamps, sutures, and cuts off the enlarged haemorrhoids along with the underlying tissues. The process takes on average 30 minutes.

Haemorrhoidectomy is performed in three modifications:

1. Open. External and internal nodes are removed simultaneously. No stitches are applied; the wounds heal on their own.
2. Closed. Postoperative wounds are sutured with absorbable material.
3. Submucosal. The mucosa over the haemorrhoidal tissue is cut, and after removing the pathological formation, it is tightened with a surgical thread.

The use of the modern LigaSure electrosurgical device does not involve the drawbacks of traditional methods: bleeding, postoperative inflammation.

The electrical impulses generated by the device quickly and reliably seal blood vessels without damaging the surrounding tissues. The duration of the procedure is reduced by 10-15 minutes, pain intensity decreases, and recovery is faster.

Rehabilitation

The sensations after Milligan-Morgan surgery are more pronounced than after minimally invasive methods. Recovery takes one and a half to two months.
Pain persists for the first few days, then gradually subsides, only bothering during bowel movements. After a month, the patient experiences no discomfort.

Main components of the rehabilitation period:

• Prevention of constipation. Diet, fluid intake regimen, and herbal laxatives help regulate bowel movements.
• Adequate pain relief. Non-steroidal anti-inflammatory drugs, analgesics, and antispasmodics make the early stage more bearable.
• Careful wound care. Antibacterial ointments, suppositories, hemostatic agents reduce soft tissue swelling, prevent infection and bleeding.

The doctor examines the patient the next day, after 7-10 days, and 2 weeks following haemorrhoidectomy, adjusting prescriptions depending on the course of the wound healing process.

Subsequent medical support includes counseling and lifestyle recommendations:

• regulate bowel movements;
• maintain perianal hygiene;
• increase fiber intake in the diet;
• refrain from sports, saunas, and hot baths for 2-3 months.

Haemorrhoidectomy radically eliminates problems that have accumulated over the years. If the surgical intervention is performed on time, the recovery period will be easier. This is better than suffering from pain for the rest of your life.