Laser removal of internal haemorrhoids

Haemorrhoids are one of the most common reasons for visiting a proctologist. According to statistics, about 41% of all diseases of the lower intestine occur due to thrombosis and inflammation of the rectal veins. But in reality, these figures may be much higher, since not everyone suffering from haemorrhoids seeks help. 

But this disease requires immediate treatment – if left unattended, it can lead to serious complications. And modern treatment methods, in particular laser removal of haemorrhoids, allow you to quickly and effectively eliminate the problem. 

When to see a doctor

At the initial stage haemorrhoids do not make themselves felt. But regular constipation, a sedentary lifestyle, excess weight, hereditary predisposition and other provoking factors allow the disease to take hold, and changes in the veins of the rectum become irreversible. 

Therefore, it is important to pay attention to any symptoms of haemorrhoids, even those that are not entirely obvious:

• pain in the anus during bowel movements and/or immediately after it;
• itching around the anus;
• sensation of a foreign body in the rectum;
• feeling of incomplete bowel movement;
• traces of blood on underwear or toilet paper;
• traces of blood and/or mucus in the stool.

It is important to understand that haemorrhoids with internal haemorrhoids can only be detected by a doctor during an examination. Therefore, the absence of this sign does not mean the absence of haemorrhoids if one or more of the above symptoms are observed. 

Complications of haemorrhoids

Haemorrhoids cannot be ignored, as this is not just a disease accompanied by unpleasant symptoms. Without treatment, the following complications may develop:

• anemia due to bleeding of haemorrhoids;
• infectious complications, including purulent abscess;
• thrombosis of the rectal veins with impaired blood supply to the tissues;
• strangulation of haemorrhoids, which can lead to tissue necrosis.

Each of these conditions has its own consequences – extremely painful and capable of causing complications for the entire body. 

Choice of treatment method

Unfortunately, conservative treatments for haemorrhoids are very limited. They make it possible to normalize the condition of the rectal veins only at the first stage of the disease, and only if the provoking factors (obesity, constipation, physical inactivity, heavy physical labor, etc.) are eliminated simultaneously with the treatment. 

Therefore, the preferred method of treatment remains surgical – removal of pathologically altered sections of the rectal veins. Today, laser technologies and classical methods are used, which are selected individually for each patient – depending on the stage of haemorrhoids:

• Laser thrombectomy. It is carried out at 1–2 stage of haemorrhoids; during the operation, a section of the haemorrhoid with a blood clot is removed using a laser. 
• Method HAL-RAR. A complex operation during which the blood supply to pathological nodes is stopped and they are tightened and fixed. 
• Operation Longo is a stapled haemorrhoidopexy for certain forms of prolapse of internal haemorrhoidal tissue. Removing the ring of mucous membrane and staple the edges tightens the prolapse; external nodes are not removed in this way. The method is not automatically prescribed at stages III–IV. The doctor compares its possible benefits with the risk of relapse, complications and alternatives. Read more on the topic: 3 · 4.
• Haemorrhoidectomy according to Milligan-Morgan. The operation is performed for haemorrhoids at stages 3-4 and involves comprehensive removal of pathological nodes.

The intervention is carried out using the most gentle methods, due to which the recovery period is reduced to a minimum, and you can return to your normal life (with minor restrictions) on the day of the operation. 

Preparation for surgery

The most important stage is the preoperative examination. Its goal is to establish all the features of the disease on which the choice of treatment method depends, as well as to exclude possible contraindications to intervention. 

First of all, a medical examination is necessary, before which you need to follow several recommendations:

• before visiting the doctor, empty your bowels;
• one day before the examination, exclude from your diet foods that stimulate gas formation in the intestines and bloating;
• for persistent constipation, it may be necessary to take a laxative or perform a cleansing enema, unless this is contraindicated;
• After bowel movements, avoid eating until you have been examined by a doctor. 

For acute haemorrhoids, which makes bowel movements extremely painful or impossible, no preparation for examination is required. 

Also at the preparatory stage, it is necessary to take blood and urine tests, which provide the doctor with key information about the patient’s overall health status. 

How the operation is performed

The anesthesia option is chosen together with the anesthesiologist: local, regional or general anesthesia is possible, depending on the intervention and the patient’s condition. Spinal and epidural anesthesia have their own contraindications and complications and do not automatically eliminate all the risks of general anesthesia. Pain relief may also be required after surgery; its scheme and actions in case of increased pain are discussed in advance.

The duration of the operation varies from 15 to 40 minutes, depending on the volume and complexity of the intervention. 

After removal of haemorrhoids, the patient is transferred to a comfortable room under the supervision of medical personnel. 

Since the operations are carried out using modern methods, there is no need for a long hospital stay – on the same day, the patient is prepared with documents for discharge and additional recommendations for the rehabilitation period. 

Postoperative period

Upon discharge, the patient is given prescriptions and recommendations, which are extremely important to follow exactly. The list of medications may include anti-inflammatory, painkillers, wound healing, or other drugs. And to speed up recovery, correction of diet, level of physical activity, etc. may be recommended.

Tactics for completing the rehabilitation period are formed for each patient personally, depending on the characteristics of the clinical case. 

Upon discharge, the patient is given a date for a follow-up examination, during which the doctor will evaluate the effectiveness of the treatment and advise on the prevention of haemorrhoids in the future.