General Practice 2022

Surgery for hemorrhoids: 6 main types and pós-operatório

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Surgery for hemorrhoids: 6 main types and pós-operatório
Surgery for hemorrhoids: 6 main types and pós-operatório

To remove internal or external hemorrhoids, surgery may be necessary, which is indicated for patients who, even after undergoing treatment with medication and proper diet, maintain pain, discomfort, itching and bleeding, especially when evacuating.

There are several techniques to remove hemorrhoids, the most common being hemorrhoidectomy, which is the traditional technique that is done through a cut. Recovery takes between 1 week and 1 month, and it is necessary to stay in the hospital for about 2 days and maintain good hygiene of the intimate region during the recovery time.

In most cases, surgeries to remove hemorrhoids are performed under general anesthesia and require the patient to stay in the hospital for about 2 days.To remove hemorrhoids, the proctologist must choose the most suitable technique for each case, as they can vary according to the type of hemorrhoid the patient has. Some techniques to remove internal or external hemorrhoids can be:

1. Hemorrhoidectomy

Hemorrhoidectomy is the most common surgery and involves removing the hemorrhoids through a cut. For this reason it is widely used in external or internal grade 3 and 4 hemorrhoids.

2. Technique by THD/ Endopex

This is an uncut surgery, in which the doctor uses an ultrasound device to identify the vessels that carry blood to the hemorrhoids. Once these vessels are identified, the doctor stops the blood circulation by sewing the artery, which causes the hemorrhoid to close and dry out over time, and the stitches are absorbed. This technique can be used for grade 2, 3 or 4 hemorrhoids.

3. PPH Technique

The PPH technique allows the hemorrhoids to be fixed in their original position, through the use of special titanium clamps. This procedure does not require sutures, has a quick recovery time, and is performed on grade 2 and 3 internal hemorrhoids.

4. Elastic ligation

This is a treatment where a small elastic band is applied to the base of the hemorrhoid, which will interrupt the transport of blood and cause the death of the hemorrhoid, being common in the treatment of grades 2 and 3 hemorrhoids.

5. Sclerotherapy

In this technique, a product that causes tissue death is injected into the vessels of hemorrhoids, being used for the treatment of grade 1 and 2 hemorrhoids. Understand how sclerotherapy is performed.

6. Infrared coagulation

Infrared coagulation is a technique that can be used to treat internal bleeding in hemorrhoids. For this, the doctor uses a device with an infrared light that heats the place and creates a scar on the hemorrhoid, causing the blood to stop being able to pass and, consequently, the hemorrhoid tissues harden and end up falling out.Infrared clotting typically has very few side effects and causes very little discomfort.

Classification of the degree of internal hemorrhoids

Internal hemorrhoids are those that develop and remain inside the anus, and may have different degrees, such as:

  • Grade 1 - Hemorrhoid located inside the anus, with a slight increase in the veins;
  • Grade 2 - Hemorrhoids that come out of the anus during defecation and return spontaneously;
  • Grade 3 - Hemorrhoids that come out of the anus during defecation and that must be reinserted into the anus by hand;
  • Grade 4 - Hemorrhoid that develops inside the anus but due to its enlargement it comes out through the anus, which can cause rectal prolapse, which is the exit of the final part of the intestine through the anus.

External hemorrhoids, are those that are on the outside of the anus, and these can also be removed through surgery, because they cause discomfort mainly when sitting and defecating.

What is the postoperative period like

Although the surgery does not cause pain, in the postoperative period it is normal for the patient to feel pain in the perineal region, especially when sitting and during the first bowel movement after surgery, as this region is more sensitive. In this way, the doctor usually indicates:

  • Use of analgesics to control pain and discomfort, such as paracetamol every 8 hours;
  • Use of laxatives to make stools softer and easier to evacuate;
  • Performing a cold water sitz bath for 20 minutes, the number of times necessary to reduce discomfort;
  • Avoid the use of toilet paper, washing the anal area, after defecating, with warm water and neutral soap;
  • Use a doctor-directed ointment twice a day to help heal the area.

After surgery, it is recommended to use a round, buoy-shaped pillow to sit on, in order to reduce the risk of bleeding and reduce pain.In addition, during the first month after surgery, you should prefer foods rich in fiber and drink plenty of water, so that the stools are softer and easier to evacuate. Check out the following video on how to eat to facilitate intestinal transit and prevent hemorrhoids:

What is the recovery time

Recovery from hemorrhoid surgery depends on the type and degree of hemorrhoid and the surgical technique performed, which can vary between 1 week and 1 month, so that the patient can resume their daily activities normally.

It is normal that during the first week after surgery, the patient has small blood loss from the anal region, however, if this bleeding is intense, it is recommended to go to the hospital to check if he is recovering properly.

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