Despite the fact that many are silent about this disease, hemorrhoids are considered one of the most common pathologies of the vascular system. The disease develops for various reasons, including: a sedentary lifestyle, or, on the contrary, a constant stay in a “standing” position, hereditary features of the veins, nutrition, etc. The disease is common among both the male population and women. However, most people ignore the symptoms of hemorrhoids, not considering them serious or embarrassed in front of a doctor. If the disease is not treated, it progresses, and complications develop. One of them is hemorrhoid thrombosis. Such a condition is not only accompanied by severe pain, but also quite dangerous. To prevent death, thrombectomy of the hemorrhoid is performed. It consists in removing the clot from the vein and restoring blood flow.
Thrombosis with hemorrhoids: causes
Hemorrhoids is a pathological change in the veins that drain blood from the muscles of the anus. Vessels become tortuous, areas of expansion appear. As a result, knots are formed that can fall out during physical exertion. Depending on which veins are involved in the pathological process, internal and external hemorrhoids are isolated. In the initial stages, the disease is characterized by periodic itching in the anus and the appearance of small knots with constipation. With hemorrhoids of stages 3 and 4, the affected veins constantly fall out of the anus, hurt and bleed. Due to the fact that the hemorrhoids are outside the anus, the sphincter is intensely reduced. This leads to the fact that the muscle infringes on the prolapsed vessels, and the blood flow in them is disturbed. Such changes are accompanied by pain in the area of the hemorrhoid.
Due to the infringement of the vessel, the blood loses its ability to circulate and thickens. This leads to the formation of a clot - a thrombus. The main causes of this complication include constipation and excessive exercise in people suffering from chronic hemorrhoids. As you know, thrombosis is one of the main causes of death. Despite the fact that the clot formed in the vein of the anus, it can circulate with the blood stream and end up in vital vessels, namely, in the pulmonary artery. In addition, such a complication is dangerous with tissue necrosis and the development of sepsis. To prevent this, it is required to perform a thrombectomy of the hemorrhoid. This is a surgical procedure that proctologists are proficient in.
Indications for thrombectomy
At the initial stages of thrombosis, therapeutic treatment is prescribed. It consists in the use of anti-inflammatory ointments and suppositories. These medications help reduce swelling and pain. Additionally, medications are prescribed that thin the blood. If, after the measures taken, the thrombus does not resolve, surgery is required. In addition to the lack of effect of conservative therapy, the following indications for surgical intervention are distinguished:
- Pain syndrome that is not amenable to drug treatment.
- Presence of symptoms of acute hemorrhoids in combination with signs of thrombosis.
- Contraindication to drug therapy (lactation, pregnancy).
- Signs of necrosis of the strangulated node.
- The desire of the patient to eliminate the disease by surgery.
Based on this, hemorrhoidal thrombectomy is not always an emergency operation, but can be carried out in a planned manner (if there is no risk of complications in the near future). This manipulation is performed both in the surgical departments of regional and city hospitals, and in specialized proctology clinics.
Contraindications for surgical treatment
Removing a blood clot from a hemorrhoid is not considered a difficult operation for an experienced surgeon. This operation does not requireperforming intravenous anesthesia, so there are few contraindications to it. Thrombectomy of the hemorrhoid during pregnancy and lactation is performed only if there is an urgent need for surgery. Such physiological conditions are not contraindicated.
Surgical treatment cannot be performed in cases where there is a risk of spreading infection throughout the body. Therefore, the following diseases are considered contraindications:
- Inflammation of the rectum (proctitis) and surrounding tissue.
- Infection of the perianal area.
- Systemic blood poisoning - sepsis.
In addition to acute inflammatory processes, the extremely severe general condition of the patient is a contraindication.
Types of surgical interventions
Hemorrhoids complicated by thrombosis can be removed in several ways. The choice of a surgical method depends on what equipment is available in the clinic, the severity of the patient's condition and the presence of contraindications. External hemorrhoids are removed in the following ways:
- Surgical treatment according to Milligan-Morgan.
- Laser photocoagulation.
- Radio wave treatment.
Such surgical procedures are performed for severe hemorrhoids, when complete removal of the node is required. If the vessels can be saved, only the removal of the clot from the vein is performed. Thrombectomy of the internal hemorrhoidal node is more difficult to carry out, since surgical access in suchcases is limited. For this reason, it is easier for the doctor to completely remove the damaged vessels using the Milligan-Morgan operation.
Preparing for a thrombectomy
Thrombectomy of hemorrhoidal vessels is a simple operation and takes about 10-15 minutes. This type of treatment does not require general anesthesia. In some cases, this manipulation is performed in an outpatient setting in the presence of a treatment room and surgical equipment. Despite this, standard tests are required before thrombectomy. These include: testing for HIV and hepatitis, microreaction, KLA, OAM, determination of blood glucose. Also, patients must undergo a fluorographic examination and an ECG before the operation.
2-3 days before thrombectomy, the patient should refuse food that causes gas formation. It is recommended to drink kefir, give preference to baked vegetables and soups. Dinner on the eve of the procedure should be light. A few hours before the operation, the lower intestines are cleaned. For this purpose, 2 enemas are done with an interval of 40-60 minutes.
Thrombectomy technique
To provide access to the thrombosed node, the patient should take the correct position: it is necessary to lie on the right side with legs bent and pressed to the stomach. The surgeon isolates the damaged vessels and cuts them with an anesthetic solution. After processing the node, an incision is made in the projection of the thrombus. If the blood flow in the vein is not disturbed, the clot comes out on its own. Sometimes a surgical clamp is required to remove it. After cleaning the clot, several sutures are placed on the vessel.
Immediately after the procedure, the patient's condition improves. Within a few hours, the symptoms of thrombosis are completely stopped. Within 4-5 days, it is required to change sterile dressings on the wound. The incision site heals quickly and the patient can lead a normal life.
Benefits of laser surgery
An alternative to the surgical method is laser thrombectomy of the external hemorrhoid. This method is similar to the operation. The difference is that instead of a scalpel, a laser beam is used to incise the vessel. However, the removal of a thrombus from a vein by this method is rarely performed. In most cases, laser treatment is aimed at excising the hemorrhoid. The advantages of this method are the speed of the operation and the absence of bleeding, which accompanies the traditional incision. The laser allows you to simultaneously coagulate the vessels, thereby carrying out their sclerosis.
Treatment is performed on an outpatient basis. It takes no more than half an hour, after which the patient can go home. After laser removal of an external hemorrhoid, there is no need for stitches and dressings.
Possible complications of thrombectomy
One of the minimally invasive surgical methods of treatment is hemorrhoid thrombectomy. Complications after this manipulation are extremely rare. Often, surgery and healingpasses quickly and painlessly. Possible complications include:
- Pain syndrome.
- Bleeding.
- Infection of the wound surface.
With severe discomfort in the anus, suppositories and ointments with an analgesic effect are prescribed. They help eliminate swelling and pain. After 5-7 days, the need for taking medications disappears. Infection or bleeding occurs when hygiene is not observed in the postoperative period. To prevent these complications from developing, you should wash the anus with warm water after each act of defecation. Also avoid constipation.
Recovery period
Return to normal life after thrombectomy is possible after 1 week. Special rehabilitation is not required. Painful symptoms disappear immediately after hemorrhoid thrombectomy. Recovery is fast, the patient feels relief already during the operation. When examining the anus after 3 hours, signs of thrombosis are completely absent.
It should be remembered that such a surgical intervention does not relieve the patient of the underlying disease - hemorrhoids. Therefore, to prevent exacerbation and re-thrombosis, diet and hygiene must be followed.
Reviews
Hemorrhoidal thrombectomy is a necessary procedure. If such a measure is not implemented, severe complications with a possible fatal outcome develop. According todoctors, hemorrhoid thrombectomy is an important operation that every surgeon should be able to perform. Only in this way can tissue necrosis and infection be avoided. However, thrombectomy will not help eliminate hemorrhoids, which cause not only blood clots in damaged vessels, but also other complications. Therefore, doctors recommend first of all to treat the underlying disease, as well as to engage in its prevention.
As for patients, they respond positively to this procedure, as it can significantly alleviate the pathological condition and get rid of the acute manifestation of symptoms.
Which clinics perform thrombectomy?
Currently, hemorrhoid thrombectomy in Moscow is carried out in many clinics. The operation is performed both in public hospitals and private medical institutions (the ATLANTiK laser surgery center, the DeltaClinic multidisciplinary medical center, the He althy Capital medical center, and others). In an emergency, surgical treatment is performed free of charge. If the patient wants to have an operation in a private clinic or on his own (in the absence of strict indications), the cost of manipulation ranges from 1.5 to 8 thousand rubles.
