When hemorrhoids get severe enough they may require surgery to deal with the problem. There are several options available:
There are two types of traditional surgery: The Milligan-Morgan technique is where the three major hemorrhoid vessels are removed. To avoid a narrowing of the bowel the three pear-shaped incisions are left open with only skin and mucosa separating them. This technique is the most common type of surgery employed to combat hemorrhoids, and sets the standard by which all other hemorrhoid surgical techniques are compared.
The Ferguson technique is a modification of the Milligan-Morgan technique, except the incisions are partially sutured or coagulated. There is a high rate of suture breakage during bowel movement; therefore it brings no advantage in terms of healing or pain. Both of these traditional surgeries can be performed as a day-case procedure, however depending on pain severity after the operation it is often required that the patient remains in the hospital.
Stapled Hemorrhoidopexy (PPH) is a technique where a circular, bullet like device is inserted into the anus. The device pulls the excess tissue to be pulled into it while simultaneously stapling the remaining hemorrhoidal tissue. Patients experience less pain and are able to return to normal activities quicker with PPH compared to traditional surgeries. There are risks however: if too much muscle tissue is drawn into the device it can result in damage to the rectal wall. Also the internal muscles of the sphincter may stretch due to the insertion of the actual device, resulting in either short or long-term dysfunction.
The Harmonic Scalpel uses ultrasonic technology to precisely and accurately cut and coagulate the hemorrhoidal tissue. Like a miniscule soldering iron, the Harmonic Scalpel burns through the tissue at temperatures ranging from 50ºC to 100ºC removing the hemorrhoids. This heat also causes the blood to clot and coagulate instantly. By contrast, electro surgery coagulates the blood by burning at temperatures in excess of 150ºC. The Harmonic Scalpel technique is the most preferred out of the two options due to there being less postoperative pain due to avoidance of thermal inhury.
Laser surgery is a very advanced and very effective method of combating hemorrhoids. Skilled surgeons use laser light with pinpoint accuracy to literally vaporise the hemorrhoids. It is precise, accurate and rapid and is able to heal quickly and unimpaired. There is less discomfort, less medication and being kept in hospital is not usually required.
Finally atomizing hemorrhoids is a brand new and emerging technique where a device literally disintegrates and atomises the hemorrhoids, turning them into a mist of tiny particles that are quickly vacuumed away. His method has been proven to cause the best postoperative results and fewer anal tags than any of the traditional techniques.
Obviously every single case is different, and it is advised that anyone who suffers with hemorrhoids consults their GP who will talk them through each of the procedures in much more detain and recommend the option that will best suit the patient.
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