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email:
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Hemorrhoidopathy

HEMORRHOIDOPATHY

INTRODUCTION - DEFINITION

The hemorrhoids, known since antiquity, had always been a matter of argue as to precise their anatomical position, their role in the defecation mechanism, the effectiveness of one or the other treatment. The hemorrhoidal disease, although so common, barely is beginning to reveal all its own secrets.

Hemorrhoids are being gradually developing and occurring over the adults. Factors favoring their occurrence are hereditary, chronic constipation, pregnancy as well as specific dietary habits.

The hemorrhoidopathy is a frequent pathology of the anal region, it is completely benign, but with a wide impact on quality of life. The hemorrhoids result from hypertrophy and dilatation of the hemorrhoidal veins, which create varicose veins situated in the lowest rectal and anal portion.

They are divided into internal, when developed in the anal canal and external when developed low and can be “visible”.

 

SYMPTOMS

Sometimes hemorrhoidopathy may not give any symptom but usually causes 4-typed symptoms:

        i.            Congestion Crises – it is a sense of heaviness in the anus, often accompanied with itching. Clinical examination shows a dilatation of usually internal hemorrhoids and the crisis recedes under gentle treatment in a few days.

      ii.            Thrombosis: - it is due to the formation of a thrombus (from coagulated blood) in an internal or external hemorrhoid. The main symptom is a severe anal pain suddenly occurred. In case of external hemorrhoid, it is occurred a round, mauve lesion which is very painful on palpation.

    iii.            Haemorrhage: - it’s about loss of vivid, red blood in small quantity during defecation. If these hemorrhages are frequent, may cause anemia with drop in hematocrit.

    iv.            Hemorrhoidal prolapse: - it is an occurrence of hemorrhoids, mostly after defecating, which patient can push back into the anal canal with a finger tip.

 

TREATMENT

The surgical treatment known since the era of Hippocrates is the one providing the best and long-term, definitive results. Many techniques have been proposed from time to time, most of which present only historical interest.

The treatment is not always surgical but even if it is, it can be performed without hospitalization. Medical management lies in dietary instructions, in avoidance of excesses, alcohol and spices. It is usually provided a combination of oral and topical (ointment) treatment.

The endoscopic treatment includes sclerosing injections preventing hemorrhoids from filling with blood, elastic bandage ligation or radiofrequency application.

Only the attending physician is responsible for the selection of treatment, which must be completely adapted to the patient’s needs.

It is required a small enema before surgery. The depilation (shaving) of the region is essential. There are applied compression stockings. The operation is performed under epidural or general anesthesia.

The two main operations are:

        i.            Hemorrhoidectomy according to MILLIGAN & MORGAN technique

      ii.            Hemorrhoidectomy according to LONGO technique

 

MILLIGAN & MORGAN hemorrhoidectomy: lies in the removal of hemorrhoids in 3rd -7th - 11th (anal) part and in the ligation of feeder vessels. With the use of new technologies (e.g. Laser, ultrasonic scissors), the postoperative course has nothing to do with the painful postoperative course a decade ago, since the reintegration into everyday life is quiet fast. It has a recurrence rate of 2% at 5 years.

LONGO hemorrhoidectomy: it is the latest concept for simultaneous treatment of hemorrhoidopathy and rectal mucosal prolapsed. With this technique, the operation is internally performed over the anal canal, in an area without nerves and therefore not sufferable, resulting in almost nonexistent, postoperative pain. The philosophy of intervention is the cutting and stapling of the mucosal remnant, i.e. the interior rectal lining and simultaneously the feeder vessels for hemorrhoids.

Patient's return to room is approximately obtained in 1 hour, gets up and receives nutrition on the same day. The hospital attendance usually lasts 24 hours.

 

COMPLICATIONS & LIFE AFTER SURGERY

After returning home, the diet is the usual, avoiding the excesses of course. Treatment after surgery concerns analgesia (no aspirin) and the treatment of constipation. It is usual the detection of a very small amount of blood when defecating even one month after surgery.

The recovery is rapid and the patient returns to his social and labor obligations in two 24-hr.

The hemorrhoidopathy is a very common disease but it requires surgeon’s careful evaluation and especially the selection of the appropriate therapeutic method. There is not a method for all the cases, but it should be preferred with regard to the patient's problem.

 

 

 

EDITORIAL

2013-11-22

Welcome

Dear friends and citizens of the internet... This website aims to be a different site for the medical aesthetics, the completeness, the objectivity of information and the immediacy of the communication with the patients and their friends. Those who are interested can get instructions and answers to questions, make online appointment, and communicate with each other…. The surgical science requires the surgeon a complete and honest commitment.During my university studies and specialty, my teachers taught me to treat patients comprehensively and not just for their surgical problem. So i did my best to acquire clinical skills, surgical techniques and the humanitarian principles which were necessary. The quality of services which have to be provided to patients depend on me and my partners group, for which I am responsible. The use of technology is now mandatory in our daily lives, but this does not makes us lose our human sense. ... I hope the adjustment period will be brief.Surgical techniques old and new, are an important chapter in my activity. Each patient is unique and requires a surgical solution, tailor-made for him. Of course, nowadays, the art of `making` is progressively replaced by the `process that should be followed`. This is due to the elimination of borders in the international scientific community, the easy exchange of views and experiences and to the installation of extremely detailed protocol. The technological progress is changing the old habits and improves the results. My education will be continued until the end of my activity. The advice and the suggestions are welcome and essential to the improvement of the quality of our services. Providing a high level of medical services is my primary concern but not the only! On this web site, you will find information and explanations regarding the most surgical diseases. The human communication remains irreplaceable, that is why there is nothing better than a meeting with the doctor.I want to thank everyone who trusted and continue to trust me all these years. We are going on..... The difficulty of our times, makes more necessary than ever the return to values such as honesty, sincerity, efficiency, pride. Values that have characterized the generations of our grandparents and our fathers, who built this place with meager means...