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Haemorrhoidectomy (Milligan-Morgan)

Haemorrhoids

Haemorrhoids, which are also known as "piles”, are swollen blood vessels that form in the anus and rectum. They are sometimes described as the varicose veins of the anus and rectum and are very common. Nearly half of us will be affected by haemorrhoids at some point during our lives.

The commonest cause is constipation. Excessive straining to open your bowels results in the normal veins becoming enlarged and forced downwards to become haemorrhoids. Other causes include pregnancy and childbirth. Sometimes haemorrhoids can run in families.

Symptoms of Haemorrhoids

Quite a few people don't get any symptoms at all from their haemorrhoids. The most frequent symptoms caused by haemorrhoids are:

  • Bleeding during bowel movements
  • Protrusion during bowel movements
  • Itching in the anal area
  • Pain
  • Sensitive lump(s) around the anus

Prolapsing haemorrhoids is the term used to describe the protrusion of the haemorrhoid which happens on bowel opening. Sometimes the haemorrhoid which prolapses can get stuck out and not go back. If this happens they can become very swollen and painful.

How Haemorrhoids Are Investigated?

The Surgeon will take a full history and carry out a clinical examination. Usually this will involve a rigid sigmoidoscopy and sometimes a proctoscopy as well. If you are over the age of 40 and have had any bleeding or change in bowel habit the doctor may recommend endoscopic examination of the bowel either by flexible sigmoidoscopy or colonoscopy to ensure that it is otherwise healthy, before treating any haemorrhoids.

Haemorrhoid Treatment

  • Most patients are advised to take a high fibre diet with plenty of fluids to avoid passing hard stools and needing to strain.
  • Mild haemorrhoidal symptoms sometimes respond to over the counter, non-prescription ointments and suppositories. Although they will not remove the haemorrhoid, they can relieve the discomfort.
  • Relief from uncomfortable haemorrhoids may also be obtained by sitting in warm water for a few minutes (sitz bath). When external haemorrhoids are very swollen and uncomfortable, the application of a cold compress such as ice wrapped in a towel can be helpful. Lying down with the legs up a little may help to reduce swelling.
  • Haemorrhoidectomy (Milligan – Morgan) is a surgical procedure which involves cutting off the haemorrhoidal tissue. This is a very effective treatment for large haemorrhoids which prolapse and are associated with significant external tags. This operation requires a general anaesthetic and may be associated with pain for several days afterwards.

What does the procedure involve?

An enema is usually given an hour or so before the operation to clear the lower part of the bowel. The operation is performed under a general anaesthetic. During the operation the haemorrhoids and tags are removed using an electrical cutting device (diathermy). Usually the wounds are left open. The operation takes around 45 minutes to complete.

What are the risks?

There are small risks associated with any operation. Pre-operative assessments are made of any heart or lung conditions, as well as any coexisting medical condition. During the hospital admission patients wear stockings to prevent thrombosis (blood clots).

Bleeding can occur after haemorrhoid surgery; most patients will notice small amounts of blood, particularly when they open their bowels. Usually this is a small amount but rarely it can be quite a lot, if that occurs patients must seek medical advice.

Infection is very rare; if patients develop increasing pain, fevers or flu-like symptoms they should seek medical advice.

Longer-term complications are rare but include:

  • Stenosis; narrowing of the back passage as a result of surgical scarring
  • Damage to sphincter muscles resulting in leakage problems after surgery

What happens after the operation?

A haemorrhoid surgery can be uncomfortable afterwards. You will have some local anaesthetic injected into the area; this will numb the pain for a few hours.

If the surgeon has placed a dressing pack in the anus this will be removed before discharge. Patients are allowed to eat and drink as soon as they feel able. Patients will normally be able to go home 2 days after the operation.

Oral pain medications will be prescribed, which you must take regularly to keep pain under control.

It will be uncomfortable when you first open your bowels after the operation, it is important that you do not avoid going to the lavatory. The discomfort will get better. Patents are given a regular stool softener to take for 4-6 weeks and are advised to avoid straining.

Patients are encouraged to keep mobile after the procedure. They should avoid heavy lifting or increased physical activities for about 6 weeks. Patients can normally resume driving after about 2 weeks but this may vary.

  • Haemorrhoidal artery ligation procedure (HAL Procedure) is a technique that involves identifying the blood vessels feeding the haemorrhoid using ultrasound and suturing them off. Further sutures are used to repair the prolapsing element of the haemorrhoids. HAL is suitable for most prolapsing haemorrhoids or those that bleed. Most cases are carried out under a short general anaesthetic. Patients go home the same day, the procedure is relatively painless and most people can return to work just 24-48 hours following the procedure.

What does the procedure involve?

An enema is usually given an hour or so before the operation to clear the lower pan of the bowel. The operation is usually performed under a general anaesthetic. During the operation the blood vessels feeding the haemorrhoids are identified using a special ultrasound probe. These vessels are then sutured to cut off the blood flow to the haemorrhoid.

Usually 3-4 vessels are found. The second part of the operation involves treating the prolapsing element of the haemorrhoid. Areas of haemorrhoidal prolapse are identified sutures are used to hold this up. This part of the operation is known as the Recto-Anal Repair (RAR)- The whole operation (HALO-RAR) takes around 45 minutes to complete. External skin tags, if present, are not routinely removed but many do shrink in size after the HAL-RAR procedure.

What are the risks?

There are small risks associated with any operation. Pre-operative assessments are made of any heart or lung conditions, as well as any co-existing medical condition.

Bleeding can occur after any haemorrhoid surgery; most patients will notice small amounts of blood, particularly when they open their bowels. Usually this is a small amount but rarely it can be quite a lot. If that occurs patients must seek medical advice.

Infection is very rare; if patients develop increasing pain, fevers or flu-like symptoms they should seek medical advice.

What happens after the operation?

You may feel uncomfortable after the operation but this is far less than experienced by patients undergoing haemorrhoidectomy. You will have some local anaesthetic injected into the area; this will numb the pain for a few hours. The commonest feeling patients describe is a feeling of "being kicked in the bottom”.

Patents are allowed to eat and drink as soon as they feel able.

Patents should be able to go home on the same day as the operation. You will be given painkillers to take by mouth; you should take these regularly to prevent pain coming on.

It may be a little uncomfortable when you first open your bowels after the operation, it is important that you do not avoid going to the lavatory. Any discomfort will get better. Patents are given a regular stool softener to take for 4-6 weeks and are advised to avoid straining.

Patients are encouraged to keep mobile after the procedure. They can normally return to normal activities including work and driving after about 48 hours but this may vary. They should avoid heavy lifting or increased physical activities for about 6 weeks.

A follow up visit with the surgeon is necessary after 1 month of the procedure.

LHP@ (LaserHemorrhoidoPlasty) — for haemorrhoids

LHP@ is used for the gentle therapy of haemorrhoids under appropriate anaesthesia and enables the endoluminal laser coagulation of both segmental and circular hemorrhoidal nodes. As the energy of the laser is inserted centrally into the hemorrhoidal node, the haemorrhoid can be treated according to its size without causing any damage to the anoderm or mucosa. No foreign materials (clamps) are needed, and LHP@ is not associated with any risk of stenosis. Healing is excellent because unlike conventional surgeries, there are no incisions or stitches.

What are the Effects of Laser Treatment with HeLP®?

Due to the targeted penetration of the laser, the enlarged haemorrhoids will also be cut off from their blood supply. The tissues shrink and relieve the haemorrhoids of their oversupply, Furthermore, continued sagging of the tissue is prevented by fixing it to the muscle layer below.

Within 7 to 14 days of the implementation of the procedure, the bleeding decreases as a result of the haemostatic effect of the laser. The hemorrhoidal tissue shrinks. This process continues over a period of up to 10 weeks.

What are the advantages of HeLP®?

HeLP® is a clean endoscopic treatment in which arteries are closed using photocoagulation. There are no incisions and no tissue is removed.

HeLP® treatment with laser radiation for haemorrhoids stands out due to the following advantages:

  • High level of safety
  • Ambulant surgery within 10 -15 minutes
  • Freedom from pain and symptoms
  • Quick return to normal activities
  • Very good results in 12 months

Important note

There is no link between haemorrhoids themselves and cancer; however, the symptoms of haemorrhoids can be similar to the symptoms of bowel cancer. You should always seek advice from your doctor about any symptoms, particularly bleeding, to ensure that they are properly investigated and treated.