Ligation of internal hemorrhoids. Description of methods. Consultation of a coproctologist at City Clinical Hospital No. 31. Appointment appointment by phone. +7(499)936-99-89.
Ligation of internal hemorrhoids
Ligation of hemorrhoids with latex rings – a minimally invasive non-surgical method, the mechanism of action of which is the mechanical clamping of the leg of the node in order to stop the supply of blood to the pathological element.
The technique is used for bloodless removal of internal hemorrhoids and is characterized by a short list of contraindications, a minimal risk of complications and a short recovery period.
Before the operation, you should clean the intestines, and during a short rehabilitation period, follow a diet, observe a protective regimen and take medications prescribed by a doctor.
The only drawback of the low-traumatic technique is the limited use. Ligation is not recommended for irreducible hemorrhoids, for large and multiple elements, as well as for complicated pathology. Therefore, you should contact a proctologist as soon as possible!
The essence of the technique
Ligation with latex rings is used for the radical treatment of uncomplicated internal hemorrhoids I-II, in some cases – III stage of development.
The essence of the method is the mechanical disconnection of the node from blood supply by ligating its legs. The cessation of blood supply leads to the death of the node.
The departure of the nodes occurs along with the applied ligature. This is an imperceptible for the patient, absolutely painless process.
Ligation of hemorrhoids with latex rings is a fairly effective method. To prevent the disease from returning, it is necessary to adhere to the rules of prevention.
Indications
The most common indication for latex ring ligation is is chronic internal hemorrhoids I-III stages. In advanced cases, doctors will be forced to turn to a full-fledged surgical operation to excise the nodes.
In order to choose the right intervention technique, a minimum amount of diagnostic procedures is prescribed.
Diagnostics
The main diagnostic procedure is an endoscopic examination of the rectum (anoscopy). This method, absolutely harmless to the body, will provide the full amount of information:
___ • number of internal hemorrhoids, their size and location,
___ • condition of the intestinal mucosa,
___ • the presence of complications and concomitant pathologies of the rectum
In cases where there is reason to suspect a pathological process in the overlying sections of the large intestine, a colonoscopy is prescribed.
If the decision is made in favor of ligation, standard preoperative diagnostic tests (lab tests) are ordered.
Contraindications
The ligation procedure will have to be postponed in case of an acute inflammatory process, as well as exacerbations of chronic diseases. Treatment is not carried out during the recovery period after serious illnesses, vascular accidents, injuries, operations.
Ligation of the internal node is not indicated for combined (internal and external) hemorrhoids, as well as in cases where the underlying disease is accompanied by other pathologies of the rectum:
___ • proctitis,
___ • anal fissure,
___ • polyps,
___ • malignant tumors of the intestine.
In addition, minimally invasive interventions are not prescribed for complicated forms of pathology (thrombosis, rectal fistulas, bleeding).
Interventions are carried out with caution in violation of blood clotting, liver pathology, diabetes mellitus, severe pathologies of the cardiovascular system.
Training
Preparation for the procedure begins in 2-3 days. It is necessary to stop taking medications that affect blood clotting (aspirin, ibuprofen), and switch to a gut-sparing diet.
The list of restrictions includes:
___ • coarse vegetable fiber (cabbage, fresh vegetables and fruits),
___ • legumes,
___ • whole milk,
___ • fatty meals,
___ • sweets,
___ • pickles, marinades, spices,
___ • carbonated drinks,
___ • alcohol.
Before the visit to the doctor an early light dinner is recommended, in the morning – a light breakfast. Bowel cleansing is carried out twice: in the evening and in the morning with the help of Microlax microclysters.
Technique
The procedure is performed with the patient lying on their side with their legs bent. The proctologist inserts an anoscope into the anus in order to apply an elastic hypoallergenic loop – a ligature – to the base of the node under visual control.
For the operation, a special device is used – vacuum ligator, with which the pathological element is captured, and a latex ring is put on it.
The manipulation is absolutely painless for the patient and therefore can be performed without anesthesia. The duration is less than an hour. At the end of the procedure, the patient can go home.
During one session, the doctor applies only one ligature. If there are several nodes, the procedure will have to be repeated. The interval between operations should be at least 1 week. Large formations are removed in stages. The date of the return visit will be appointed by the doctor.
Unpleasant consequences and methods of dealing with them
Unpleasant sensations
The most common side effect after applying a latex ring to an internal hemorrhoid is sensation of a foreign body in the rectum. Medical measures in such cases are not indicated, over time, the intensity of sensations decreases and does not cause concern to the patient.
In some cases, there may be pain syndrome, the severity of which depends on a number of factors (the size of the node, its location, the characteristics of the patient's individual sensitivity).
Pain should be relieved with medications recommended by your doctor. With resistant (permanent) pain syndrome, you should consult a specialist, since pain can be a symptom of the development of complications.
Thrombus formation, bleeding, inflammation
___ 1. Thrombus formation is a very rare complication. The actions of doctors will depend on the situation: both conservative and surgical treatment can be prescribed.
___ 2. Sometimes there is such an unpleasant side effect as staining of stool with blood. Most often, blood in the feces appears during the natural discharge of the pathological element. Less often, a symptom indicates trauma to the node with feces and / or the development of complications. If severe bleeding occurs, you should immediately consult a doctor.
___ 3. Inflammatory processes with minimally invasive interventions are extremely rare. As a rule, an infectious-inflammatory process occurs as a result of trauma to the nodule with solid feces, therefore, to prevent complications, it is necessary to adhere to a diet.
slippage of the latex ring
premature slippage of latex ligature – a rather rare complication that cancels the result of the operation. As a rule, excessive physical effort (lifting weights, sports, straining with constipation) becomes the cause of slipping. If this happens, contact your doctor for a second procedure.
Recovery period
Protective regime and hygiene procedures
All ongoing rehabilitation measures are aimed at the speedy healing of the wound and the prevention of complications:
___ • In the early days limitation of physical activity is necessary. You can not lift weights more than 5 kg and go to the bath.
___ • A week later after the operation, moderate physical activity is allowed: swimming and walking.
___ • The ban on strength sports and heavy physical labor remains within a month.
___ • The toilet of the perineum is carried out as usual (twice a day, in the morning and in the evening).
Diet food
The overwhelming majority of complications after the ligation operation arise as a result of injury by hard fecal masses. Therefore, it is necessary to exclude from the menu products that have an irritating and fixing effect:
___ • semolina, rice,
___ • potato,
___ • legumes,
___ • spicy and smoked dishes,
___ • wheat bakery products,
___ • carbonated drinks,
___ • alcohol.
It is necessary to observe the temperature regime: you can not eat too hot, as well as too cold dishes. The optimal solution is warm, soft food: stewed, boiled, mashed (fried and smoked meats are strictly prohibited).
In order for the rehabilitation process to take place at a normal pace, you need good nutrition: dietary meat, poultry, fish, boiled or stewed vegetables, fermented milk products.
Medical support
To prevent complications of hemorrhoid ligation, proctologists prescribe drugs from several groups.
Painkillers from the group of non-steroidal anti-inflammatory drugs reduce the severity of pain and inhibit the inflammatory response. Such drugs are prescribed orally ("Nurofen", "Ketanov").
To avoid injury with hard feces, take softening feces laxatives (for example, Forlax).
How to avoid relapse
Ligation of hemorrhoids is a reliable method of treatment. However, if the patient has a predisposition to the development of this disease, hemorrhoids may occur repeatedly.
To prevent relapse, the number of factors contributing to the development of pathology should be minimized:
___ • normalize stool,
___ • get rid of excess weight,
___ • avoid spicy foods and alcohol,
___ • avoid prolonged sitting,
___ • limit heavy physical activity, visiting baths, saunas,
___ • it is recommended to engage in physiotherapy exercises,
___ • timely treat diseases of the gastrointestinal tract and genitourinary system.
Statistical data show that, if all recommendations are followed, the relapse-free period after node ligation can last indefinitely (10-15 years or more).
Can the operation be postponed?
Ligation of hemorrhoids is a planned procedure that can always be postponed. Even sparing intervention should be carried out against the background of physical and psychological well-being.
However, it should be borne in mind that chronic hemorrhoids are prone to the development of complications such as:
___ • thrombosis and bleeding of the node,
___ • infectious and inflammatory complications (proctitis, paraproctitis),
___ • anal fissure.
At the stage of irreducible hemorrhoids, with large and / or multiple nodes, as well as in the event of complications, doctors will be forced to abandon low-traumatic methods of treatment in favor of a traditional operation (hemorrhoidectomy).
The long course of chronic hemorrhoids, accompanied by bleeding, leads to anemia, physical and nervous exhaustion.
Conclusion
Knot ligation is the optimal solution for uncomplicated stage I-III hemorrhoids with a small number of small elements.
Our clinical experience proves that this procedure is highly effective and well tolerated by patients. Unpleasant side effects are extremely rare and are successfully stopped by conservative measures. Compliance with the elementary rules for the prevention of recurrence guarantees a long-term effect of the operation.
Proctologists of the GKB number 31 clinic use the whole range of treatment methods Hemorrhoids: conservative therapy, traditional surgical operations, as well as minimally invasive techniques:
___ • Sclerotherapy,
___ • Ligation of hemorrhoidal nodes,
___ • Radio wave surgery.
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