What is the success rate of hemorrhoidectomy?

Laser Hemorrhoids surgery (hemorrhoidectomy) in Turkey, cost of Istanbul Clinics

Hemorrhoidal pathology is dysfunction related to the inflammation of the hemorrhoidal veins, the hemorrhoids, which slip out of their natural seat in the anus due to the sagging of the rectal mucosa. In some cases, a blood clot (clot or thrombus) forms, which amplifies the painful symptoms.

The dysfunction can affect internal and external hemorrhoids, located around the anus. Hemorrhoids are a common condition. It is estimated that about half of people over 50 have had, more or less acutely, a hemorrhoid problem.

Laser hemorrhoids operation in Turkey is a new procedure for outpatient treatment of hemorrhoids, in which the hemorrhoidal arterial flow supplying the hemorrhoidal plexus is interrupted by laser coagulation.

This type of gastroenterologysurgery is called hemorrhoidectomy, hemorrhoidopexy, or colorectal surgery.

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Who is this procedure for?

• Patients with hemorrhoids, and cannot get rid of them after non-invasive methods
• Patients with very large internal or external hemorrhoids

Side effects

• Bleeding
• Stenosis
• Urinary retention

Intervention or treatment’s duration

• The surgery lasts no more than 30 minutes

Recovery time

• Back to work after 10 days
• Back to sport after 2 months

Success rate

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Hemorrhoids: What Are They?

Hemorrhoids are cushions of richly vascularized tissue, present in the terminal part of the rectum, near the anus. Hemorrhoids are firmly anchored to the wall of the anal canal, thanks to fibrous ligaments which hold them in place.

Their function is to contribute, with the anal sphincter, to evacuation and continence, therefore to the ability to retain feces, liquids, and gases. Under normal conditions, their presence is not felt, but their excessive swelling generates discomfort and symptoms such as prolapse, pain, burning, itching, or bleeding.

The term hemorrhoids referred to both the venous structures and the dysfunction, more properly referred to as hemorrhoidal pathology or disease.

What are the risk factors for hemorrhoidal pathology?

Inflammations of hemorrhoids can affect men and women of different ages, for various reasons.

Hemorrhoidal disease is multifactorial, therefore caused by the combination of several contributing causes, such as:

• Unbalanced diet low in fiber with low water intake that prevents the proper functioning of the intestine. This results in alterations of the alvus (constipation/diarrhea) which are irritating to the hemorrhoidal plexus.
• Chronic constipation: during defecation, increased effort and prolonged sitting on the toilet promote irritation of hemorrhoids.
• Pregnancy: In many cases, women are more prone to hemorrhoidal diseases. In particular, women can develop hemorrhoidal diseases during pregnancy or immediately after childbirth. This occurs as a result of increased pelvic pressure related to the presence of the fetus and hormonal changes related to the pregnancy itself.
• Sedentary lifestyle, the habit of smoking tobacco and practicing certain sports, such as horse riding or cycling.
• Obesity and overweight. Medicines: contraceptives and laxatives.
• Other concomitant pathologies such as portal hypertension resulting from cirrhosis, certain pelvic tumors, or prostatic hypertrophy.

Other factors causing or promoting hemorrhoids are:

• Maintain an upright posture for long periods.
• Habit of sitting on the toilet bowl for long periods, for example when reading.
• Defecation too early or postponed for various reasons.
• Personal and family history of vascular fragility and tendency to varicose veins, even in other parts of the body.

What are the symptoms?

Among the most important symptoms of hemorrhoids, we can mention:

• Heartburn;
• Feeling of discomfort in the anus;
• Pain during defecation;
• Presence of rectal hyperplasia;
• Mucus goes down through the anus;
• Bleeding;
• Feeling of heaviness in the anus.

Hemorrhoids aren’t always perceptible to the naked eye. Only when they spread out, they can appear red or stained bumps or lumps.

Four kinds of hemorrhoids exist:

• Internal hemorrhoids;
• External hemorrhoids;
• Prolapsed hemorrhoids;
• Thrombosed hemorrhoids.

Most hemorrhoids aren’t severe, and you may not cause any symptoms. Only 5 percent of people with hemorrhoids suffer from pain and discomfort. The surgical treatment is only needed in case the hemorrhoids become disabling.

Hemorrhoids surgery: Laser treatment

Laser hemorrhoidoplasty is an operation performed in Turkey at the cutting edge of technology. It is a minimally invasive treatment that provides quick relief and eliminates painful symptoms.

The advantage of using a laser rather than a scalpel for this cut is that lasers instantly close the incision by coagulating blood and eliminating bleeding.

During the surgery in Istanbul Turkey, the surgeon inserts surgical forceps into the anal canal to remove hemorrhoids. Then, he cuts and removes part of the rectal wall or uses a laser beam. Finally, the surgeon tightens it with small metal clips and puts it inside the rectum.

Hemorrhoids Surgery: Recovery & side effects

The hemorrhoid surgery does not exceed 30 minutes, and in most cases, patients return to their homes on the same day. However, stopping work is mandatory for at least 10 days after the operation.

This treatment is the radical solution to completely get rid of the pain. However, you may experience some side effects during recovery.

How do alleviate the side effects of this surgery during recovery?

The patient should wash the wounds with water and very mild soap twice a day. He should avoid using toilet paper and rubbing it at the anal level. The patient must also avoid consuming spicy food, drink alcohol, and coffee, and eat fat-rich meals.

Exercise is very necessary after the operation. The patient should also:

• Eat fresh green vegetables;
• Consume fruits;
• Eat salads;
• Add whole bread to his meals;
• Consume cereals;
• Avoid stress.

Hemorrhoidectomy: Cost & Price in Istanbul Turkey

Turquie santé allows you to communicate directly with the most famous specialists and doctors in Turkey. Our partner health professionals have international experience in medical services and hemorrhoid treatment in Istanbul and Izmir in Turkey.

You can be sure of getting the best medical advice and the best treatment plan.

Is this surgery covered by health insurance?

The hemorrhoidectomy or hemorrhoidopexy procedure can be covered by most insurance plans. However, many private health insurances do not reimburse surgical procedures in other countries.

To get the right information, we advise you to talk to your insurer before undergoing this surgery.

How much does Hemorrhoidectomy Cost in Turkey?

The Hemorrhoidectomy cost and price in Turkey can vary depending on the patient’s condition and the clinic.

With Turquie santé’s assistance, you will benefit from the best care plans for treating your illness at any stage. So, by asking for your quote, you will benefit from important health services discounts in our medical centers, clinics, and hospitals in Turkey.

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What is the success rate of hemorrhoidectomy?

Am Fam Physician. 2002;65(8):1629-1632

External hemorrhoids represent distended vascular tissue in the anal canal distal to the dentate line. Persons with thrombosed external hemorrhoids usually present with pain on standing, sitting or defecating. Acutely tender, thrombosed external hemorrhoids can be surgically removed if encountered within the first 72 hours after onset. Hemorrhoidectomy is performed through an elliptic incision over the site of thrombosis with removal of the entire diseased hemorrhoidal plexus in one piece. Caution must be exercised to avoid cutting into the muscle sphincter below the hemorrhoidal vessels. Infection after suture closure is rare secondary to the rich vascular network in the anal area. Stool softeners must be prescribed postoperatively to help prevent tearing at the suture line. Training and experience in general and skin surgery are necessary before the physician attempts this procedure unsupervised.

External hemorrhoids usually develop over time and may result from straining with stools, child-birth, lengthy car trips or prolonged sitting, constipation or diarrhea. External hemorrhoids represent distended vascular tissue in the anal canal distal (outside) to the dentate line (the junction between the rectal mucosa and the specialized skin of the anal canal, called the anoderm). External hemorrhoids are covered by anoderm and perianal skin richly innervated with somatic pain fibers. Diseases affecting the anal canal or the external hemorrhoidal vessels can be extremely painful.

External hemorrhoids often develop in healthy young persons and may suddenly become thrombosed. Persons with thrombosed external hemorrhoids usually present with pain on standing, sitting or defecating. The thrombosis is slowly absorbed by the body during the course of several weeks. A resolving thrombosis may erode through the skin and produce bleeding or drainage.

Acutely swollen and tender thrombosed external hemorrhoids can be surgically removed during the first 72 hours after onset. After 72 hours, the discomfort of the procedure often exceeds the relief provided by the surgery. Some patients still chose to undergo late surgery, although they should understand that without surgery the hemorrhoid will eventually become fibrosed and resolve over a period of days to weeks.

An elliptic incision can be made over the thrombosis, and the clot and the entire diseased hemorrhoidal plexus can be removed in one piece. Although the site can be left open, many physicians prefer to place subcutaneous sutures to limit postoperative pain and bleeding. Suturing in this area, historically, has been avoided because of fear of complications, yet the rich vascular network in the anal tissues usually provides for rapid healing.

Simple incision over a thrombus after the administration of local anesthesia can be performed to remove the clot, but this procedure has been associated with a significant rate of rethrombosis. Many experts now recommend excision of the entire thrombosis and the external hemorrhoidal vessels beneath. This procedure is more extensive than simple incision but usually yields a better outcome.

Hemorrhoidectomy

A hemorrhoidectomy is the surgical removal of a hemorrhoid, which is an enlarged, swollen, inflamed cluster of vascular tissue combined with smooth muscle and connective tissue located in the lower part of the rectum or around the anus. A hemorrhoid is not a varicose vein in the strictest sense. Hemorrhoids are also known as piles.

Purpose

The primary purpose of a hemorrhoidectomy is to relieve the symptoms associated with hemorrhoids that have not responded to more conservative treatments. These symptoms commonly include bleeding and pain. In some cases the hemorrhoid may protrude from the patient’s anus. Less commonly, the patient may notice a discharge of mucus or have the feeling that they have not completely emptied the bowel after defecating. Hemorrhoids are usually treated with dietary and medical measures before surgery is recommended because they are not dangerous, and are only rarely a medical emergency. Many people have hemorrhoids that do not produce any symptoms at all. As of 2003, inpatient hemorrhoidectomies are performed significantly less frequently than they were as recently as the 1970s. In 1974, there were 117 hospital hemorrhoidectomies performed per 100,000 people in the general United States population; this figure declined to 37 per 100,000 by 1987.

Demographics

• hormonal changes associated with pregnancy and childbirth
• normal aging
• not getting enough fiber in the diet
• chronic diarrhea
• anal intercourse
• constipation resulting from medications, dehydration, or other causes
• sitting too long on the toilet

Hemorrhoids are categorized as either external or internal hemorrhoids. External hemorrhoids develop under the skin surrounding the anus; they may cause

KEY TERMS

Defecation— The act of passing a bowel movement.

Fistula (plural, fistulae)— An abnormal passageway or opening between the rectum and the skin near the anus.

Ligation— Tying off a blood vessel or other structure with cotton, silk, or some other material. Rubber band ligation is one approach to treating internal hemorrhoids.

Piles— Another name for hemorrhoids.

Prolapse— The falling down or sinking of an internal organ or part of the body. Internal hemorrhoids may prolapse and cause a spasm of the anal sphincter muscle.

Psyllium— The seeds of the fleawort plant, taken with water to produce a bland, jelly-like bulk which helps to move waste products through the digestive tract and prevent constipation.

Resection— Surgical removal of part or all of a hemorrhoid, organ, or other structure.

Sclerotherapy— A technique for shrinking hemorrhoids by injecting an irritating chemical into the blood vessels.

Sphincter— A circular band of muscle fibers that constricts or closes a passageway in the body.

Thrombosed— Affected by the formation of a blood clot, or thrombus, along the wall of a blood vessel. Some external hemorrhoids become thrombosed.

pain and bleeding when the vein in the hemorrhoid forms a clot. This is known as a thrombosed hemorrhoid. In addition, the piece of skin, known as a skin tag, that is left behind when a thrombosed hemorrhoid heals often causes problems for the patient’s hygiene. Internal hemorrhoids develop inside the anus. They can cause pain when they prolapse (fall down toward the outside of the body) and cause the anal sphincter to go into spasm. They may bleed or release mucus that can cause irritation of the skin surrounding the anus. Lastly, internal hemorrhoids may become incarcerated or strangulated.

Description

There are several types of surgical procedures that can reduce hemorrhoids. Most surgical procedures incurrent use can be performed on an outpatient level or office visit under local anesthesia.

Rubber band ligation is a technique that works well with internal hemorrhoids that protrude outward with bowel movements. A small rubber band is tied over the hemorrhoid, which cuts off the blood supply. The hemorrhoid and the rubber band will fall off within a few days and the wound will usually heal in a period of one to two weeks. The procedure causes mild discomfort and bleeding. Another procedure, sclerotherapy, utilizes a chemical solution that is injected around the blood vessel to shrink the hemorrhoid. A third effective method is infrared coagulation, which uses a special device to shrink hemorrhoidal tissue by heating. Both injection and coagulation techniques can be effectively used to treat bleeding hemorrhoids that do not protrude. Some surgeons use a combination of rubber band ligation, sclerotherapy, and infrared coagulation; this combination has been reported to have a success rate of 90.5%.

Surgical resection (removal) of hemorrhoids is reserved for patients who do not respond to more conservative therapies and who have severe problems with external hemorrhoids or skin tags. Hemorrhoi-dectomies done with a laser do not appear to yield better results than those done with a scalpel. Both types of surgical resection can be performed with the patient under local anesthesia.

Diagnosis/Preparation

Diagnosis

Most patients with hemorrhoids are diagnosed because they notice blood on their toilet paper or in the toilet bowl after a bowel movement and consult their doctor. It is important for patients to visit the doctor whenever they notice bleeding from the rectum, because it may be a symptom of colorectal cancer or other serious disease of the digestive tract. In addition, such other symptoms in the anorectal region as itching, irritation, and pain may be caused by abscesses, fissures in the skin, bacterial infections, fistulae, and other disorders as well as hemorrhoids. The doctor will perform a digital examination of the patient’s rectum in order to rule out these other possible causes.

Following the digital examination, the doctor will use an anoscope or sigmoidoscope in order to view the inside of the rectum and the lower part of the large intestine to check for internal hemorrhoids. The patient may be given a barium enema if the doctor suspects cancer of the colon; otherwise, imaging studies are not routinely performed in diagnosing hemorrhoids. In some cases, a laboratory test called a stool guaiac may be used to detect the presence of blood in stools.

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

A board certified general surgeon who has completed one additional year of advanced training in colon and rectal surgery performs the procedure. Specialists typically pass a board certification examination in the diagnosis and surgical treatment of diseases in the colon and rectum, and are certified by the American Board of Colon and Rectal Surgeons. Most hemorrhoidectomies can be performed in the surgeon’s office, an outpatient clinic, or an ambulatory surgery center.

Preparation

Patients who are scheduled for a surgical hemorrhoidectomy are given a sedative intravenously before the procedure. They are also given small-volume saline enemas to cleanse the rectal area and lower part of the large intestine. This preparation provides the surgeon with a clean operating field.

Aftercare

Patients may experience pain after surgery as the anus tightens and relaxes. The doctor may prescribe narcotics to relieve the pain. The patient should take stool softeners and attempt to avoid straining during both defecation and urination. Soaking in a warm bath can be comforting and may provide symptomatic relief. The total recovery period following a surgical hemorrhoidectomy is about two weeks.

Risks

As with other surgeries involving the use of a local anesthetic, risks associated with a hemorrhoidectomy include infection, bleeding, and an allergic reaction to the anesthetic. Risks that are specific to a hemorroidectomy include stenosis (narrowing) of the anus; recurrence of the hemorrhoid; fistula formation; and nonhealing wounds.

Normal results

Hemorrhoidectomies have a high rate of success; most patients have an uncomplicated recovery with no recurrence of the hemorrhoids. Complete recovery is typically expected with a maximum period of two weeks.

QUESTIONS TO ASK THE DOCTOR

• How many of your patients recover from hemorrhoids without undergoing surgery?
• How many hemorrhoidectomies have you performed?
• How many of your patients have reported complications from surgical resection of their hemorrhoids?
• What are the chances that the hemorrhoids will recur?

Morbidity and mortality rates

Rubber band ligation has a 30-50% recurrence rate within five to 10 years of the procedure whereas surgical resection of hemorrhoids has only a 5% recurrence rate. Well-trained surgeons report complications in fewer than 5% of their patients; these complications may include anal stenosis, recurrence of the hemorrhoid, fistula formation, bleeding, infection, and urinary retention.

Alternatives

Doctors recommend conservative therapies as the first line of treatment for either internal or external hemorrhoids. A nonsurgical treatment protocol generally includes drinking plenty of liquids; eating foods that are rich in fiber; sitting in a plain warm water bath for five to 10 minutes; applying anesthetic creams or witch hazel compresses; and using psyllium or other stool bulking agents. In patients with mild symptoms, these measures will usually decrease swelling and pain in about two to seven days. The amount of fiber in the diet can be increased by eating five servings of fruit and vegetables each day; replacing white bread with whole-grain bread and cereals; and eating raw rather than cooked vegetables.

Resources

“Hemorrhoids.” Section 3, Chapter 35 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.

PERIODICALS

Accarpio, G., F. Ballari, R. Puglisi, et al. “Outpatient Treatment of Hemorrhoids with a Combined Technique: Results in 7850 Cases.” Techniques in Coloproctology 6 (December 2002): 195–196.

Peng, B. C., D. G. Jayne, and Y. H. Ho. “Randomized Trial of Rubber Band Ligation Vs. Stapled Hemorrhoidectomy for Prolapsed Piles.” Diseases of the Colon and Rectum 46 (March 2003): 291–297.

Thornton, Scott, MD. “Hemorrhoids.” eMedicine, July 16, 2002 [June 29, 2003]. www.emedicine.com/med/topic2821.htm.

ORGANIZATIONS

American Gastroenterological Association. 4930 Del Ray Avenue, Bethesda, MD 20814. (301) 654-2055; Fax: (301) 652-3890. www.gastro.org.

American Society of Colon and Rectal Surgeons. 85 W. Algonquin Road, Suite 550, Arlington Heights, IL60005. www.fascrs.org.

National Digestive Diseases Information Clearinghouse (NIDDC). 2 Information Way, Bethesda, MD 20892-3570. www.niddk.nih.gov.

National Digestive Diseases Information Clearinghouse (NDDIC). Hemorrhoids. Bethesda, MD: NDDIC, 2002. NIH Publication No. 02-3021. www.niddk.nih.gov/health/digest/pubs/hems/hemords.htm.

Laith Farid Gulli, M.D., M.S.

Bilal Nasser, M.D., M.S.

Nicole Mallory, M.S., PA-C