[vc_row row_type=”0″ row_id=”” blox_height=”” video_fullscreen=”true” blox_image=”” blox_bg_attachment=”false” blox_cover=”true” blox_repeat=”no-repeat” align_center=”” page_title=”” blox_padding_top=”” blox_padding_bottom=”” blox_dark=”false” blox_class=”” blox_bgcolor=”” parallax_speed=”6″ process_count=”3″ video_url=”” video_type=”video/youtube” video_pattern=”true” row_pattern=”” row_color=”” maxslider_image1=”” maxslider_image2=”” maxslider_image3=”” maxslider_image4=”” maxslider_image5=”” maxslider_parallax=”true” maxslider_pattern=”true”][vc_column width=”1/1″][vc_column_text]WHAT ARE
They are vascular formations, more arterial and venous nature and reside in the anal submucosa. Are normal anatomical structures of the anal canal, present from birth have a physiological role and only later, due to various factors, they become hemorrhoidal disease.
Hemorrhoids are commonly divided into internal, those placed in the anal canal above the dentate line (set at 1.5 cm. From the anal verge) and external ones placed in the subcutaneous area of the anal margin (Fig. 1). Often mistaken for external hemorrhoids are the internal ones, being bulky, protrude from the anus; They are quite rare and appear as small masses more or less congested, bluish.
The marische, no external hemorrhoids, but the small fleshy growths on the anal margin which often are the sign, left, of previous thrombophlebitis of external hemorrhoids or the presence of an anal fissure.
ONSET OF CAUSES
The hemorrhoidal disease starts before the age of thirty, without distinction of sex.
The predisposing factors that are hereditary, family and constitutional, in addition to the triggering factors such as hive disturbance and moments of female genital life such as menstruation, pregnancy and childbirth. Not only constipation but also diarrhea, in equal measure, unleashes the hemorrhoidal crisis.
EVENT
The most important symptom is bleeding (red blood) that often appears at the end of defecation and must be distinguished from the doctor from the deeper source of bleeding characteristic of other diseases of the colon.
Anal itching is often present in the hemorrhoidal disease.
The pain is often absent when this is contemporary defecation. It is not characteristic of hemorrhoidal disease, but complications such as internal hemorrhoidal thrombosis and / or external or other anal diseases.
TREATMENT AND CARE
The hygienic-dietary rules require local hygiene, without excess, which consists of bidet ‘warm-hot with neutral soaps and in case of itching the addition of a sachet of the water chamomile.
Power must be smooth, rich slag and water (at least two liters a day), low in spices, alcoholic beverages, chocolate, coffee, smoke.
The hive regularity is an indispensable factor.
The treatment of hemorrhoids varies with the variation of the stages of the disease that normally provides four (Fig. 2).
In the first stage (I °) hemorrhoids takes the simple dilation of veins under stress; in the second stage (and. II °) there is the externalization of hemorrhoids under stress which are reduced spontaneously; in the third stage (e. III °) the prolapsed hemorrhoids under stress, can be reduced only by hand, in the fourth stage (e.di IV) hemorrhoids are constantly externalized and can not be reduced manually.
OUTPATIENT TREATMENT
Outpatient treatment can occur by sclerotherapy, photocoagulation, elastic ligatures, cryotherapy.
The most used technique is that of elastic ligatures to haemorrhoids of the I ° -II ° (Fig.3). It consists in dell’emorroide in more sessions, applying over the haemorrhoid hemorrhoidal a strap cauciù that cause ischemia of the tissue and the subsequent fall of the linked portion of hemorrhoids. The feeling is given by the presence of a small ball (as a small lingo fecal) of the anal canal and a sense of weight of the duration of a few days at most.
At a distance of 5-8 days. Sometimes you can see a slight bleeding given by dell’emorroide fall. The treatment involves four sessions, at least, which are about 15 days. and a maximum of two ligatures at a time.
In the cases sanguianmento hemorrhoidal and / or II hemorrhoids, red hemorrhagic anus, the infrared photo coagulation is the technique of choice.
It determines a well-defined point on the surface of necrosis and in depth at the level of sopraemorroidaria mucosa. There will be about four sessions of 15 days away. and two three applications on each hemorrhoidal package.[/vc_column_text][ultimate_carousel slider_type=”horizontal” slide_to_scroll=”all” slides_on_desk=”6″ slides_on_tabs=”3″ slides_on_mob=”2″ infinite_loop=”off” speed=”300″ autoplay=”off” autoplay_speed=”5000″ arrows=”show” arrow_style=”default” border_size=”2″ arrow_color=”#333333″ arrow_size=”24″ next_icon=”ultsl-arrow-right4″ prev_icon=”ultsl-arrow-left4″ dots=”off” dots_color=”#333333″ dots_icon=”ultsl-record” draggable=”on” touch_move=”on” item_space=”15″][vc_single_image image=”78″ alignment=”center” border_color=”grey” img_link_large=”” img_link_target=”_self”][vc_single_image image=”71″ alignment=”center” border_color=”grey” img_link_large=”” img_link_target=”_self”][vc_single_image image=”102″ alignment=”center” border_color=”grey” img_link_large=”” img_link_target=”_self”][vc_single_image image=”109″ alignment=”center” border_color=”grey” img_link_large=”” img_link_target=”_self”][vc_single_image image=”110″ alignment=”center” border_color=”grey” img_link_large=”” img_link_target=”_self”][vc_single_image image=”108″ alignment=”center” border_color=”grey” img_link_large=”” img_link_target=”_self”][/ultimate_carousel][vc_column_text]SURGICAL TREATMENT
The past 10 years or so you can treat bleeding hemorrhoids of II ° – III ° without intervening directly on these. The HAL DOPPLER technique involves the identification of arterial branches that feed the hemorrhoids and their subsequent ligation with a dot under Judas doppler.
The operation takes place above the dentate line where there are no sensitive fibers and so it is not painful. It is to obtain a reduction of the haemorrhoidal flow with a consequent reduction of the volume of the same, the mucous membrane is anchored to the underlying tissue and this determines the disappearance of bleeding avoiding a postoperative pain and long healing time of wounds as in conventional surgical techniques. The surgery can be performed in Day Surgery, anesthesia
local or locoregional with the ability to immediately resume a regular life, it does not require dressings. This recent technique is intended as a more effective alternative, rapid and decisive in all patients presenting of bleeding hemorrhoids and are usually treated with elastic ligatures.
THE traditional surgical treatment is normally provided in the most serious cases III ° – IV °.
1) The hemorrhoidectomy sec. MILLIGAN MORGAN is the most used in the world technique and involves removal (ligation and section) of three internal hemorrhoidal packages at 3, 8, 11 (in the gynecological position) and external hemorrhoidal component.
The anesthesia is local and consists of four injections with insulin needle in the perianal; surgery usually takes about twenty minutes.[/vc_column_text][ultimate_carousel slider_type=”horizontal” slide_to_scroll=”all” slides_on_desk=”6″ slides_on_tabs=”3″ slides_on_mob=”2″ infinite_loop=”off” speed=”300″ autoplay=”off” autoplay_speed=”5000″ arrows=”show” arrow_style=”default” border_size=”2″ arrow_color=”#333333″ arrow_size=”24″ next_icon=”ultsl-arrow-right4″ prev_icon=”ultsl-arrow-left4″ dots=”off” dots_color=”#333333″ dots_icon=”ultsl-record” draggable=”on” touch_move=”on” item_space=”15″][vc_single_image image=”74″ border_color=”grey” img_link_large=”” img_link_target=”_self” alignment=”center”][vc_single_image image=”75″ alignment=”center” border_color=”grey” img_link_large=”” img_link_target=”_self”][vc_single_image image=”76″ alignment=”center” border_color=”grey” img_link_large=”” img_link_target=”_self”][vc_single_image image=”77″ alignment=”center” border_color=”grey” img_link_large=”” img_link_target=”_self”][/ultimate_carousel][vc_column_text]2) the hemorrhoidectomy with LigaSure (RF) is a technique recently performed in only a few centers in Italy, including ours.
It involves the removal of the external and internal hemorrhoidal packages without electric scalpel and without stitches (responsible mainly post-operative pain, the feeling of weight and obstructed defecation), allowing a significant reduction of postoperative pain.
We recommend this technique to all those patients who are not operated with Stappler and have hemorrhoids III ° -IV ° with important external hemorrhoids.
3) The prolassectomia the emorroidopessia with STAPPLER, innovative technique, it is recommended in those pieces. which are in addition to internal hemorrhoids III a mucosal prolapse of the rectum of II ° -III ° and an external component eomorroidaria minimum. The anesthesia is performed preferably of spinal type. This technique drastically reduces postoperative pain allowing a quick return to work after only 4-5 days. intervention.
In all cases, patients are admitted to the morning of surgery and discharged the following morning, unless complications. The night before the operation and the next morning the patient will have to perform an enema remaining fasting from midnight.[/vc_column_text][ultimate_carousel slider_type=”horizontal” slide_to_scroll=”all” slides_on_desk=”6″ slides_on_tabs=”3″ slides_on_mob=”2″ infinite_loop=”off” speed=”300″ autoplay=”off” autoplay_speed=”5000″ arrows=”show” arrow_style=”default” border_size=”2″ arrow_color=”#333333″ arrow_size=”24″ next_icon=”ultsl-arrow-right4″ prev_icon=”ultsl-arrow-left4″ dots=”off” dots_color=”#333333″ dots_icon=”ultsl-record” draggable=”on” touch_move=”on” item_space=”15″][vc_single_image image=”93″ alignment=”center” border_color=”grey” img_link_large=”” img_link_target=”_self”][vc_single_image image=”94″ alignment=”center” border_color=”grey” img_link_large=”” img_link_target=”_self”][vc_single_image image=”95″ alignment=”center” border_color=”grey” img_link_large=”” img_link_target=”_self”][vc_single_image image=”97″ alignment=”center” border_color=”grey” img_link_large=”” img_link_target=”_self”][vc_single_image image=”98″ alignment=”center” border_color=”grey” img_link_large=”” img_link_target=”_self”][vc_single_image image=”99″ alignment=”center” border_color=”grey” img_link_large=”” img_link_target=”_self”][/ultimate_carousel][vc_column_text]OPERATIVE COURSE
The postoperative course provides, only in cases of hemorrhoidectomy, painkillers (Ketorolac XXV drops 20 minutes before defecation), bathrooms with euclorina for 8 days. and then with soap, aasunzione of 1 sachet of Isolcolan a day for three days, a diet rich in waste and water at least two liters a day, no dietary restriction.
The postoperative control will occur for all patients operated after 7 days. after surgery and again after 30 days. The recovery is expected in the intervention of hemorrhoidectomy after about 30-40 days. and it requires daily use of a diaper for the mild bleeding in the first days and for the subsequent production of secretions (about one month). Intervention with Stappler being no external wounds everyday use of the diaper will be necessary only for a few days. for the modest bleeding if present.[/vc_column_text][vc_row_inner][vc_column_inner el_class=”” width=”1/3″][ultimate_modal icon_type=”none” modal_title=”Video intervention” modal_contain=”ult-youtube” modal_on=”button” onload_delay=”2″ btn_size=”lg” btn_bg_color=”#325b7b” btn_txt_color=”#ffffff” modal_on_align=”center” btn_text=”Video intervention” txt_color=”#f60f60″ modal_size=”medium” modal_style=”overlay-cornerbottomleft” overlay_bg_color=”#333333″ header_text_color=”#333333″ modal_border_width=”2″ modal_border_color=”#333333″ modal_border_radius=”0″]
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