What is combined hemorrhoids
In the combined form, both the internal nodes, located above the dentate line, and the external ones, located under the skin around the anus, are enlarged. It is irrational to treat them separately: a second group of nodes remains, the symptoms persist, and after some time a repeat operation is required. Combined hemorrhoidectomy removes all nodes in one procedure. The operation is performed under spinal anesthesia; the volume is larger than in the isolated form, so a bed-day is provided for observation and complete pain relief.
Stages of hemorrhoids and choice of method
Hemorrhoids develop gradually: at first the nodes only bleed, then they fall out when straining and are reduced on their own, later they require manual reduction, and at the last stage they are not reduced at all. The treatment method is chosen according to the stage.
In the early stages, minimally invasive techniques work - latex ligation and infrared coagulation. In later cases, node removal is required: classic hemorrhoidectomy, laser technique, or desarterization with suturing of the feeding arteries.
Basic methods
- infrared coagulation - non-contact cauterization, outpatient, for early stages
- latex ligation - clamping the leg of the node with a ring
- classic hemorrhoidectomy - excision of nodes, the most radical method
- laser hemorrhoidectomy - less blood loss and pain
- HAL-RAR - suturing of arteries under ultrasound control with tightening of the mucosa
What determines the price of surgery
Scope of intervention: number of nodes removed, presence of thrombosis, combination with anal fissure or polyp. Combined operations are more expensive, but eliminate the need for a second anesthesia and a second recovery period.
Recovery
The most sensitive period is the first 7–10 days, especially the first bowel movements. The key condition for a smooth recovery is soft stools: a laxative diet, plenty of fluids and, if necessary, laxatives are prescribed. You cannot push during this period.