Hofer - Liebl - Specialists

Hemorrhoids removal

Sustainable and proven

Laser -Hemorrhoidectomy

Hemorrhoids - Always operate away?

In the removal of hemorrhoids, a change in thinking has taken place in recent decades. Hemorrhoids are no longer regarded as pathological growths, but as a fundamentally useful part of the so-called continence organ, i.e. the anatomical structures that are important for sealing the rectum. This tissue is worth preserving.

Therefore, today we treat most patients with hemorrhoidal complaints with shirring and laser sclerotherapy (HAL-LHP). Removal of the hemorrhoids is the first choice only if either a lump can no longer be pushed back into the anal canal, an anal fissure is present at the same time, or a malignant change is suspected with the need for histological examination. Occasionally, the patient's desire for removal of an external mariske may also be the reason for conventional hemorrhoid removal.

For the removal of hemorrhoids we use the laser(Intros Lina 30). Our experience shows that this allows a particularly precise release of the hemorrhoidal knot in the layer specified by nature. The focused application of laser energy avoids undesirable thermal damage to the surrounding area. In terms of the basic principle, we follow the Milligan-Morgan open technique, which was developed at St. Marks Hospital in London. Numerous studies have shown that the closed techniques of hemorrhoidectomy offer no advantages in terms of postoperative pain or sphincter function.

Hemorrhoidectomy -Cutting out hemorrhoids

Hemorrhoid removal through a surgical procedure is called hemorrhoidectomy in technical language. In this procedure, the surgeon cuts around the outer portion in an arc and detaches the enlarged hemorrhoid from the internal sphincter. A - dissolvable - suture cuts off the central, feeding blood vessels. The wound may be left open (Milligan-Morgan), sutured continuously (Ferguson), or closed reconstructively (Parks, each according to the initial describer of the technique). Most surgeons use an electric scalpel (diathermy). Alternatives may be sealing instruments (e.g. Ultracision®, Ligasure®) or a surgical laser.

Precise and effective

Hemorrhoid surgery procedure and aftercare

We operate on an outpatient basis and under anaesthesia (general or spinal). Our surgery day is every second Friday afternoon. The operations take place in the Iatros - Clinic, an outpatient surgery center. After the operation you will be monitored in the recovery room for 1 - 2 hours. Then you can be picked up again.

You will receive the prescription for necessary medication on the day of the surgery, as well as a mobile number for urgent matters at the weekend. I will bring you the necessary certificate of incapacity for work on the day of the operation. Most patients are on sick leave for 2 - 3 weeks after a haemorrhoidectomy.

Significant afterpains (dampness, wound pain) are to be expected until the second week after the operation. Once the healing has begun after this time, it goes steadily noticeable uphill.

Aftercare after hemorrhoid surgery is not demanding:

  • Stool regulation with psyllium husks or macrogol
  • Cleaning the anal region with the shower or in a sitz bath at a comfortable temperature
  • Generous administration of painkillers
  • Wearing a panty liner / sanitary napkin to absorb the wound secretion
  • if necessary, application of hydrocolloid gel
  • if necessary, application of local antibiotic ointment preparations (metronidazole-vaseline)
  • If necessary, promotion of wound healing and pain reduction by Low Level Laser (LLLT)

Sphincter injury does not occur when performed properly. Sensitivity in the anal area is best protected if sufficient sensitive anal skin is left behind. Scarred constrictions of the anus are very rare consequences, as are significant restrictions in the ability to hold stool (incontinence).

In our proctological practice in Munich, we also use laser haemorrhoidoplasty or haemorrhoid artery ligation. We will be happy to advise you in detail on all therapy options - do not hesitate to contact us.

Removal of "external haemorrhoids

Should skin folds (marisques) and anal vein thrombosis be surgically removed?

  • "Acute external haemorrhoids" are mostly anal vein thrombosis and heal on their own. The wound resulting from removal would take longer to heal than the anal thrombosis. We therefore recommend symptom-oriented therapy with painkillers, stool regulants, decongestant ointments and LLLT.
  • skin folds (marisques) may bother for various reasons. Many patients come with the desire to get rid of the annoying growths. However, wound pain and healing time argue against surgical intervention. The resulting scars can sometimes be more functionally disturbing than the marisk before (loss of elasticity, loss of sensitivity, stool smearing). We therefore adviseagainst the removal of marisques . In the area of statutory health insurance, we are also bound by the principle of economic efficiency. Only absolutely necessary treatments are covered by the health insurance.

Literature Haemorrhoid Removal

  1. Trompetto, M., Clerico, G., Cocorullo, G. F., Giordano, P., Marino, F., Martellucci, J., Milito, G., Mistrangelo, M., & Ratto, C. (2015). Evaluation and management of hemorrhoids: Italian society of colorectal surgery (SICCR) consensus statement. Techniques in coloproctology, 19(10), 567-575. https://doi.org/10.1007/s10151-015-1371-9