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Hofer - Liebl - Specialists in Visceral Surgery and Proctology

The way to laser surgery

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Diagnosis: What should be treated?

Hemorrhoids, anal fissure or anal fistula?

Would you like to get rid of your stubborn haemorrhoids? At the Proctology Practice of Dr. Bernhard Hofer in Munich, we specialise in outpatient haemorrhoid surgery. Our doctors have years of experience and offer an excellent service. Here we describe in detail the course of treatment in our surgery centre Iatros Clinic and mention everything that is important for the patient on the day of the operation. Only when you can answer all the coming questions with yes, you are well prepared for the operation. These general explanations apply equally to the surgery for anal fissure and anal fistula.

Why operate?

Indication and planning: Every operation needs a good rationale

Treatment begins with a personal examination and consultation in the practice. In this way, the doctor can get to know the patient better and find out about the patient's expectations. The intake consultation is followed by a proctological examination. Your doctor will discuss the results of this examination with you and discuss conservative and surgical options with you.

The decision for an operation is always a weighing up of the expected benefits and possible risks. Clear reasons for an operation are 

for haemorrhoidal disease:

  • a stage 3, i.e. haemorrhoids that protrude outwards and need to be retracted manually
  • Frequent and intense bleeding

in anal fissure:

  • severe pain that lasts for hours even after defecation
  • Frequent and intense bleeding
  • Repeated, conservative treatment with stool regulation and a suitable ointment without lasting stabilisation
  • Fistula formation

 in anal fistula:

  • Substantial secretion
  • recurrent abscesses
  • chronic pains

for all diagnoses:

  • Changes in the skin and mucous membrane where a malignant growth cannot be ruled out with certainty

Clarify cost absorption

Health insurance, Integrated care, self-payer

Post follows

Before the operation: Preparation for surgery

Operation date

Plan the operation in such a way, unless significant complaints force you to operate at short notice, that the expected restrictions and the inability to work for 2-3 weeks do not become a problem. So if you have a holiday, a wedding or a sporting event coming up, you'd better plan the time generously.

Perhaps there are times of the year at work when your boss can more easily do without you. Then you will be under less emotional pressure to return to work early. Of course, the employer does not have to be informed about the illness and type of treatment. As a self-employed person, consider how you might be able to delegate some of your work from home or use holidays for convalescence to minimise the loss of earnings.

On the day of the operation, you can leave the outpatient surgery centre again after the procedure and the subsequent monitoring in the recovery room. The prerequisite for this - apart from you being well, of course - is an adult collector who will meet you at the Iatros Clinic.

Examinations by the general practitioner and specialist

Healthy patients up to 60 years of age do not need any special preliminary examinations. In individual cases, the anaesthetist may order necessary examinations. Healthy patients over 60 years of age should bring their existing examination results, ECG and laboratory with them. In the case of chronic illnesses with performance limitations as well as cardiovascular events in the last 12 months (heart attack, stroke), we advise against outpatient surgery and would organise surgery for you in an appropriately equipped acute clinic.

  • If you have to take "blood thinning" medication: With any permanent medication, please talk to your family doctor and the anaesthetist about the use before and after the operation! Operations with a slightly increased risk of bleeding can be performed with ASA (Aspirin®). If it is not necessary, ASA should be discontinued 5 days before the operation and only taken again after one week. We advise against outpatient surgery with clopidogrel (Plavix®), phenprocoumon (Marcumar®) and the new oral anticoagulants (NOAKs).
  • Medication for diabetes: Please discuss with the anaesthetist whether metformin should be paused and whether and when insulin should be injected.

Anaesthesia talk (premedication)

Anaesthesia is also a medical measure for which you must have an explanatory talk with the anaesthetist at least 48 hours before the planned operation. You will receive the corresponding information sheet, on which you also confirm your consent to the anaesthesia by signing it, in our practice. The interview will be conducted by telephone, unless medical reasons require a personal presentation.

3 G - Covid - Regulations

As of 14.09.21, the 3 G regulation applies until further notice, a PCR test is no longer obligatory. For convalescents whose infection occurred more than 6 months ago and unvaccinated persons, a PCR test no older than 72 hours with subsequent quarantine at home is still mandatory.

We ask patients from abroad to also check the current, legal regulations on entry with the Federal and State Ministry of Health in Bavaria.

On the day of surgery

Anesthesia, Operation, monitoring, discharge

Operation date

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Examinations by the general practitioner and specialist

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Anaesthesia talk (premedication)

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3 G - Covid - Regulations

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... contribution in progress.

What if...

Complications: What to do in case of pain, bleeding, nausea, circulation problems?

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DR. BERNHARD HOFER, FLORIAN LIEBL & COLLEAGUES

Specialists in visceral surgery, proctology

Brienner Str. 13, D-80333 Munich, Germany