Hemorrhoid disease, or hemorrhoids, as it is known among the people, is the event that this vascular system expands, loosens, turns into vesicles and finally hangs out of the anus as swollen breasts in parallel with the increase in the internal pressure of the vein network around the anus and the deterioration of the wall flexibility.
Although the formation of hemorrhoids is affected by very controllable factors such as genetic characteristics of the person, body structure, eating habits since childhood, environmental factors and co-morbidities, nutrition and toilet habits generally play the most important role. Constipation and diarrhea have an equal effect on the formation of this problem. In other words, whether it is a large toilet every few days or a toilet that requires a lot of hard and straining, or going to the toilet many times a day and having watery and high pressure stools that are difficult to hold, cause hemorrhoids. The habit of sitting on the toilet for a long time also plays a major role in the formation and progression of hemorrhoids. Excessive intake of chemicals that damage the vessel wall structure, such as alcohol and excessive consumption of spices and bitters, is one of the mechanisms of this disease.
Like the development of varicose veins in the legs and the accumulation and swelling of blood by gravity, blood accumulates in the hemorrhoid parallel to the increase in pressure during gravity and straining. Due to this, the wall of the hemorrhoid is stretched, edema (watering) occurs, and therefore, swelling, pressure sensation, stinging or pain around the anus, pain and burning, itching, and finally bleeding occurs as a result of the perforation of the thinned vessel walls.
The most important treatment step of hemorrhoids is, of course, the correction of nutrition and changing lifestyle and toilet habits. The most important step of the treatment is to eat 3 meals with plenty of plant fiber foods, excessive fluid intake, avoiding long-term standing or sitting, regular mobility, reducing the consumption of food and chemical substances that cause hemorrhoids, and quitting smoking. In addition, suggestions such as the treatment of constipation and diarrhea, learning not to push excessively on the toilet and not sitting for a long time on the toilet are the sine qua non of hemorrhoid treatment. In addition to the drugs taken orally and systemically supporting the vascular wall, the use of locally acting ointments and suppositories is sufficient for the treatment of many patients. However, the use of interventional methods for the treatment of patients whose hemorrhoid-related complaints do not go away despite these precautions and treatments is on the agenda.
In parallel with technological developments, the treatment technique of hemorrhoids has been used for more than 10 years by finding and connecting the arteries that supply blood to the hemorrhoidal sacs. With the help of a special ultrasound device (Doppler) that shows the blood flow, a special tip is entered into the anus, and there are hemorrhoidal arteries 5-6 cm above the anus at a level where there are no nerves and no pain occurs during the intervention, and they are tied with the help of special sutures. Again, with the same device and a similar technique, the sagging giant hemorrhoid breasts are hung up, that is, into the intestine, without cutting, and the outflow of the hemorrhoids with straining and the occurrence of complaints such as swelling, burning and itching are prevented. This procedure is called Hemorrhoidal Artery Ligation and together with Retro Anal Rectopexy / REPAIR (HAL+RAR).
Doppler hemorrhoidectomy or HAL procedure can be performed under general anesthesia, as well as with techniques that numb the waist down, such as spinal and epidural. There is no need for a very serious diet or bowel cleansing program after the preoperative diagnosis and the routine tests required before anesthesia and surgery. In the operating room, the procedure is completed in approximately 30 minutes and the patient who is taken to the service can start feeding as soon as possible without the need for any dressing, stitches or wound care. Patients who are discharged on the same day are told that they can return to all their daily activities immediately and continue their active business life, and activities such as bathing and sports are not interrupted.