Hemorrhoidectomy and excision of skin tags

The approach to the treatment of hemorrhoidal disease, although always adapted to the individual needs of the patient, predominantly dictates the degree of severity of the disease.

Namely, the division of hemorrhoidal disease into 4 stages is widely accepted:

• THE FIRST STAGE is characterized by small internal hemorrhoids that prolapse (do not "fall out") from the anus, and cause subjective problems such as itching and burning, very rarely discomfort or moderate pain, and occasional bleeding from objective symptoms.
• THE SECOND STAGE is characterized by the occasional "falling out" of hemorrhoids during tension, most often during urination, where it is discreet and spontaneously "hemorrhoids" return "after exertion. Patients usually complain of bleeding, pain, burning, itching, they can feel the hemorrhoids themselves or feel them "as if something is in the anus."
• THIRD DEGREE is characterized by constant prolapse of hemorrhoidal nodules (can be seen and felt), but it is possible to "return" them by hand to the anal canal. In addition to the problems mentioned in the earlier stages of the disease, extremely difficult hygiene is already common here, despite all the efforts of patients, and there is often a "trace on the panties" which can be stool, blood, or both.
• THE FOURTH STAGE of this disease is characterized by hemorrhoidal masses that cannot be "returned inside" even by hand. Patients have a constant feeling of discomfort, and bleeding that does not have to be related to urination, pain, burning, and completely disabled adequate hygiene.

While in the first stage of hemorrhoidal disease, according to all the guidelines of evidence-based medicine, the application of adequate conservative therapy is sufficient, other stages require a more engaged and often somewhat invasive approach. Among outpatient and surgical approaches, different methods differ throughout the history and progress of surgery. Today, for the approach to the 2nd degree of the disease, as well as the initial forms of the 3rd degree, we recognize laser hemeriodoplasty as the optimal and minimally invasive approach, during which laser energy is used to coagulate the vascular hemorrhoidal plexus.

However, markedly advanced stage 3 disease, as in any case of stage 4, cannot be adequately and completely treated with laser hemorrhoidoplasty. Namely, the degree of prolapse, ie "falling out" of hemorrhoids is such that there is inevitably a significant "stretching" of the skin of the perianal region. Such skin cannot be completely pulled back or "restored" after "burning" the hemorrhoidal node with laser energy and remains a constant "reminder" and problem, primarily through the almost impossible hygiene of the perianal area. Although all patients regularly feel the need for multiple daily showers of the affected area, even before doctors advise the same, the results are necessarily unsatisfactory. Inevitably, part of the feces remains in the cavities between the large skin folds and a certain amount of intestinal bacteria that cause irritation, itching, and often the development of infection. The same happens after the degree of hemorrhoidal disease rises only temporarily and for a short time, and in rare cases in rare cases where this is possible (after pregnancy and childbirth, and after acute thrombosis of hemorrhoids). Here the volume of the hemorrhoidal nodule itself normalizes spontaneously, but the skin fold or more lags behind.

Thus, in advanced cases of grade 3 and all cases of grade 4 hemorrhoidal disease, as well as in developed perianal skin folds accompanied by any currently active stage of hemorrhoidal disease, "cutting" of skin folds is indicated. It can be combined with laser hemeroidoplasty in the lower stages of the disease or "cutting" which includes hemorrhoid itself, in the 4th stage of the disease. Although history records the classic "bloody" approaches to this procedure, today we perform it with minimally invasive methods, using so-called "hemostatic scissors" which simultaneously stop bleeding and cut excess tissue. This method is an indisputable approach to the treatment of grade 4 hemorrhoidal disease. But it is also a medical as well as an aesthetic indication for residual skin folds of the perianal area, regardless of the degree and general existence of the active hemorrhoidal disease.

The procedure is short, does not require special preparation of the patient, and is performed as part of a one-day surgery, under short-term general or spinal anesthesia. Patients go home on the same day, and in the first 2 weeks of postoperative recovery, as well as after laser hemorrhoid plastic surgery, analgesic pain is actively suppressed and stool is softened to reduce postoperative pain. This method offers a permanent solution in over 95% of cases.