Hemorrhoid disease, or piles as it is popularly known, is a phenomenon in which the internal pressure of the vein network around the anus increases and parallel to the deterioration of wall elasticity, this vascular system expands, relaxes, turns into vesicles and eventually protrudes from the anus in the form of swollen breasts.
Although the formation of hemorrhoids is affected by controllable factors such as the person's genetic characteristics, body structure, eating habits since childhood, environmental factors and concomitant diseases, nutrition and toilet habits generally play the most important role. Constipation and diarrhea are equally effective in causing this problem. In other words, whether it is defecation every few days or a hard toilet that requires a lot of straining, or defecation many times a day and watery and high-pressure defecation that is difficult to hold, causes hemorrhoids to form. The habit of sitting on the toilet for a long time also plays a big role in the formation and progression of hemorrhoids. Excessive intake of chemical substances that damage the vascular wall structure, such as alcohol and excessive consumption of spices and bitters, is one of the mechanisms of this disease.
The development of varicose veins in the legs and the accumulation of blood and swelling of the common vein bags due to gravity also cause hemorrhoids. Blood accumulates in parallel with the increase in pressure during pulling and straining. As a result, the wall of the hemorrhoid stretches, edema (watering) occurs, and therefore swelling around the anus, feeling of pressure, stinging or pain, pain and burning, itching and eventually bleeding occurs as a result of the puncture of the thinned vascular walls.
The most important treatment step for hemorrhoids is, of course, improving nutrition and changing lifestyle and toilet habits. The most important step of the treatment is to eat 3 meals a day with plenty of plant fiber foods, excessive fluid intake, avoiding long-term standing or sitting and regular mobility, reducing the consumption of foods and chemicals that cause hemorrhoids, and quitting smoking. In addition, recommendations such as treating constipation and diarrhea, learning not to strain excessively on the toilet and not sitting on the toilet for a long time are indispensable for hemorrhoid treatment. In addition to drugs taken orally and systemically that support the vascular wall The use of locally acting ointments and suppositories is also sufficient for the treatment of many patients. However, the use of interventional methods is on the agenda for the treatment of patients whose hemorrhoid-related complaints do not go away despite these precautions and treatments.
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 hemorrhoid sacs. With the help of a special ultrasound device (Doppler) that shows blood flow, a special tip is entered into the anus, and hemorrhoidal arteries are located 5-6 cm above the anus, at a level where there are no nerves and pain does not occur during the procedure, and they are tied with the help of special stitches. With the same device and a similar technique, the hanging giant hemorrhoid nozzles are suspended upwards, that is, into the intestine without being cut, and straining prevents the hemorrhoids from coming out and causing complaints such as swelling, burning and itching. This procedure is called Hemorrhoidal Artery Ligation and Retro Anal Rectopexy / REPAIR (HAL+RAR).
Doppler hemorrhoidectomy or HAL procedure can be performed under general anesthesia, or it can be performed with techniques that numb the area below the waist, such as spinal and epidural. After preoperative diagnosis, anesthesia and routine examinations required before surgery, there is no need for a serious diet or bowel cleansing program. The procedure is completed in the operating room in approximately 30 minutes and the patient can start feeding as soon as possible without the need for any dressing, stitches or wound care. Patients discharged on the same day are told that they can immediately return to all their daily activities and continue their active work lives, and activities such as bathing and sports are not interrupted.
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