After minimally invasive surgery, the pain is not obvious or the pain is significantly reduced, but there is generally no minimally invasive surgery except for internal hemorrhoids and anal fissures.
①The current minimally invasive surgery for hemorrhoids is limited to internal hemorrhoids, such as internal hemorrhoid sclerosing agent injection or RPH or PPH.
Mixed hemorrhoid surgery generally uses external stripping and internal ligation (milligan-morgan operation) or internal ligation and external resection. The key is to prevent postoperative edema. If there is no obvious postoperative edema, the pain will be significantly reduced and the recovery will be faster.
②The internal sphincter resection can be used for anal fissure, which is minimally invasive, but the recurrence rate is high; the partial sphincterotomy of the posterior internal and external sphincter has large trauma and slow recovery. The above two operations are not as thorough and safe as partial sphincterotomy. The partial posterior internal and external sphincterotomy is less traumatic, pain is also significantly reduced, and recovery is quicker.
③ Anal fistula and perianal abscess surgery must maintain the normal shape of the anus. If there is no collapse or deformity, the postoperative pain will be significantly reduced and the recovery will be quick.
1.1 Minor internal hemorrhoid bleeding: Most patients with internal hemorrhoid bleeding do not need surgery.
a. Eat more vegetables, maintain anal hygiene, and do more anal contractions.
b. Orally take the spirit of Maizhi, and put Jiuhua Hemorrhoid Suppository into the anus.
c. If conservative treatment fails, after the intestinal tract is cleaned, a specialist will pierce the submucosa of the hemorrhoids with a professional tonsil needle under a flat anoscope, and inject about 5ml of sclerosing agent, each injection of 1-2 hemorrhoids. The patient can rest for one night, and occasionally have slight pain, just take painkillers orally. As the operation was avoided, the patient had no obvious pain and recovered very quickly.
1.2 Mixed hemorrhoids dominated by external hemorrhoids: external stripping and internal ligation.
1.3 Mixed hemorrhoids dominated by internal hemorrhoids: internal ligation and external resection.
1.4 Prolapse of ring internal hemorrhoids: PPH surgery.
Points to note for external stripping and internal ligation or internal ligation and external resection:
a. Since hemorrhoids are vascular masses under the skin and mucous membranes, resection or ligation of the hemorrhoid tissue should be performed on the surface of the sphincter, and the sphincter tissue will not be damaged, and the bowel control function will not be affected after the operation.
b. The intersection of external stripping and internal ligation of traditional external stripping and internal ligation or internal ligation and external resection is 0.5cm on the dentate line. The author recommends that the intersection be set at the lower edge of the internal sphincter. So the patient recovers quickly.
c. The author believes that the most important factor leading to the slow recovery of hemorrhoids is perianal edema. At present, it is difficult to prevent edema with various Chinese medicines or physical therapy methods. After years of exploration, the author uses radial decompression incisions to effectively prevent postoperative edema. Practice has proved that the postoperative pain of the patient is significantly reduced and the recovery is much earlier.
2 Anal fissure
2.1 Acute anal fissure: Generally, surgery is not required.
a. Maintain daily defecation.
b. Maintain anal hygiene.
c. Mayinglong hemorrhoid ointment is applied externally.
2.2 Chronic anal fissure: surgery is generally required.
a. The traditional method is lateral internal sphincterotomy or posterior median resection. The author believes that lateral internal sphincterotomy is not easy to perform under direct vision, and the incision of posterior median resection heals too slowly or even does not heal.
b. The author recommends a posterior and lateral anal incision under local anesthesia. The incision should be slightly lateral to the middle of the anus. The incision is 2.5cm long. Cut off the anal sphincter stripe and anal sphincter at the posterolateral anus. Make the incision into a V-shaped slope. Debride in situ with scissors. So the patient recovers quickly.
3 Anal fistula or perianal abscess
a. The shape of the anal canal is forward and backward. For example, cutting part of the sphincter tissue from the side can easily lead to deformity of the anal canal and cause severe pain to the patient when changing the dressing. Therefore, try not to cut the sphincter tissue from the side incision. Cut off part of the anal canal and part of the sphincter tissue from the back or back slightly to the side, and still maintain the normal shape of the anal canal. It is not easy to cause obvious pain to the patient when changing the dressing. The second-stage healing of the incision can restore the preoperative anal shape and function.
b. Lateral anal fistula or perianal abscess: The author recommends that the incision be made into a fusiform radial. Will not damage the sphincter tissue. If an obvious internal ostium is found during the operation, do not cut off part of the sphincter tissue from the side. The internal ostium can be treated by first-stage threading, second-stage tightening or incision.
c. Posterior anal fistula or perianal abscess: The author recommends that the incision should be placed slightly to the side in the posterior center of the anus to explore the space behind the anal canal. The incision is about 3cm outside the anus, and the dentate line can be reached inside. Try to treat the inner mouth as a primary treatment and make the incision into a V-shaped slope.
d. Horseshoe anal fistula or perianal abscess: The author recommends that the lateral incision is the same as the lateral anal fistula or perianal abscess, and the posterior incision is the same as the posterior anal fistula or perianal abscess. However, a rubber band or latex tube should be placed between the two incisions to make a pair of mouth drainage, and rinse with water each time the medicine is changed to relieve pain.