Nov 3, 2021
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No hemorrhoids: domestic know-how will help to overcome a delicate problem

No hemorrhoids: domestic know-how will help to overcome a delicate problem

Photo: Euroonco

There are diseases that can be discussed with friends or even casual acquaintances in line at the clinic. Who and what is being treated, what folk methods are used, what diet follows … But there are diseases that are not accepted to talk about, and even going to the doctor with them is awkward and, perhaps, the most common among them is hemorrhoids. According to WHO statistics, this disease affects up to 40% of the working-age population of the planet. And given the fact that we are more and more moving to sedentary work, including against the background of the “remote” in recent years, there is no doubt that this number will grow.

Anyone who has ever encountered this disease knows that the word “hemorrhoids” in Russian is not accidentally called a difficult problem, the solution of which requires considerable effort. This unpleasant disease, which is accompanied by itching and burning in the anus, prolapse of hemorrhoids, bleeding, often requires long and painful treatment. Surgical intervention, that is, removal of nodes, is effective, but at the same time it is accompanied by a relatively high risk of complications, a long recovery period and the possibility of relapses.

Fortunately, medicine does not stand still, and methods of treating hemorrhoids are improving and becoming less painful. On October 26, the world celebrates the International Day of Coloproctology, and on the occasion of this date, “Free Press” decided to ask the candidate of medical sciences, an endovascular surgeon with more than 20 years of experience, a radiologist of the federal network of expert oncology clinics “Euroonco” Andrey Kukushkin, is it possible today to cure hemorrhoids once and for all without traditional operations. And – spoiler – it turned out that you can.

The Euroonco clinic uses a unique embolization technique developed in the mid-90s by Russian specialists in Krasnoyarsk. Paradoxically, domestic know-how was more appreciated in Europe, where it has been successfully used for a long time. In our country, the method is relatively unknown. Nevertheless, its effectiveness and minimally invasiveness speak for itself. Andrey Kukushkin told “SP” about how it is possible to defeat hemorrhoids with a small puncture in the thigh in just a day and live a normal life after that.

In the photo: Andrey Kukushkin, endovascular surgeon, radiologist of the federal network of expert oncology clinics
In the photo: Andrey Kukushkin, endovascular surgeon, radiologist of the federal network of expert oncology clinics “Euroonco” (Photo: Euroonco)

“SP”: – Andrey Vsevolodovich, hemorrhoids are such a delicate problem that many are embarrassed not only to talk about it, but also to go to the doctor, and drag on until the last, when the disease becomes neglected. How important is it to see a specialist on time when treating hemorrhoids?

– Timely diagnosis is relevant in the treatment of any diseases, the earlier you start treating them, the easier and more successful this treatment is. Patients who suffer from this disease, in no case need to pull. It is clear that this is a rather delicate problem, and many are embarrassed to contact specialists. However, the earlier treatment is started, the better the outcome will be.

“SP”: – What are the consequences of delaying treatment?

– Hemorrhoids are divided into two types. The first is acute hemorrhoids, when thrombosis of hemorrhoids occurs and inflammation develops against this background, which can lead to all sorts of unpleasant consequences up to purulent complications. The second is chronic hemorrhoids, which are divided into four stages. The first is usually accompanied by the release of blood, on the second hemorrhoids can fall out of the anus and be accompanied by bleeding. In the third, hemorrhoids have to be adjusted manually, while in the fourth it is not possible because of their size. In addition, it can be accompanied by prolapse of the mucous membrane and rectum. Therefore, it is quite obvious that it is impossible to delay treatment.

“SP”: – Before going to a specialist, many are stopped not so much by awkwardness as by fear of the upcoming treatment. Are there modern methods of treatment for hemorrhoids that make it possible to do without painful surgeries?

– Today there are many methods of treating hemorrhoids, but almost all of them are transanal, that is, they are produced by accessing the anus. These are methods such as ligation, application of rubber rings, but all of them, one way or another, are transanal. However, in our clinic, we use a method that avoids such an intervention.

This is a domestic technique that was created in Krasnoyarsk in the mid-90s. Despite this, in our country, unfortunately, it is little known, but in Europe, primarily in France and Spain, this technique has long been adopted and widely used. This technique is called emborroid or superior rectal artery embolization. It’s hard to say why we don’t use it more widely. In Europe, this procedure is performed even when patients are to be operated on the coronary vessels, that is, the vessels of the heart. Before heart surgery, this technique is also used to treat hemorrhoids, if the patient has one.

“SP”: – What is this method?

– This technique is aimed at stopping the blood flow through the vessels that feed the hemorrhoids by introducing microcoils or microembols. After that, they shrink and disappear, and the person can return to normal life. This whole procedure is carried out without surgery on the anus.

“SP”: – How then do microcoils get into the body?

– First, under local anesthesia, the right femoral artery is punctured, where a special catheter is inserted, with the help of which the inferior mesenteric artery is catheterized (puncture is a small puncture, – ed.). Already through it, the rectal artery is also catheterized. An angiographic examination is performed – the introduction of a contrast agent under fluoroscopy to assess the vascular architectonics and localization of hemorrhoids.

After that, special tiny microcoils or microspheres with a diameter of 500-700 microns are inserted into the lower rectal artery, which leads to a cessation of blood flow through the superior rectal artery. After the procedure, the catheters are removed, and a pressure bandage is applied to the puncture site. The patient is in the clinic for just a day, after which he can be discharged home. Unlike transanal operations, the recovery period does not last long, up to a week. During this time, unpleasant sensations in the anus are possible, but after a week they disappear.

“SP”: – Who is this method shown to and what are the contraindications?

– The embolization method is used only for chronic hemorrhoids of the first, second and partially third stages. Acute hemorrhoids are contraindications. In addition, it can be used for heavy bleeding of hemorrhoids, as a stage in preparation for surgical treatment.

A contraindication may be pronounced atherosclerotic changes in the aorta, since its tortuosity or the presence of a large number of atherosclerotic plaques can interfere with the manipulation of the catheter.

“SP”: – Have there been patients in your practice who, after this procedure, were able to forget about hemorrhoids forever?

– We have quite a lot of such patients. There are people who have undergone more than one transanal intervention, but they still have relapses. After embolization, they left as practically healthy people. There were cases when patients returned to us after this procedure, because there are cases when hemorrhoids receive blood supply not only from the superior rectal artery, but also from the middle one. In this case, re-embolization of not the upper, but the middle rectal arteries can be performed. In this case, the blood flow is maintained through the lower arteries, ischemic damage to the rectum does not occur. It is an effective and working technique that allows patients to avoid painful and difficult transanal intervention.

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