Operation – hemorrhoidectomy
In mid-2013, for hemorrhoids of the 4th stage, and in some cases of the 3rd stage, we proposed and are currently actively using hemorrhoidectomy with a corrugated suture (RF patent 254455).
The essence of the proposed method is that, under the control of Doppler ultrasound, the hemorrhoidal artery is sutured and ligated with a corrugated suture applied to the internal node, which “goes” inward, pulling the external node along with it.
In this case, when applying a corrugated suture, the stitched node (we are talking about large nodes of the 4th stage) is partially excised, which allows for adequate lifting. Such a manipulation cannot be performed using an anuscope, which is usually used for disarterization. We use special rectal mirrors, which improves the view of the surgical field and allows partial excision of the treated node. The latter increases the radicality of the operation and enhances the lifting effect.
All manipulations are carried out to the so-called. dentate line, which minimizes postoperative pain. In fact, the proposed modification of the operation is something between disarterization and hemorrhoidectomy, retaining all the advantages of both operations (minor pain, virtually no complications, high radicality). If the external component does not completely “go inside” and nodes (fimbriae) remain, albeit reduced, then we resolve the issue with the patient each time on an individual basis. If the patient is bothered by external nodes (they become aggravated, cause discomfort) or if “serious” aesthetics of the perineum is required, then they are partially excised during surgery. The remaining components are removed 1-2 times during dressings with anesthesia for 2-3 weeks after surgery (so-called wound correction). The manipulation is usually tolerated easily and without loss of ability to work.
Proctologists
Bagdasaryan Lev Karapetovich Surgeon - coloproctologist, candidate of medical sciences, doctor of the highest category, member of the Association of Coloproctologists of Russia.
Cost of admission 3500
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Bagdasaryan Samvel Lvovich Surgeon - coloproctologist, candidate of medical sciences, member of the Association of Coloproctologists of Russia.
Cost of admission 2900
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What should the patient do?
Summarizing the above and based on the experience of over 1,500 radical operations and the experience of over 3,000 minimally invasive manipulations on hemorrhoids over the past 13 years, we have come to the following treatment tactics:
1. If a person has rare bleeding, say, up to 2-3 times a month or even less often, then conservative treatment is quite acceptable, provided that nothing threatening is revealed during colonoscopy. The main thing is to monitor your stool, take 2-week courses of Detralex (phlebodia), therapeutic microenemas, etc. several times a year.
2. Bleeding has become more frequent up to several times a week, has become a nuisance, and a person simply wants to live without any restrictions on food, sports and without regard for his hemorrhoids. In addition, tablets and ointment suppositories do not have to be purchased for free. In these cases, the patient is offered one of the minimally invasive treatment methods (latex ligation, sclerotherapy, etc.)
3. In the 2nd-3rd stages of the disease, when the patient has severe symptoms: bleeding, prolapse of nodes, in these cases we perform disarterization of internal hemorrhoids (with or without lifting and mucopexy);
4. For hemorrhoids of the 3rd-4th stage with pronounced nodes and in the absence of a border between the internal and external hemorrhoids, we perform the operation we propose - hemorrhoidectomy with a corrugated suture. But most often in these patients we perform a combination of methods. Since not all nodes in the same patient will necessarily be the same size, therefore, on very large nodes we perform hemorrhoidectomy with crimped sutures, on smaller ones - disarterization with lifting. Such tactics of operations, along with other techniques, can reduce postoperative pain and improve treatment results.
For how long is sick leave issued for conservative treatment?
Conservative treatment of hemorrhoids includes medication. This includes the use of ointments, rectal suppositories, and phlebotropic drugs. Each of the drugs has its own direction of action - relieving pain symptoms, swelling, eliminating bleeding, increasing the tone of the veins. The average period for which sick leave is given with conservative therapy is seven days.
Most often, sick leave for hemorrhoids is issued at the second and third stages of the disease. For symptoms characteristic of the first stage of the disease, the doctor may give sick leave only for a day to relieve pain.
How long do you need to stay in the clinic?
Differently. Most often, 2-3 hours are enough for the anesthesia to wear off and the person to feel the degree of pain. This period is usually enough for the patient to start walking and feel normal. Before leaving home, a final examination is carried out, the bandage is changed, and detailed recommendations on activity, nutrition, and wound care are given. Sometimes it takes up to 4-6 hours for the condition to completely normalize. If there is the slightest doubt, the patient is left in the clinic under the supervision of medical staff. This also applies to people living far away.
Should I take baths?
The day after the operation, patients begin to take warm (38 - 40 °C) lying baths, which significantly reduce pain, promote the free passage of gases and provide maximum comfort to the vast majority of patients. Our patients enjoy taking baths: pain is reduced, the wound is cleaned, and healing is accelerated. In no case did we observe any problems associated with this procedure. We do not recommend or advise with caution taking baths for people with varicose veins of the lower extremities.
How to go to the toilet after surgery
The first bowel movement after surgery is a question that usually raises a lot of questions in people: “how will I go to the toilet?”, “maybe it’s better for me not to eat?” etc. Naturally, you need to eat. Starting from the first hours after surgery, you need to drink water (tea, coffee), eat chocolate, and fruit. For dinner on the day of surgery - light foods: yogurt, cereal, cottage cheese, tea. From the next day after surgery, eat normal food, excluding spicy foods and alcohol. The emphasis in food should be on foods that promote soft stools (soups, vegetables, liquid oils, boiled beets, prunes, dried apricots...). The faster a person goes to the toilet, the softer the stool will be and the easier it will be to defecate. Usually our patients have their first stool the day after surgery. Painkillers and laxatives (mucofalk, duphalac, etc.) are taken before bowel movements, which makes defecation easier. After defecation, the patient immediately takes a bath. But we have had cases where patients were afraid to eat and ate little in order to delay defecation. In such cases, a small meal may not cause an active urge to defecate. Fecal masses in the rectum accumulate, thicken and the so-called. fecal blockage, which requires anesthesia and manual bowel cleansing. The procedure is unpleasant for both the patient and the doctor. This happened in the past with us, up to 2-3 cases a year. Fortunately, no one has had anything like this for the last 2 years.
Is sick leave required for hemorrhoids?
Hemorrhoids are a serious disease that often worsens, causing severe pain that prevents the introduction of a normal lifestyle. A person cannot move normally, sit, lift even small weights (2-3 kg), as all this increases the pain. Accordingly, many patients, during an exacerbation of the disease, have a question: do they give sick leave for hemorrhoids?
Undoubtedly, the period of exacerbation requires complete rest and the use of drug therapy, therefore, in case of hemorrhoids, a certificate of incapacity is issued. However, to receive it, you must immediately consult a doctor on the day the clinical manifestations of the disease appear. Remember that sick leave is opened strictly on the day you go to the clinic. If a person applies later, the days he spent at home are counted as absenteeism at work.
To obtain a document confirming temporary disability, you need to contact a proctologist. In district clinics, such a specialist is usually absent. In such cases, it is recommended to contact a surgeon.
Physical activity and sports
But first, is it possible to sit? A frequent question from patients and on the forum. You can sit. There's nothing wrong with that. Many people go home after surgery in their own car. But don’t “overstay” if sitting causes discomfort in the perineum, heaviness, inconvenience, then you don’t need to sit anymore - get up, walk around, lie down. In everything, listen to your body. He himself will tell us what to do. The same goes for sports. Usually the wound heals completely by a month after the operation and by this time you can gradually give yourself full exercise without limiting the load. Small loads, say 50-60%, can be given already 2-3 weeks after the operation, depending on how you feel. In any case, listen to the body, do not bring yourself to the point of heaviness and discomfort in the operated area.
Disability payment
The sick leave certificate must be submitted to the personnel department of the enterprise where the work is carried out immediately upon returning to work. This document will prove that the official absence from work was due to illness, and will allow you to quickly resolve the issue of sick leave payment.
Payment for days of incapacity for work on sick leave does not have an exact amount, since it completely depends on the length of service and the amount of salary. According to the Labor Code, the amount of payments is calculated as follows:
- 100% payment – if the patient’s work experience at one enterprise lasts more than eight years;
- 80% of the salary – if the work experience lasts from five to eight years at one enterprise;
- 60% of the salary – if the patient has worked at the company for no more than five years.
When an employee leaves the company, the employer is obliged to pay sick leave within one month after he leaves his workplace. The payment will be approximately 60% of the average salary.
When can an employee not count on paid sick leave? If during the illness the employee was on regular leave. In this case, the employer will pay only the first 3 days of incapacity for work, the rest will be paid by the Social Insurance Fund (SIF).
If a certificate of incapacity for work is not submitted within six months after sick leave, payment will be denied.
Work ability
Patients' ability to work is restored in different ways and depends on many reasons (stage of hemorrhoids, combination with a fissure, level of pain threshold, nature of work, need to be in the office, etc.). There are patients who started working the day after hemorrhoidectomy, but on average these periods were 7-10 days. Complete healing of the wound usually occurs within 25 - 30 days. By this time, patients “forget” about their problem, and all restrictions are lifted. The person returns to the normal rhythm of life, without any restrictions, including sports activities.
Sick leave after hemorrhoid surgery
After surgery on hemorrhoids, sick leave is issued for 10 days or more. The period of temporary disability depends on several factors:
- type of surgery;
- stages of hemorrhoids;
- presence of complications during the rehabilitation period;
- work activity of the patient.
Minimally invasive interventions
Such operations are rarely accompanied by complications, so in most cases sick leave for hemorrhoids is issued only for 1 day, namely the day when the operation is performed. From the next day the patient can begin work, unless, of course, it requires heavy physical labor. In such cases, sick leave can be extended by 2-3 days maximum.
Extensive interventions
In this case, we are talking about hemorrhoidectomy, during which hemorrhoids and the adjacent mucous membrane of the rectal canal are removed. This type of operation is used for advanced hemorrhoids, when there is loss of hemorrhoidal cones, development of thrombosis, necrosis, etc.
Despite the fact that this is the only effective way to remove hemorrhoids, it has a big drawback - long and difficult rehabilitation. During this period, the patient is contraindicated in any physical activity, including walking. Complete rest is indicated, as well as up to 15 days of treatment at home.
The period of hospital treatment after surgery is on average a week. In this case, the sick leave is opened in the hospital where the surgery was performed. Then it is transferred to a proctologist, who prescribes outpatient therapy. The patient must visit the doctor regularly. If, upon completion of home drug treatment, there are no complications requiring extension of therapy, the sick leave is closed. The next day the person goes to work.
In cases where, after outpatient treatment, the patient complains of pain, bleeding or other complications that require continued therapy, the issue of extending sick leave is decided individually by the commission.
Prevention of hemorrhoids
What can I do to avoid the matter leading to surgery? How to “stop” hemorrhoids? Many similar questions are asked on the forum. Frankly, this question always causes me difficulties, because in reality there are not many moments in this life that can be changed in order to “close” the topic of hemorrhoids. You can: do not eat spicy food and do not abuse alcohol, this is acceptable. It's bad to sit at the computer all day, but most of us have to do it - work! It’s bad to lift weights, but what should manual workers and athletes do? It's not a good idea to spend your day driving or standing at a counter, but many people have to do it. Again, pregnancy and childbirth! What's left? Daily bowel movements and treatment of constipation. This is what really prevents hemorrhoids and, most importantly, maintains overall health. Helpful: moderation in food, enough water, physical activity and much more.
For example, it is very useful for people in sedentary professions to periodically get up from the table, walk around, stretch, and restore blood circulation in the legs. For those who have a standing job, who stand on their feet for a long time, it is useful to periodically rise a little on tiptoes and sharply drop onto their heels, as surgeons do during long operations.
In conclusion, I would like to say that today hemorrhoids can be cured at any stage. So is it worth devoting all your time to the prevention of hemorrhoids? There are much more interesting things in this life than this disease. But let me remind you where I started - if symptoms of hemorrhoids appear, you need to check the entire colon.
Do they give sick leave for hemorrhoids?
Hemorrhoids in the acute stage prevent a person from living a full life and performing the most basic functions. Where to go to get sick leave? This is a hospital where a proctologist sees a doctor.
There are several circumstances that determine how many days the period of incapacity for work will pass with the issuance of sick leave:
- hemorrhoids in acute and chronic manifestations;
- professional activity of the patient;
- effectiveness of treatment methods (conservative and surgical).
