Hemoroidal Hastalık
Özet
Hemoroidal hastalık, anal kanaldaki vasküler yastıkçıkların kanama, sarkma ve ağrı gibi semptomlarla patolojik hale gelmesi durumudur ve toplumun yaklaşık %30'unu etkileyen yaygın bir sağlık sorunudur. Hastalığın gelişiminde kronik kabızlık, gebelik, obezite ve yanlış tuvalet alışkanlıkları gibi faktörler temel rol oynarken, teşhis aşamasında rektal kanamanın ayırıcı tanısı için dijital muayene ve endoskopik değerlendirmeler kritik önem taşır. İç hemoroidler, anatomik yerleşimlerine ve sarkma derecelerine göre dört evrede sınıflandırılır; ilk evrelerde diyet ve ilaç gibi konservatif yaklaşımlar tercih edilirken, ileri evrelerde cerrahi müdahale gereklidir. Tedavi seçenekleri arasında bant ligasyonu, skleroterapi ve lazer gibi minimal invaziv yöntemlerin yanı sıra, Milligan-Morgan (açık) ve Ferguson (kapalı) hemoroidektomi gibi geleneksel cerrahi teknikler de etkinliğini korumaktadır. Güncel tıbbi yaklaşımlar, Longo tekniği (stapler) ve Doppler rehberliğinde hemoroidal arter ligasyonu gibi, postoperatif ağrıyı minimize eden ve hastanın günlük yaşama hızlı dönüşünü sağlayan doku koruyucu yöntemlere odaklanmaktadır. Başarılı bir tedavi süreci için doğru hasta seçimi ve yaşam tarzı değişiklikleri esastır; zira lifli beslenme ve kabızlıktan kaçınma, hem hastalığın önlenmesinde hem de nükslerin engellenmesinde en pratik ve etkili koruyucu stratejilerdir.
Hemorrhoidal disease is a common health problem affecting approximately 30% of the population, characterized by vascular cushions in the anal canal becoming pathological through symptoms such as bleeding, prolapse, and pain. While factors like chronic constipation, pregnancy, obesity, and poor toilet habits play a key role in its development, digital examination and endoscopic evaluations are critical for the differential diagnosis of rectal bleeding. Internal hemorrhoids are classified into four stages based on their anatomical location and degree of prolapse; while conservative approaches such as diet and medication are preferred in the early stages, surgical intervention is necessary for advanced stages. Treatment options include minimal invasive methods like band ligation, sclerotherapy, and laser, as well as traditional surgical techniques such as Milligan-Morgan (open) and Ferguson (closed) hemorrhoidectomy, which maintain their effectiveness. Modern medical approaches focus on tissue-preserving methods that minimize postoperative pain and ensure a quick return to daily life, such as the Longo technique (stapled) and Doppler-guided hemorrhoidal artery ligation. Correct patient selection and lifestyle changes are essential for a successful treatment process; as fiber-rich nutrition and avoiding constipation are the most practical and effective preventive strategies for both preventing the disease and inhibiting recurrences.
Referanslar
Review of Hemorrhoid Disease: Presentation and Management Zhifei Sun, MD1 John Migaly, MD1 1Department of Surgery, Duke University, Durham, North Carolina Clin Colon Rectal Surg 2016;29:22–29.
Sun WM, Peck RJ, Shorthouse AJ, Read NW. Haemorrhoids are associated not with hypertrophy of the internal anal sphincter, but with hypertension of the anal cushions. Br J Surg. 1992;79:592-594.
Morgado PJ, Suárez JA, Gómez LG, Morgado PJ. Histoclinical basis for a new classification of hemorrhoidal disease. Dis Colon Rectum. 1988;31:474-480.
Ibrahim S, Tsang C, Lee YL, Eu KW, Seow-Choen F. Prospective, randomized trial comparing pain and complications between diathermy and scissors for closed hemorrhoidectomy. Dis Colon Rectum. 1998;41:1418-1420.
Seow-Choen F, Ho YH, Ang HG, Goh HS. Prospective, randomized trial comparing pain and clinical function after conventional scissors excision/ligation vs. diathermy excision without ligation for symptomatic prolapsed hemorrhoids. Dis Colon Rectum. 1992;35:1165-1169
Varut Lohsiriwat. Hemorrhoids: From basic pathophysiology to clinical management. World J Gastroenterol. May 7, 2012; 18(17): 2009-2017 Published online May 7, 2012. doi: 10.3748/wjg.v18.i17.2009
Kheng-Seong Ng, Melanie Holzgang, Christopher Young, Still a Case Of “No Pain, No Gain?” An Update and Critical Review of the Pathogenesis, Diagnosis and Management Options for Hemorrhoids in 2020 Annals of Coloproctology 2020; 36(3): 133-147.
Rakinic J, Poola VP. Hemorrhoids and fistulas: new solutions to old problems. Curr Probl Surg 2014;51:98–137.
Johannsson HO, Pahlman L, Graf W. Randomized clinical trial of the effects on anal function of Milligan-Morgan versus Ferguson haemorrhoidectomy. Br J Surg 2006;93:1208–14.
Ho YH, Buettner PG. Open compared with closed haemorrhoidectomy: meta-analysis of randomized controlled trials. Tech Coloproctol 2007;11:135–43.
J. A. Ferguson, W. P. Maizer ve M. I. Ganchrow, «The Closed Technique of Hemorrhoidectomy,» Surgery, cilt 70, pp. 480-484, 1971.
Kenan Erzurumlu , Kağan Karabulut , Gökhan Selçuk Özbalcı , İsmail Alper Tarım , Gökhan Lap ve Bülent Güngör. Whitehead operasyon prosedürü: Yararlı bir teknik mi?Türk J Surg. 2017; 33(3): 190–194.
A. Longo. Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device: a new procedure Monduzzi (Ed.), 6th World Congress of Endoscopic Surgery, Rome, 3–6 June 1998, Bologne (1998), pp. 777-784
Manfredelli S, Montalto G, Leonetti G, ve ark. Convantional (CH) vs. Stapled hemorrhoidectomy (SH) in surgical treatment of hemorrho- ids. Ten years experience. Ann Ital Chir. 2012İ83:129-134.
Aigner F, Gruber H, Conrad F, Eder J, Wedel T, Zelger B, Engelhardt V, Lametschwandtner A, Wienert V, Böhler U. Revised morphology and hemodynamics of the anorectal vascular plexus: impact on the course of hemorrhoidal disease. Int J Colorectal Dis. 2009;24:105-113.
Aigner F, Bodner G, Gruber H, Conrad F, Fritsch H, Margreiter R, Bonatti H. The vascular nature of hemorrhoids. J Gastrointest Surg. 2006;10:1044-1050.
