Operation of rectal vein thrombosis - Ars Medica Laserclinic

Rectal venous thrombosis is an intergrowth of haemorrhoidal illness mostly at the stage IV (external hemorrhoidal illness). Hemorrhoids are prevalent to epidemic proportions, affecting 20% of the adult population. As long as the dilating veins together with the mucosa - growing slowly outwards from the inside - are inside the anus it is considered internal haemorrhoidal tumor but when they reach in front of the anus they are called external haemorrhoidal tumor. Hemorrhoids may lead to various complications: mucosal fissures that are extremely painful, venous thrombosis, bleeding, each of which can be frightening so these often prompt patients to see their doctors. Rectal venous thrombosis is formed when due to the fall of the blood stream in the dilated vein blood clots that forms blood-clot blocking veins. The clot-blocked vein swells due to the formed oedema. Patients observe fastly evolving pulp-sized tense tumor at the rectum.

There are three options considering rectal venous thrombosis treatment. One of them is the removal of the blood-clot; the other is the removal together with performing surgery for to remove hemorrhoids (hemorrhoidectomy). Urgent removal of blood-clot is highly recommended for parts may get of the blood-clot that may cause embolism when getting into blood-stream. The quick operation that may be performed with local anesthesia terminates this danger although for it is not a final solution since the untreated hemorrhoids may lead to further complications in the future. Only the hemorrhoidectomy performed together with the clot removal means final solution for the problems caused by the illness and its complications. The third option is the conservative treatment of the rectal venous thrombosis with creams, rectal suppositories. Danger of embolism is decreasing in progress of time since the blood-clot sticks to the wall of vein and slowly - by losing its water-content - starts to shrink and later it transforms by connective tissue.

Difference has to be made between the examination of the recent and old rectal venous thrombosis performed by the surgeon. In case of recent one In case of the recently evolved thrombosis mostly the simple observation of the pulp-sized, bluish coloured tense tumor is enough and the rectal examination for the pain is impossible, only may the digital (finger) rectal examination is to be performed but at most cases it is neither. Rectoscopy is out of question at this case. We do not force examinations at this case we highly recommend the immediate removal of the blood-clot for the patients. When performing observation the old partly shrank tumor formed couple of weeks ago only differs from the external hemorrhoidal tumor in its deep blue-blackish colour. It is mostly an unpleasant but unpainful rather soft tumor.

During rectoscopy first the size and location of hemorrhoids is examined and followingly the lower app. a 15-18-cm-long part of the rectum is observed in order to eliminate other inflamed tumorous illnesses and so this is biopsy at the same time. Afterwards the examining doctor gives detailed information for the patient on its state and treatment opportunities. One-day-surgery is mentioned here as a special way of treatment together with all the required lab tests and other further exams to be carried out, the anesthesia types, possible complications, home care to-dos, phases of recovery, may occurring problems during recovery, so in a word all and every information that are necessary for the patient to make a decision on the way of treatment and/or surgery. During consultation it is often asked if the doctor recommends surgery or conservative treatment. I personally always recommend urgent blood-clot removal in case of recently formed thrombosis in order to avoid danger of embolism and deliberation of symptoms caused by hemorrhoids on what basis a decision can be made if the two problems should be eliminated at the same time, namely blood-clot removal is to be performed together with hemorrhoidectomy. Concerning I do tell two things all the time to my patients. Firstly that this is an anatomical deformation (rectal varicose vein) so the process cannot be blocked by conservative treatment only symptoms can be eased. If we do not eliminate hemorrhoids than any time new symptoms may evolve. Secondly all rectal illness related problems (pain, bleeding etc.) are tolerated differently by everyone so it is only defined by the individual tolerance capability for how long one may live with this illness and when is the time for decision on surgery. During consultation patients do frequently ask for advice on method of anaesthetization: if I do recommend local or general anesthesia. The answer is definite: in case of blood-clot removal the operation can be performed in either local or general anesthesia due to individual sensitivity. First of all the individual sensitivity is determinant: in case of local anesthesia the pain of prick and pressure of the three Lidocaine injections (0.5%) shot under mucosa is unavoidable. In case of general anesthesia injection is given into vein of the lower arm and after operation patients leave the surgery room and after 6-8 hours of observation the clinic on their own feet. If blood-clot removal is to be performed together with hemorrhoidectomy only general anesthesia is possible.

The provided fully detailed information is certified by patients with their signature in their own information minute.

"One day surgery" means, that patients can leave the outpatient center on their own feet, accompanied by a helper, within 24 hours of surgery (usually after few hours of observation), and continue the healing process in the familiar confines of their own home. "One day surgery" requires strict professional, social, and various other preconditions that are discussed at the stage of the consultation when the need for surgery becomes clear. (I.e.: good general health, absence of serious systemic disease, patient must take responsibility for arrangement of transportation, home care, must have phone to contact the clinic or the surgeon if necessary, etc).

At the booked operative time patients must bring their lab tests, slippers, night-suit. Before placed into sick-room a "STATEMENT" is to be signed in order to entitle our clinic for the performance of the procedure. Besides patients have to undertake home wound care.

Considering that operation is performed in general anesthesia, food and drink intake is allowed until 24:00 pm on the prior day to procedure -for patient have to arrive with empty stomach for the surgery!

Please take the regularly taken drugs in time and dose. Take morning drugs with little liquid at home before departure and in case you may have drugs to be taken in day-time, please bring them with to the clinic!

Operation can be either performed in local or general anesthesia. Local anesthesia means: three Lidocaine (0.5%) injections shot due to the location of the hemorrhoids tumours ensuring total senselessness. General anesthesia means: one injection shot into the lower arm due what patients are sleeping during the operation and are awaken only afterwards. Vein wall containing blood-clot is opened and so is blood-clot removed. A loose tampon is placed into scar followingly.

No doctor can guarantee a complication-free surgery. Complications can arise even following the most carefully performed procedures. The possible early complications: post-operative bleeding but its occurrence is very rare with this operative method; for safety reasons post-operative observation is compulsory. Fever on the evening of the operation and low-fever on the following days may occur. In the first days slight bleeding, later at dejections is not distressing. In case of persistent low-fever, fever, bleeding you may contact your surgeon 24/7 who gives solution for the complications. Later complications usually do not occur after blood-clot removal.

The operation is followed by a 1-hour long post-operative observation and afterwards patients can leave the clinic on their own feet. In the first week physical load is to be avoided, but permanent bed-rest is not necessary. Post-operative pain in the first 2-3 days may occur spontaneously but mostly at dejections. To terminate this use of painkillers work supplemented by intervallic chilling of the operative area and camomile bath. Settlement of dejection during recovery is prominently important (regular, soft dejecta). Intake of one spoon of liquid paraffin is proposed 3 times a day but usually no other ejective is necessary. Low-fever may occur on the post-operative days. If it takes more than a day antibiotics are advisory. In the first days bleeding generally and later at dejections should cause no distress. Defluxion of scar is normal for 4-7days and use of panty-liners are recommended. The total recovery time is approximately one week during what physical load is to be avoided but brain-work can be done. The first control takes place after two weeks.

Surgery under local anesthesia: 0 HUF (paid by National Health Insurance Fund)
Charge for general anesthesia: 40.000 HUF (paid by patient, optional) > Euro
Charge for overnight stay: 0 HUF
Fees of control examinations: 0 HUF (paid by National Health Insurance Fund)

We provide air-conditioned, TV-, phone- and WIFI equipped one-or two-bedded rooms, personal nurse and meal but these mean no further costs for our patients.

Surgery under local anesthesia: 80.000 - 100.000 HUF > Euro
Charge for general anesthesia: 80.000 HUF > Euro
Charge for overnight stay: 30.000 HUF > Euro
Fees of control examinations: 5.000 HUF > Euro

50% of the fee is due at the time the operation is scheduled, as a prepayment.
These are estimated charges and may also be affected by the severity of the condition.

We provide air-conditioned, TV-, phone- and WIFI equipped one-or two-bedded rooms, personal nurse and meal.

INFORMATION ON OPERATION OF RECTAL VEIN THROMBOSIS