Longo surgery to remove ring hemorrhoids

The article is professionally consulted by Master, Doctor Nguyen Ngoc Thang, Department of General Surgery - Vinmec International General Hospital Da Nang.

Longo surgery is currently one of the most commonly used methods to treat hemorrhoids. This method can be applied to both internal hemorrhoids and mixed hemorrhoids, especially it is considered the most optimal method in treating ring hemorrhoids.

Hemorrhoids, also known as prolapsed veins, is a medical condition that occurs due to excessive dilation of the hemorrhoidal plexus or bulging of the veins in the tissues around the anus, causing inflammation or congestion. There are 3 types of hemorrhoids: internal hemorrhoids, external hemorrhoids and mixed hemorrhoids.
When hemorrhoids are joined together and occupy most of the anal circumference, they are called ring hemorrhoids. Thromboembolic hemorrhoids occur when the hemorrhoids gradually increase in size causing compression, pain and bleeding, possibly even necrosis due to lack of nourishment.
Treatments for ring hemorrhoids are similar to internal hemorrhoids, external hemorrhoids or mixed hemorrhoids including using medical drugs and surgical procedures. Depending on the patient's condition, condition of hemorrhoids, size, location as well as clinical manifestations to choose the appropriate treatment method. However, because the characteristics of ring hemorrhoids are many hemorrhoids of different sizes, arranged around the entire anal circumference, so far, the Longo surgical method to cut hemorrhoids is still the most optimal choice. for the treatment of ring hemorrhoids.

Longo surgery is a method of using a loop suture machine to cut a segment of mucosa above the dentate line about 3-5 cm and suture the ring with an automatic sewing machine.
The principle of treatment is to reduce blood flow to the hemorrhoidal plexus to reduce the volume of hemorrhoids by cutting and suturing the mucosa of the hemorrhoid area and hanging the anal cushion into the anal canal. The technique of cutting a segment of mucosa can allow the treatment of many different hemorrhoids with hemorrhoid roots on the same mucosal segment. Therefore, this method is completely consistent with the structure of ring hemorrhoids.
2.1. Indications and contraindications Indications:
Longo's hemorrhoid surgery is good for treating internal hemorrhoids of grade 2, 3, sometimes applied to grade 4, especially for treatment of ring hemorrhoids. At the same time, this method can also be used to treat cases of rectal mucosal prolapse. Contraindications:
Patients with other diseases of the anal region such as para-anal abscesses, anal canal stenosis or cases of total rectal prolapse, patients with rectal ulcers. The patient is taking anticoagulants or has blood clotting problems. Patients with cardiovascular diseases or serious medical diseases that have not been thoroughly treated. 2.2. Techniques of the Longo method Patient preparation:
Advise and explain to the patient about the Longo method before surgery. Patient position: Lie on back, legs in obstetric position, psychologically comfortable. Doctors and medical staff perform:
Make sure about the outfit and sterile before, during surgery. Prepare all necessary equipment for surgery. The doctor stands in the middle of the patient's legs. The surgical assistant stands next to the doctor to provide support. Carry out surgery:
Re-examine the anus to accurately re-evaluate the status, position, and size of the hemorrhoids with the surrounding structures around the anus. Note the rectal wall of the vagina in women. Insert an anal dilator. Place the round valve and then sew the valve fixed. Using monofile suture, sew a closed loop around the mucosa, about 2-3 cm below the dentate line. Place the circular stapler head on the stitching ring then tighten the bag tie thread, close the machine to the specified line limit and wait for 30 seconds to enhance hemostasis, and even out the tissues. Re-examine the posterior vaginal wall if the patient is female. If there is nothing abnormal, remove the safety pin and press the machine to cut the hemorrhoid. Note that you can only cut 1 time definitively, not allowing to press the camera more than 1 time. Wait 20 seconds to enhance hemostasis, then press release. Twist and release the device about 1⁄2 to 3⁄4 of the anal circumference and gently shake it to remove the device from the anus. If you use Covidien's EEA, be sure to turn it off. After unplugging the machine, check the cutting ring again, if there is bleeding, then stitch it up with PDS or vicryl thread. 2.3.Advantages and disadvantages of Longo hemorrhoidectomy

Advantages of this method:
No downtime, short hospital stay. This method is good for treating rectal prolapse and internal hemorrhoids. Longo surgery uses self-dissolving sutures, so it can ensure aesthetics and limit wound infection when the sutures are exposed to the outside environment. Patients can return to normal activities and activities after a short time. Cons:
High cost. The recurrence rate is high, it is possible to recur in a short time if the patient does not have a reasonable lifestyle. There may be some complications during surgery such as secondary bleeding, rectal perforation, and secondary rectal stricture.