BRIGHT-RED BLEEDING
Blood on paper, in the bowl or on the stool surface should be assessed, especially when persistent or recurrent.
NAZAD NA USLUGESYMPTOMS · DIAGNOSIS · CONTEMPORARY TREATMENT
HEMOROIDI: INDIVIDUALIZOVANO LEČENJE U ATINI
Haemorrhoids are normal vascular cushions. Treatment may be needed when they enlarge or prolapse and cause bleeding, discomfort, pain or hygiene difficulty. The appropriate method is selected after examination, not by grade alone.
LASER & RAFAELO® RFATHD / HAL–RARMILLIGAN–MORGAN
POGLEDAJTE OPERACIJENapomena: navigacija na stranici dostupna je na srpskom. Detaljan medicinski sadržaj ove stručne stranice trenutno je prikazan na engleskom.
ELIXIS · ADVANCED CARE
There is no single technique suitable for everyone
Selection depends on bleeding, degree of prolapse, the external component, previous treatment, bowel function and the patient's priorities. The aim is to balance symptom control, recovery and recurrence risk.
SIMPTOMI
When a proctology assessment is needed
Symptoms may resemble other anal, rectal or colonic conditions. Diagnosis is based on history and examination, often including inspection, digital examination and anoscopy.
PROLAPSE
Tissue protruding during a bowel movement that returns spontaneously or needs manual reduction.
ITCHING & IRRITATION
Moisture, mucus, itching or difficulty cleaning may accompany prolapse.
PAINFUL LUMP
Sudden severe pain with a firm lump may indicate a thrombosed external haemorrhoid.
Bleeding should not automatically be attributed to haemorrhoids. A change in bowel habit, unexplained weight loss, anaemia or a family history of colorectal cancer may require further investigation and, in selected cases, colonoscopy.
OPERACIJE
Treatment options, separately
Treatment is stepwise. It begins with bowel-habit optimisation and, when needed, progresses from office treatment to tissue-preserving procedures or excisional haemorrhoidectomy.
BOWEL-HABIT OPTIMISATION & CONSERVATIVE CARE
Fibre, fluids and constipation management form the basis of treatment. Topical preparations may provide temporary relief but do not correct prolapse.
- KADA SE RAZMATRA
- Low-grade symptoms and as an essential foundation before or after any procedure.
- ŠTA OBUHVATA
- Avoiding straining and prolonged toilet time, adequate fibre and individualised stool regulation.
RUBBER-BAND LIGATION
An office treatment that interrupts blood flow to selected internal haemorrhoidal tissue, which then shrinks.
- KADA SE RAZMATRA
- Most grade I–II and selected grade III internal haemorrhoids without a dominant external component.
- ŠTA OBUHVATA
- Placement of a small elastic band above the dentate line. More than one session may be required.
03LASER
LASER HAEMORRHOIDOPLASTY
Intratissue laser energy is used to promote shrinkage and fibrosis of haemorrhoidal tissue without wide excision.
- KADA SE RAZMATRA
- Selected internal haemorrhoidal disease, usually grade II–III, with a limited external component.
- ŠTA OBUHVATA
- The fibre is introduced through small punctures and energy is applied in a controlled manner. It is often associated with less short-term pain, although long-term comparative evidence is less robust than for excisional treatment.
04RAFAELO® · RFA
RAFAELO® RADIOFREQUENCY ABLATION
Controlled intratissue thermocoagulation of an internal haemorrhoid with a fine radiofrequency probe, aiming for shrinkage and fibrosis without anoderm excision.
- KADA SE RAZMATRA
- Selected symptomatic internal haemorrhoids, mainly grade II–III, without a dominant large external component. Suitability is confirmed after proctological examination.
- ŠTA OBUHVATA
- After local anaesthesia, the probe is placed centrally within the haemorrhoidal tissue above the dentate line and delivers controlled radiofrequency energy. Early recovery is often faster than after excisional haemorrhoidectomy, but residual prolapse, recurrence or further treatment remain possible.
05THD · HAL-RAR
DOPPLER-GUIDED THD / HAL–RAR
Doppler-guided ligation of haemorrhoidal arteries and, when prolapse is present, mucosal lifting with mucopexy.
- KADA SE RAZMATRA
- Selected internal haemorrhoidal disease with bleeding and prolapse, without a major external component.
- ŠTA OBUHVATA
- No anoderm is excised. It usually causes less early pain than excisional haemorrhoidectomy, but advanced disease may carry a higher risk of recurrence or persistent prolapse.
06MILLIGAN–MORGAN
MILLIGAN–MORGAN WITH ULTRASONIC SHEARS
Excisional haemorrhoidectomy for extensive mixed disease, using an instrument that combines tissue division and haemostasis.
- KADA SE RAZMATRA
- A large external component, grade III–IV prolapse, combined internal and external disease, or failure of less invasive options.
- ŠTA OBUHVATA
- Anatomical excision of diseased columns while preserving skin and mucosal bridges. Initial recovery is usually more demanding, but excision offers durable control when appropriately indicated.
Educational anatomical and clinical images. Some images contain surgical content. Sources and permissions are identified where required.
CERTIFIED TRAINING
Training in the Rafaelo® procedure
Efstratios K. Kouroumpas completed F Care Systems certified training in radiofrequency treatment of haemorrhoids under local anaesthesia.
- F CARE SYSTEMS
- Enddarmpraxis Köln · Germany
- DATE
- 26 September 2025
PLANIRANJE I BEZBEDNOST
Grades I–IV: a useful guide, not the only decision
Grade mainly describes internal haemorrhoidal prolapse. Bleeding, the external component, thrombosis, continence, previous procedures and patient priorities complete the picture.
GRADE I
Bleeding or discomfort without prolapse outside the anus. Treatment usually begins with conservative care or an office procedure when required.
GRADE II
Prolapse during a bowel movement that reduces spontaneously. Office and tissue-preserving options may be considered.
GRADE III
Prolapse requiring manual reduction. Choice depends particularly on the external component and recovery priorities.
GRADE IV
Permanent, irreducible prolapse. Excisional treatment is more often considered after full assessment.
PITANJA
ČESTA PITANJA
Kratki odgovori pre individualne hirurške procene.
01Is laser the best option for everyone?
No. It may offer less short-term pain in appropriately selected internal disease, but it does not address every form of prolapse or a large external component equally well. Selection follows examination.
02What is the Rafaelo® procedure?
It is a technique that ablates internal haemorrhoids using controlled radiofrequency energy. It may be performed under local anaesthesia in appropriately selected disease and does not excise anoderm. It is not suitable for everyone, particularly when there is a large external component or very advanced prolapse.
03When is THD / HAL–RAR considered?
In selected internal haemorrhoidal disease with bleeding and prolapse, particularly when avoiding anoderm excision is a priority. Recurrence risk is balanced against the usual advantage of less early pain.
04Is Milligan–Morgan haemorrhoidectomy painful?
Excisional haemorrhoidectomy usually has a more demanding early recovery than non-excisional techniques. Structured pain control, bowel regulation and clear care instructions are essential parts of treatment.
05Is colonoscopy always needed when there is bleeding?
Not always. The decision depends on age, history, examination, screening status and warning signs such as anaemia, a change in bowel habit or unexplained weight loss.
KLINIČKI DOKAZI
KLINIČKI DOKAZI
Konačan izbor zavisi od kliničke slike, anatomije i savremenih smernica.
01ASCRS · Management of Hemorrhoids 2024Clinical guideline for diagnosis and treatmentZVANIČNI IZVOR02European Society of Coloproctology · GuidelineEuropean guideline for haemorrhoidal diseaseZVANIČNI IZVOR03ASCRS · HemorrhoidsPatient information on symptoms, diagnosis and optionsZVANIČNI IZVOR04Laser Hemorrhoidoplasty · Systematic ReviewSystematic review of laser haemorrhoidoplastyZVANIČNI IZVOR05Laser versus conventional haemorrhoidectomy · 2024 meta-analysisComparative evidence on short- and long-term outcomesZVANIČNI IZVOR06F Care Systems · Rafaelo® treatment protocolOfficial protocol for the radiofrequency procedureZVANIČNI IZVOR07Rafaelo® radiofrequency ablation · Eddama et al.Early clinical series and description of the techniqueZVANIČNI IZVOR08Rafaelo® radiofrequency ablation · 2-year outcomesMid-term outcomes and requirement for repeat treatmentZVANIČNI IZVOR
Sadržaj je informativan i ne zamenjuje pregled. Koristi, rizici i alternative razmatraju se individualno.
INDIVIDUALNA HIRURŠKA PROCENA
Prava operacija počinje pravom indikacijom.
Simptomi, nalazi i alternative razmatraju se na konsultaciji.
Ordinacija REA MED i dolazak