Proctology

The Surgical Department at Na Františku Hospital has been performing hemorrhoid surgeries using the Long method since 2002 and played a key role in introducing this method into clinical practice in the Czech Republic. During this time, the proctology team has treated more than 3,500 patients using this method, making it one of the largest groups of patients treated with the Long method in the Czech Republic.

A reference center for the Long method was also established at Na Františku Hospital, where training sessions were held for doctors from hospitals across the Czech Republic. In addition to theoretical instruction, participants had the opportunity to take part in practical training in the operating rooms. Over the years, nearly 300 surgeons have completed these courses. Since the beginning of 2008, the Long procedure has been included in the list of procedures covered by public health insurance.

We also perform hemorrhoid surgery using the traditional surgical method—hemorrhoidectomy. We treat milder cases of hemorrhoidal disease on an outpatient basis using ligation (application of a rubber band) or laser treatment. This is the HeLP (Haemorrhoid Laser Procedure) method, performed on an outpatient basis without the need for anesthesia or lifestyle restrictions.

We refer patients for these surgeries (as well as other procedures involving the rectum) and provide follow-up postoperative care through our proctology clinics.

Hemorrhoids are a very common condition we encounter among patients in surgical outpatient clinics. It is estimated that 4.5% of the population suffers from symptomatic hemorrhoids. Surgical treatment of hemorrhoids today encompasses a wide range of procedures, some of which can be performed on an outpatient basis. In the advanced stages of the disease (i.e., stages III and IV), surgical intervention is necessary; this is performed under general or regional anesthesia in operating rooms and requires a hospital stay of several days. One of the most modern surgical treatments for hemorrhoidal disease is the so-called Longo method. This procedure was introduced into clinical practice by Italian professor Antonio Longo in 1998.

The Long procedure is a radical, safe, and minimally invasive surgery that allows patients to return quickly to both work and leisure activities without restrictions. It effectively treats not only advanced hemorrhoidal disease but also anorectal mucosal prolapse, restoring the anorectal tissue to its physiological position. The correct indication of the most appropriate treatment method for the patient and its performance by an experienced and trained surgeon are the foundation for the success of the surgery and a low complication rate.

Unlike traditional hemorrhoid surgeries, this procedure is performed using a single-use instrument—a so-called stapler. It involves the circular excision of the rectal mucosa and submucosal tissue, followed by suturing the tissue back into its original anatomical position using fine staples. It addresses the cause and not just the consequence of hemorrhoidal disease, as is the case with traditional surgeries. By removing the prolapse, the hemorrhoidal tissue is returned to its physiological position. This resolves the main cause of hemorrhoidal disease—the loosening of the anorectal mucosa. At the same time, the interruption of blood vessels significantly reduces blood flow to these tissues. Unlike traditional surgeries, the procedure itself takes place in an area with low sensory innervation, so postoperative pain is significantly reduced and healing is rapid. Additional benefits include a significantly shorter procedure time and the associated shorter duration of anesthesia, as well as a shorter hospital stay and recovery time, a rapid return to full physical activity, and a much lower risk of recurrence.

Furthermore, in our experience, the use of conventional surgical procedures for the treatment of hemorrhoidal nodules is associated with higher analgesic use. In patients who have undergone the Longo procedure, the use of both opioid and non-opioid analgesics is significantly lower. Most patients manage with standard analgesics in the first few postoperative days, and some manage without them altogether. Only a small percentage of patients require opioid analgesics.

External hemorrhoids and skin tags are a separate issue; while the Long method does not address them directly, they cause discomfort for patients, particularly during anal hygiene. For this reason, we treat them during surgery using the Long method by simply excising them.

The most common indications for surgery are grade III hemorrhoids (68% of patients) and grade IV hemorrhoids (20% of patients). Grade II hemorrhoids or isolated prolapses are significantly less common (up to 10%). All patients with anorectal symptoms are examined at the proctology clinic and are recommended an appropriate treatment plan (conservative or surgical). At the same time, we always explain the advantages and disadvantages of each procedure in detail. We perform an anoscopic examination on all patients. For patients over 50 years of age or in cases of a positive family history of colorectal cancer, we recommend a colonoscopy. We require standard preoperative examinations according to WHO guidelines and also focus on the use of anticoagulant medications (e.g., warfarin) during the medical history review.

We explain the procedure in detail to patients for whom a Longo procedure is indicated.
We always perform the procedure during a short hospital stay. The surgery itself is performed under general or spinal anesthesia following preparation with an enema. The total length of the hospital stay for this procedure is 2–3 days. The average time off work is 10 days. We follow up with patients 3 weeks after discharge and again after two months. Further follow-ups are determined on an individual basis depending on the patient’s condition.

As with any surgical procedure, complications can occur with this operation. The most common intraoperative complication is bleeding from the stapler suture. Therefore, after removing the stapler, it is necessary to inspect the suture using the included semicircular anoscope; any source of bleeding can then be easily treated with a cross-stitch. Thanks to the type of staplers currently used at our facility, the incidence of this complication has decreased significantly. Late bleeding after the patient’s discharge that would require surgical treatment is very rare.