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Table of Contents
Year : 2021  |  Volume : 4  |  Issue : 2  |  Page : 54-55

Making hemorrhoidectomy simpler and safer

HON. Consultant, Rajeev Gandhi Medical College, Kalwa, Thane, Maharashtra, India

Date of Web Publication09-Nov-2021

Correspondence Address:
Dr. Kushal Mital
Medicare Hospital, Esis Road, Thane West, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2666-0784.330170

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How to cite this article:
Mital K. Making hemorrhoidectomy simpler and safer. Indian J Colo-Rectal Surg 2021;4:54-5

How to cite this URL:
Mital K. Making hemorrhoidectomy simpler and safer. Indian J Colo-Rectal Surg [serial online] 2021 [cited 2022 May 20];4:54-5. Available from: https://www.ijcrsonweb.org/text.asp?2021/4/2/54/330170

Surgical excision of hemorrhoids remains a very effective approach for patients who fail or cannot tolerate office-based procedures, those who have Grade III or IV hemorrhoids, or patients with substantial concomitant skin tags.

  Objectives Top

  • Problems to be addressed in hemorrhoidectomy

    1. Bleeding during surgery
    2. Preventing anal stenosis
    3. Preventing secondary hemorrhage
    4. Minimizing recurrences
    5. Decreasing pain.

  Possible Solutions Top

  1. Surgery in prone position – ideal – the reason why, as [Figure 1]

    • Grade remains same
    • Congestion less
    • Decreased blood in field
    • Better vision
    • Cleaner surgery
    • Patient, surgeon, assistant comfort.

  2. Bleeding during surgery

    • Pedicle stitch by vicryl 2/0
    • Injection hylase 1 ml−1500 U in each hemorrhoid (1–6 amp) [Figure 2]
    • Injection saline + adrenaline – subcutaneous/submucosal
    • Closed hemorrhoidectomy.

  3. Prevention of anal stricture or stenosis [Figure 3]

    • Excision of hemorrhoid with preservation of mucosa anoderm and skin, too much excision leads to narrow anus
    • Primary wound closer without tension.

  4. Prevention of secondary hemorrhage

    • Preoperative - No proctitis or inflammatory bowel
    • Achieve hemostasis at surgery
    • Not too many sutures increase necrosis
    • Minimal cautery: To decrease eschar formation
    • Use of bipolar dissector, harmonic [Figure 4]

    What else should we take care of?

    • Intravenous antibiotics prior surgery – cephalosporin and metronidazole – I use ofloxacillin and ornidazole
    • Use of antiseptic ointment – Metronidazole gel 2%
    • Use of stool softener, osmotic laxative

  5. Prevention of recurrence

  6. Under-running secondary hemorrhoid-suturopexy

    • Sclerotherapy of secondary hemorrhoid 2 CC foam + polidocanol 3%) [Figure 5]
    • Prevent STRAINING at defecation – LAXATIVES stimulant if straining and osmotics in hard stools
    • U Hitch of secondary hemorrhoid
    • Secondary hemorrhoids after 3-column hemorrhoidectomy
    • The U-shaped stitch fixes mucularis of distal rectum [Figure 6]
    • Suture from anorectal ring to hemorrhoid to anorectal ring.

    It prevents anal stenosis.

  7. Preventing pain

    • Preserve the anoderm, less pain postoperative
    • Minimal cautery is used as eschar causes pain
    • Suture without tension – just approximation, as there may be cut through
    • Leave last 5 mm open to any collection to come out, relieving pain [Figure 7].
Figure 1: Grade 4 hemorrhoid visualized in prone position

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Figure 2: Injection Hylase 1 ml ( 1500 units) in each hemorrhoid

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Figure 3: (a) marking with cautery, (b) marking dumbbell shaped, (c) closing wound with 3/0 Vicryl

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Figure 4: Bipolar dissector can be used to minimise bleeding

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Figure 5: Simple vertical suturopexy with 2/0 Vicryl for small hemorrhoids or secondary hemorrhoids

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Figure 6: Treatment of secondary hemorrhoid from Dr. Mario Pescatori, Prevention and treatment of Complications in Proctology Surgery

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Figure 7: In closed hemorrhoidectomy leave 5 mm skin open for drainage

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  Conclusion Top

The presentation was aimed at making hemorrhoidectomy simpler and safer. Doing the surgery in a stepwise manner will ensure better outcomes and long-term results.

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Conflicts of interest

There are no conflicts of interest.


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]


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