• Users Online: 80
  • Print this page
  • Email this page


 
 
Table of Contents
TECHNIQUES IN SURGERY
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
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2666-0784.330170

Rights and Permissions

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 2021 Dec 4];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

Click here to view
Figure 2: Injection Hylase 1 ml ( 1500 units) in each hemorrhoid

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

Click here to view
Figure 4: Bipolar dissector can be used to minimise bleeding

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

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

Click here to view
Figure 7: In closed hemorrhoidectomy leave 5 mm skin open for drainage

Click here to view



  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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


    Figures

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



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Objectives
Possible Solutions
Conclusion
Article Figures

 Article Access Statistics
    Viewed110    
    Printed2    
    Emailed0    
    PDF Downloaded9    
    Comments [Add]    

Recommend this journal