I48 .

Surgicol Procedures lncluding Minimol Accqss Procedures

Goslroiniestinol Surgery

r l{Q

(or a comAnesthesia may be regional, local, or general of anesthesia' proctination). Following the induction tosigmoidoscopY is Performed'

(1) No. 10, (1) No. 15

magnet or counter

basin Procedure
The proximal portions of the hemorrhoidal complex are

tubing

ic agent (e.g., Surgicel, Gelfoam) ical pencil

."t"i" G^t"d^, and the

;;;tp"t,

"f.uua'(usuallv anus is stenotic, the distal internal [;"t*) 'iiT; A mucous ;h#ter -;y be incised'employed tomembrane flap cover denuded ;-;t"; skin flaps may be to excise too much skin, anout"".. Ct"" is iaken not

ciutery, or laser. Less often cryosurgery is emreserved for limited outpatient proce-

hernorrhoid

is

excised by

,4' x

dressing (e.g,, petrolatum-impregnated

4, sponges)

Notes

derm, or mucous membrane and to avoid injury to the sphincter mechanism.

skin under adhesive tape with tincture of ben.

prepared for sigmoidoscopy prior to procedure.

retractors.
Carbon dioxide laser may be used. See Appendix, pp. lss.24, for safery precautions. Ifthe primary pathology is anal fissure or fistula, the rsic sslup is essentially the same as when hemorare the primary pathology.
CYSTECTOMY AND

Preporotion of the Potient See Sigmoidoscopy' PP. 99-100'

Skin PrePorotion

Preparatiou is minimal. Begil inside tape margins'

discarding each spbnge after wiping the anus' Droping

Jackknife. Folded towels and a laparotomy sheet

folded towels, drape sheet'over abdomen -fr"ain.a LateraUSims. Folded towels 4nd a laparotomy sheet

iitft"totnv.

Drape sheet under buttocks, Ieggings'

s.to the removal ofa cystic mass containing hair, tissue debris, and so on, fiost often locatedln the geal area.

Equipment Stirrups or pillow a4d Electrosurgical unit lnstrumentotion

Rectal nrocedures traY -"et"actors,
ro11

for positioning

cysts are most frequently found in the sacrobut they can occur about the perineum, ls, and so on. When acutely or chronically infected, il treatment is indicated. These cysts may be very ive with multiple and deep side tracts. Fitoniaat disease is not related to the gastrointestinal.tract, it is included here for convenience.
r_eglon,

il;;i

inciuding Sims, Hill-Ferguson, and

incision is made about the cyst or into the cyst dily. Necrotic tissue, hair, tissue debris, and so-on are

Sawyer

Curettes