II.

DRAPING:
A. Anesthesia:

Hemorrhoidectomy may be performed under general anesthesia (the patient is rendered

unconscious), under spinal anesthesia (the patient is numbed from the waist down), or under
local anesthesia (the immediate area is injected with a numbing agent). The choice of anesthesia
depends on the extent of surgery, the patient's health and personal preference, and surgical
standards of the facility.

B. Draping and Positioning:

Put the patient in Jackknife position (as seen below). Folded towels and a laparotomy sheet.
Tapes are attached to table sides.

C. Preparation of the Patient:

Antiembolitic hose may be applied to the legs. A Foley catheter may be inserted. Bony
prominences and areas vulnerable to skin and neurovascular trauma or pressure are padded.
Apply electrosurgical dispersive pad.Tincture of benzoin is applied to the buttocks over which
wide adhesive is applied prior to sigmoidoscopy.

D. Skin Preparation

Begin inside tape margins, discarding each sponge after wiping the anus.

E. Aftercare

Patients may experience pain after surgery as the anus tightens and relaxes. The doctor may
prescribe narcotics to relieve the pain. The patient should take stool softeners and attempt to
avoid straining during both defecation and urination. Soaking in a warm bath can be comforting
and may provide symptomatic relief. The total recovery period following a surgical
hemorrhoidectomy is about two weeks.
III. DISCUSSION OF THE PROCEDURE:

Hemorrhoidectomy refers to the removal of the hemorrhoidal tissues, including the enlarged
veins within.Hemorrhoids may be treated with concomitant anal conditions, such as fissure (anal
ulcer) and fistula or excision of the veins of the anus and associated overlying skin and anoderm
(externally) and mucous membrane(internally).Numerous modalities are employed for internal
hemorrhoids and associated rectal mucosal prolapse (latex band ligation, sclerosing injections,
laser, cryotherapy, and others), most often performed as an office procedure without anesthetic
(not to include external hemorrhoidal tissue).A circular intraluminal stapler, as used for intestinal
anastomosis, can be employed for rectal mucosal prolapse performed as a formal transanal
surgical procedure.

A. Background

Hemorrhoids are amongst the common anal disorders. Patients may complain of bleeding,
prolapse, personal discomfort and minor anal leakage.

Where traditional palliative measures such as rest, suppositories and dietary advice fail to
improve the condition, there is then a choice of further treatments.

Opinion on the best management for patients varies considerably. While many treatments for
hemorrhoids may be performed without anaesthetic, the lasting effect of these conservative
therapies has been questioned. Many patients treated with rubber band ligation or injection
sclerotherapy require multiple treatments and there is high recurrence rate following these
procedures.

Conventional hemorrhoidectomy provides permanent symptomatic relief for most patients, and
effectively treats any external component of the hemorrhoids. However, the wounds created by
the surgery are usually associated with considerable post-operative pain which necessitates a
prolonged recovery period. This can put a stress on a general practitioner’s resources, may
alienate the patient and delays the patient’s return to a full, normal lifestyle and the workplace.

Because of this, surgeons will generally reserve formal excision for the most severe cases of
prolapse, or for patients who have failed to respond to conventional treatments.

B. Procedure

The patient lies on the operating table face down with the buttocks slightly elevated or on their
back with their legs up in stirrups, so the anus and rectal area are exposed. After the anesthesia
has taken effect, the area is cleaned with an antiseptic solution. The hemorrhoids are clamped,
tied off, and cut away. The wound is then sutured. After the operation, the surgeon packs the
anus with gauze or applies antibiotic ointment. A hemorrhoidectomy takes about 1 to 1 1/2 hours
to perform.
Newer methods for hemorrhoid removal are being used. One method involves using an
ultrasonic scalpel to cut away hemorrhoids. This method is quicker and does not require sutures.
Another innovation is the stapled hemorrhoidectomy, in which tissue from further in the anus is
used to close the wound with surgical staples after the hemorrhoids are removed. Patients may
recover faster and have less postoperative pain, but some research has shown an increase in
complications with this procedure.

C. Summary:

The proximal portions of the hemorrhoidal complex are suture-ligated, and the hemorrhoid is
excised by scalpel, electrosurgery, or laser. Less often, cryosurgery is employed (usually
reserved for limited outpatient procedures). If the anus is stenotic, the distal internal sphincter
may be incised. A mucous membrane flap and/or skin flaps may be employed to cover denuded
areas. The surgical area may be sewn closed or left open. Medicated gauze covers the wound.
Care is taken not to excise too much skin, anoderm, or mucous membrane and to avoid injury to
the sphincter mechanism.

D. Risks

As with other surgeries involving the use of a local anesthetic, risks associated with a
hemorrhoidectomy include infection, bleeding, and an allergic reaction to the anesthetic. Risks
that are specific to a hemorroidectomy include stenosis (narrowing) of the anus; recurrence of the
hemorrhoid; fistula formation; and nonhealing wounds.
 Hemorrhoids can occur inside the rectum, or at its opening .To remove them, the surgeon
feeds a gauze swab into the anus and removes it slowly. A hemorrhoid will adhere to the gauze,
allowing its exposure. The outer layers of skin and tissue are removed, and then the hemorrhoid
itself . The tissues and skin are then repaired.