Haemarrhoidectomy
Haemorrhoids
- Cushions of dilated vascular tissue at anal verge
- Anal cushions are required for full continence
- Straining causes the cushions to slide down and become engorged - results in symptomatic haemarrhoids
Classification
- First degre: small non-prolapsing
- Second degree : prolapsing but reduce spontaneously
- Third degre: prolapse that cannot be reduced
Treatment options
- Asymptomatic
- No treatment required
- First degree
- Stool-bulking agents
- Injection sclerotherapy
- Second degree
- Banding
- Third degree
- Haemarrhoidectomy
Haemarrhoidectomy procedure
- Prepared + consented + phosphate enema
- Lithotomy position + GA
- Skin or anus/perineum prepared + Parkes proctoscope passed PR
- Gently draw haemorrhoid towards surgeon and then make V-shaped incision in anal skin at base of haemorrhoid
- Raise haemorrhoid towards lumen away from sphincter fibres + transfixed and ligated with vicryl suture
- Divide haemorrhoid 5mm distal to ligation and removed
- Repeat for other haemorrhoids (3,7,11 position)
- Pack anal canal with gauze or spone to keep mucocutaneous bridges flat against the internal sphincter (prevents an anal stricture forming)
- Apply perineal pad and firm T-bandage
Post-op care
- daily bulking agents
- glycerin suppositories for faecal retnetion
- Analgesia 30 minutes before bowel movements and change of dressings
- External wounds managed with twice daily baths, irrigation and dressings
- 4 week outpatient review
complications
- Bleeding
- Constipation
- Anal stenosis
- Faecal incontinence due to damage of sphincter mechanism
- Anal fissure
- Recurrence
- Perianal fistula
