Hemorrhoidectomy

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS

Perianal Skin Tag Removal

  • Large perianal skin tags interfering with anal hygiene
  • Perianal skin tags that annoy the patient or are symptomatic (e.g., pruritus)

Hemorrhoid Removal

  • Thrombosed, painful hemorrhoid, particularly if it is less than 48 hours old
CONTRAINDICATIONS

Perianal Skin Tag Removal

  • If the patient with perianal skin tags complains of pain, bleeding, or itching, then another source for these symptoms must be sought.
  • Crohn's disease

Hemorrhoid Removal

  • Bleeding diathesis (relative)
  • Pregnancy or immediate postpartum period (less than 8 weeks)
  • Inflammatory bowel disease
  • Anorectal fissures
  • Active anorectal infections
  • AIDS or other immunodeficiency states
  • Portal hypertension (relative)
  • Rectal wall mucosal prolapse
  • Anorectal tumors
  • Recommendations for cardiac prophylaxis are not specific.
EQUIPMENT

Perianal Skin Tag Removal

  • If the patient with perianal skin tags complains of pain, bleeding, or itching, then another source for these symptoms must be sought.
  • Crohn's disease

Hemorrhoid Removal

  • Bleeding diathesis (relative)
  • Pregnancy or immediate postpartum period (less than 8 weeks)
  • Inflammatory bowel disease
  • Anorectal fissures
  • Active anorectal infections
  • AIDS or other immunodeficiency states
  • Portal hypertension (relative)
  • Rectal wall mucosal prolapse
  • Anorectal tumors
  • Recommendations for cardiac prophylaxis are not specific.
ANATOMY

Anal Canal

  • The anal canal can be divided into eight segments. These segments are as noted with the patient lying in the left lateral decubitus position.

Hemorrhoids

  • Hemorrhoids are classified according to their origin from above or below the dentate (pectinate) line. Those that develop from above the dentate line are internal hemorrhoids; those from below are external hemorrhoids.
  • Hemorrhoids below the dentate line—external hemorrhoids—are covered by skin (anoderm) and are extremely sensitive. Treatment for external hemorrhoids requires some form of anesthesia.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE

Perianal Skin Tag Removal

  • Advise the patient to wash the area gently three to four times a day and after defecation with mild soap and water.
  • Prescribe a nonconstipating pain medication. Xylocaine ointment 5% or an antibiotic ointment may be used.
  • Further advise the patient to follow a high-fiber diet with commercial fiber supplements and four to six glasses of water per day.
  • Time off from work is usually minimal.
  • Total healing time may take up to 6 weeks for complete new skin coverage.
  • Advise the patient that perianal discomfort generally will be present for 1 week or less.

Thrombosed External Hemorrhoids

  • Recommend that the patient take sitz baths two to three times per day for 1 week.
  • Oral analgesics, topical anesthetic cream, and stool softeners are helpful.
  • A follow-up examination should be scheduled for 4 weeks.
  • Emphasize that the patient needs to avoid prolonged sitting on the toilet.
  • Explain to the patient that a high-bulk, high-fluid diet is essential.
COMPLICATIONS
  • Perianal abscess
  • Chronic fissure
  • Perianal cellulitis
  • Bleeding complications
  • Excision of skin tags or an external hemorrhoid should not alter anal continence.
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