haemorrhoidectomy Flashcards
indications for haemorrhoidectomy
3rd or 4th degree haemorrhoid
- 3rd degree - prolapse and require manual reduction
- 4th degree - prolapse and cant be reduced
incomplete rectal prolapse
indications for stabled haemorrhoidectomy
prolapsing haemorrhoids
when large internal component
Milligan-Morgan open haemorrhoidectomy
excision of the 3 haemorrhoidal cushions with incisions separated by adequate skin or mucosal bridges
excision of piles +- ligation of vascular pedicles
day case, need 2wks off work
scalpel, electrocautery or laser may be used
most effective treatment
stapled haemorrhoidectomy
mucosectomy 2cm proximal to dentate line
to hitch up the prolapsing anal lining and distrupt the proximal blood flow
(less pain and shorter convalescence)
highe recurrence and prolapse rate than excisional
post-op Mx of haemorrhoidectomy
lactulose - to avoid constipation
complications of haemorrhoidectomy
pain
bleeding
more rarely incontinence due to sphincteric injury
anal stricture
constipation
infection
