Chapter 40 Hemorrhoidectomy
Common indications
The treatment of thrombosed external hemorrhoids and chronic hemorrhoidal skin tags is best accomplished by local excision (Figure 39-1). A patient can have immediate relief of symptoms and the prompt return to normal activities after these excisions. Conservative management leads to prolonged symptoms, and the hemorrhoids recur often.
Equipment
A minor surgery tray with lidocaine and bupivacaine, iris scissors, curved hemostats, and gauze are all that is required for treatment (Figure 40-1).
Key steps
1. Preparation: The patient is placed in a left lateral Sims’ position (Figure 40-2) with knees flexed upward toward the chest. The rectal area is cleaned with Betadine solution. With an acutely thrombosed hemorrhoid, marked tenderness to palpation is common. Recurrent hemorrhoids are often non-tender and leave only a remnant skin tag. The excision technique is the same in both cases, although fresh clots should be removed from acute hemorrhoids.
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