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Piles Surgery

Severely swollen and prolapsed hemorrhoids require surgical intervention. When symptoms are bothersome, surgical treatment is always warranted. Local anaesthesia with intravenous sedation is administered. Preoperative care requires distal evacuation of the rectum with small volumes of saline enemas. Haematologic testing such as CBC, coagulation studies, anoscopy, flexible sigmoidoscopy, proctoscopy and complete evaluation of the large bowel is carried out before the procedure. Acute haemorrhoidal crisis involves a large internal haemorrhoid prolapse and requires emergency treatment.

Techniques

Surgical haemorrhoidectomy – The procedure is usually carried out for haemorrhoids at Grade III and IV with severe symptoms. There is a presence of associated anal fissure, history of external thromboses, and hygiene troubles due to large skin tags. Incisions are made around the anus to excise the haemorrhoids. Excisional haemorrhoidectomy is a closed technique.

  • Patient is positioned in a jackknife position

  • Adhesive tape will retract the buttocks to aid exposure

  • A bilateral pudendal nerve block is performed

  • The perianal skin and mucosa are infiltrated with 1% lidocaine or 0.5% bupivacaine with epinephrine

  • A Hill-Ferguson retractor is used to inspect the distal rectum and the anal canal

  • The prolapsed haemorrhoid is retracted towards the centre of the anal canal with the help of a Kelly clamp

  • A figure of 8 suture is first placed above the pedicle to decrease blood loss

  • An elliptical incision is made from the external component of the haemorrhoid to the proximal end of the clamp

  • The haemorrhoid is excised with electrocautery or scissors

Procedure for prolapsing haemorrhoids (PPH) – Internal haemorrhoids do not respond to conservative therapy and PPH is the only option available. The internal haemorrhoids are large and the external components are minimal. Patient is administered local anaesthesia. A circular stapler designed especially for the procedure along with a smaller stapler is used. A suture is placed in the mucosal and submucosal layers above the dentate line. A purse string closure is accomplished slowly as the stapler is placed around it. As the stapler is fired, excess tissue is resected and a circular line of staple is made above the dentate line. The excessive internal haemorrhoidal tissue is excised and the pexy of the haemorrhoidal tissue is left behind.

Infrared photocoagulation – The area is infiltrated with about 2 – 5 ml of 0.5% bupivacaine, simultaneously adjusting the local anaesthesia. The infrared photocoagulation uses infrared radiation to evaporate the water contained in the cells and coagulate the tissue protein.

Dr. Deepak plans long-term monitoring schedules at regular intervals following the surgery to ensure complete relief of all symptoms.

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