#11. HEMORRHOIDECTOMY

PREOPERATIVE DIAGNOSIS: Thrombosed hemorrhoids.

POSTOPERATIVE DIAGNOSIS: Same.

PROCEDURE PERFORMED: Hemorrhoidectomy times three.

SURGEON: Dr. Daffy Duck

ANESTHESIA: General.

FINDINGS: Large, circumferential prolapsed hemorrhoids, with partial thrombosis. Three of the largest hemorrhoids were excised, without complication. There was still hemorrhoidal tissue left at the conclusion, but I did not feel it was safe to do any further excision.

SPECIMEN: Hemorrhoids.

CULTURES: None.

DRAINS: None.

ESTIMATED BLOOD LOSS: 50 cc.

DRESSINGS: Xeroform pack and ABD.

COMPLICATIONS: None.

CONDITION: Stable.

OPERATIVE INDICATIONS: This is a 20-year-old female, one week postpartum, who presented to my clinic with excruciatingly painful hemorrhoids. She had had previous thrombosed hemorrhoid which was incised and drained in the clinic earlier in the pregnancy. She has not had a bowel movement in a week due to pain. On exam she had circumferential prolapsed hemorrhoids with partial thrombosis in multiple areas. I discussed hemorrhoidectomy with the patient and her sister. They understood and wished to proceed.

DESCRIPTION OF PROCEDURE: The patient was identified in the holding area and brought to the operating room where she was placed in the supine position. After induction of general anesthesia, she was prepped and draped in the usual sterile fashion. The legs were brought up in the lithotomy position and a retractor was placed in the anus. Very prominent, large, partially thrombosed, external hemorrhoid was identified at 7-8 o'clock in the lithotomy position. It was grasped with a hemorrhoidal clamp. A 2-0 chromic stitch was placed at the apex. The Bovie electrocautery was then used to elliptically excise the large hemorrhoid, staying superficial to the sphincter muscle. Hemorrhoid was then passed off as specimen. Further bleeding was controlled with Bovie electrocautery. The mucosa was closed with a running chromic stitch, leaving the end-point epidermis open.
Two other very large hemorrhoids with thrombosis were then identified, at the 5 o'clock position in lithotomy and at the 10-11 o'clock position. These two hemorrhoids were excised in the exact same fashion as the first hemorrhoid. At the conclusion, there was no evidence of bleeding. There was still some prominent hemorrhoidal tissue remaining. However, I did not feel any further excision would be safe at this time.
Xeroform wrapped around 4x4s was then placed in the anus as a dressing and ABD placed over the top. The patient was then awakened and taken to the recovery room in good condition. There were no operative complications.