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Haemorrhoidectomy

Haemorrhoidectomy. Mr Graham Williams Consultant Surgeon Royal Wolverhampton Hospitals . Haemorrhoidectomy. Indications for Haemorrhoidectomy. Symptomatic haemorrhoids 3 rd degree 2 nd degree not responding to other Rx Acutely thrombosed haemorrhoids. Haemorrhoidectomy.

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Haemorrhoidectomy

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  1. Haemorrhoidectomy Mr Graham Williams Consultant Surgeon Royal Wolverhampton Hospitals

  2. Haemorrhoidectomy Indications for Haemorrhoidectomy • Symptomatic haemorrhoids • 3rd degree • 2nd degree not responding to other Rx • Acutely thrombosed haemorrhoids

  3. Haemorrhoidectomy Principles of Operation • Remove swollen haemorrhoidal tissue • Remove associated external element • Preserve uninvolved anoderm and perianal skin • Avoid damage to sphincters

  4. Haemorrhoidectomy Techniques • Whitehead • Open • Milligan Morgan • Closed • Ferguson • Parks’ submucosal

  5. Open Haemorrhoidectomy Injecting local anaesthetic and 1:200,000 adrenalin

  6. Open Haemorrhoidectomy Isolating each haemorrhoid

  7. Open Haemorrhoidectomy Commencing excision of haemorrhoid

  8. Open Haemorrhoidectomy Preserving internal sphincter

  9. Open Haemorrhoidectomy Ligating pedicle of haemorrhoid

  10. Open Haemorrhoidectomy Excising haemorrhoid

  11. Open Haemorrhoidectomy Finished operation

  12. Closed Haemorrhoidectomy Fansler Retractor

  13. Closed Haemorrhoidectomy

  14. Closed Haemorrhoidectomy

  15. Closed Haemorrhoidectomy

  16. HaemorrhoidectomyOpen vs Closed

  17. Haemorrhoidal DiseaseAcute Thrombosis • Will eventually resolve completely • Often minimal residual problems • Patients often other medical problems • MI, Stroke, Late pregnancy • Theoretical risk portal pyaemia • Conservative vs operative treatment

  18. HaemorrhoidectomyAcute Thrombosis Injection of local anaesthetic

  19. HaemorrhoidectomyAcute Thrombosis

  20. Haemorrhoidectomy Complications - 1 • Pain • Laxatives, Metronidazole • Dilatation /sphincterotomy GTN / Botox • Bleeding • 1o / 2o • Foley catheter / antibiotics • Urinary retention • Males, previous obstructive symptoms • Caudal, Over hydration • Infection • Rare, Submucosal abscess / fistula • Beware of increasing pain

  21. Haemorrhoidectomy Complications - 2 • Fissure • Unhealed wound • Rx as common garden variety • Stenosis • Excess removal of anoderm • Dilatation / advancement flap anoplasty • Incontinence • Soiling (<30% late soiling in some series) • Loss of sensitive anoderm • Change in symmetry of anal canal • Sphincter damage

  22. Haemorrhoidectomy Summary • Painful!! • Effective operation • Attention to detail to avoid complications • Symptoms can recur • Still has a place in 21st Centruy

  23. Thank You

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