Perioperative management - Diathermy excision / contact destruction of anal condylomata acuminata

• Except for small, insular, perianal condyloma clusters, the diagnosis of perianal and intra-anal condyloma mandates total surgical excision.

• The sole contraindication is for seriously ill moribund patients. In florid local inflammation (e.g., abscess), the procedure should be postponed until the infection has cleared.

• Proctological examination: Inspection, palpation, proctoscopy, rectoscopy
• If malignant transformation and infiltration are suspected, biopsy first and then follow up with appropriate diagnostic measures

• None, some cases may require cleansing or emptying of the rectum

• Recurrence
• Local wound healing problems
• Bleeding
• In extensive findings cosmetically vexing changes of the anal region possible
• Impaired skin sensitivity

• General anesthesia (General anesthesia),
• Regional anesthesia (Epidural anesthesia, Caudal block)
• In special cases also local anesthesia

With corresponding exposure of the anal region:

• Lithotomy position (predominantly in Germany)
• Prone 
• Left-lateral recumbent

• The surgeon sits facing the patient in the lithotomy position, with the first assistant to his/her left. The scrub nurse on the right side behind the surgeon.

• Anal retractor/ -locker (Parks anal retractor recommended)
• Standard proctology instrument set
• Small and large electric snare, ball-tipped diathermy

Postoperative analgesia:
Nonsteroidal anti-inflammatory drugs usually suffice

Follow this link to PROSPECT (Procedures Specific Postoperative Pain Management)

Follow this link to the International Guideline Library.

Postoperative care: Postoperatively close follow-up visits are recommended in the first three months (e.g., every four weeks), subsequently at longer intervals.

Deep venous thrombosis prophylaxis:
Unless contraindicated, the moderate risk of thromboembolism (surgical operating time > 30 min) calls for prophylactic physical measures and low-molecular-weight heparin, possibly adapted to weight or dispositional risk, until full ambulation is reached.

Note: Renal function, HIT II (history, platelet check)

Follow this link to the International Guideline Library.

Ambulation:Immediate mobilization

Physical therapy: Not necessary

Diet: Unrestricted

Bowel movement:No intervention

Return to work: depending on severity a few days to 2 weeks