Perioperative management - Milligan-Morgan hemorrhoidectomy

• Symptomatic grade III and IV hemorrhoids
• Grade II hemorrhoids refractory to conservative treatment

Asymptomatic hemorrhoids do not primarily require surgery.

Absolute contraindication only if the patient is generally unfit for surgery.

Following is a list of relative contraindications:

• Local inflammatory changes
• Limited immunocompetence
• Hemorrhagic diathesis

• Proctological examination:

→ Inspection, palpation, proctoscopy, rectoscopy

• None
• Oral antegrade intestinal lavage or rectal retrograde colonic enema is not needed. For personal reasons some surgeons prefer rectal enemas to cleanse the ampulla.

General risks:

• Bleeding
• Thrombosis
• Embolism
• Pain

Special risks:

• Impaired continence due to scarring
• Sensory deficit with impaired continence
• Stenosis through scarring
• Fissures
• Protracted wound healing
• Inadequate wound healing
• Inflammatory changes
• Recurrence