Perioperative management - Hemorrhoidectomy according to Milligan-Morgan

• Symptomatic hemorrhoids III and IV
• Hemorrhoids II not treatable conservatively

Non-symptomatic hemorrhoids primarily do not require surgery.

An absolute contraindication is only present in the case of general inoperability of the patient.

The following list represents a compilation of relative contraindications:

• local inflammatory changes
• impaired immune competence
• bleeding diathesis

Proctological Examination: Inspection, Palpation, Proctoscopy, Rectoscopy

• none
  An orthograde bowel lavage or a retrograde enema is not required. Some surgeons prefer an enema for personal reasons.

General Risks:

• Bleeding
• Thrombosis
• Embolism
• Pain

Specific Risks:

• Incontinence due to scar formation
• Sensory deficit with incontinence
• Stenosis due to scar formation
• Fissures
• Delayed wound healing
• Insufficient wound healing
• Inflammatory changes
• Recurrence