Perioperative management - Milligan-Morgan hemorrhoidectomy

  1. Indications

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

    Asymptomatic hemorrhoids do not primarily require surgery.

  2. Contraindications

    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
  3. Preoperative diagnostic work-up

    • Proctological examination:

    → Inspection, palpation, proctoscopy, rectoscopy

  4. Special preparation

    • 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.
  5. Informed consent

    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
Anesthesia

Depending on the general condition of the patient:General anesthesia, Laryngeal mask airway anesthe

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