Perioperative management - Milligan-Morgan hemorrhoidectomy - general and visceral surgery
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- 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
Preoperative diagnostic work-up
- Proctological examination:
→ Inspection, palpation, proctoscopy, rectoscopy
- Oral antegrade intestinal lavage or rectal retrograde colonic enema is not needed. For personal reasons some surgeons prefer rectal enemas to cleanse the ampulla.
- Impaired continence due to scarring
- Sensory deficit with impaired continence
- Stenosis through scarring
- Protracted wound healing
- Inadequate wound healing
- Inflammatory changes
Operating room setup
Special instruments and fixation systems