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Perioperative management - Hemorrhoidopexy with stapler technique

general and visceral surgery
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Anatomy Perioperative management Technique Complications Evidence Total Video

  1. Indications

    • Hemorrhoids 3° (multi-segmental)
    • isolated or in combination with completely reducible anal prolapse

  2. Contraindications

    • acute inflammatory anal diseases

  3. Preoperative Diagnostics

    • Proctological examination: inspection, palpation, proctoscopy, rectoscopy

  4. Special Preparation

    • none

    An orthograde bowel lavage or a retrograde enema is not necessary; however, some surgeons prefer an enema for personal reasons.

  5. Informed consent

    General Risks:

    • Bleeding
    • Thrombosis
    • Embolism
    • Pain

    Specific Risks:

    • Incontinence due to scar formation
    • Sensory deficit with incontinence
    • Stenosis due to scar formation
    • Partial dehiscence of the suture
    • Insufficient wound healing
    • Inflammatory changes
    • Recurrence
    • Remaining external nodes

  6. Anesthesia

    Depending on the general condition of the patient:

  7. Positioning

    Positioning
    • Lithotomy position

  8. OR Setup

    OR Setup

    The surgeon sits in front of the patient positioned in lithotomy, with the first assistant to the left. The scrub nurse stands laterally to the right behind the surgeon.

  9. Special instruments and holding systems

    A suitable disposable instrument set (anal dilator with obturator, Ferguson proctoscope, suture guide) is usually supplied with the stapler.
    Supplement: Standard proctology tray

  10. Postoperative treatment

    postoperative analgesia: Non-steroidal anti-inflammatory drugs are generally sufficient; if necessary, an increase with opioid-containing analgesics can be made.
    Follow the link here to PROSPECT (Procedures Specific Postoperative Pain Management).
    Follow the link here to the current guideline Treatment of acute perioperative and post-traumatic pain.

    medical follow-up treatment: none
    thrombosis prophylaxis: In the absence of contraindications, due to the moderate thromboembolism risk (surgical procedure > 30min duration), in addition to physical measures, low molecular weight heparin should be administered in prophylactic, possibly weight- or disposition risk-adapted dosage until full mobilization is achieved.
    Note: Renal function, HIT II (history, platelet control)
    Follow the link here to the current guideline Prophylaxis of venous thromboembolism (VTE).

    mobilization: immediate
    physical therapy: none
    dietary progression: immediate normal diet
    bowel regulation: none
    incapacity for work: generally 2 weeks