Perioperative management - Milligan-Morgan hemorrhoidectomy - general and visceral surgery
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Indications
- Symptomatic grade III and IV hemorrhoids
- Grade II hemorrhoids refractory to conservative treatment
Asymptomatic hemorrhoids do not primarily require surgery.
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
Preoperative diagnostic work-up
- Proctological examination:
→ Inspection, palpation, proctoscopy, rectoscopy
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.
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
Positioning
Operating room setup
Special instruments and fixation systems
Postoperative Behandlung
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