HEMORRHOIDECTOM

HEMORRHOIDECTOM

Presentation by:
Rosalejos, Chloie Marie
Romanca, Kris Ann
BS N 3 - A

Submitted to:
D r . M a r i a L y n C . Pa r a mb i t a
 WHAT
WHATIS
IS
HEMORRHOIDECTOMY?
HEMORRHOIDECTOMY?
Surgery to
remove internal or
external hemorrhoids
that are extensive
or severe.

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 WHAT
WHATIS
IS
HEMORRHOIDECTOMY?
HEMORRHOIDECTOMY?

P r e s e n t a t i o n b y : Ro s a le j o s & R o m a n c a
 WHAT
WHATIS
IS
HEMORRHOIDECTOMY?
HEMORRHOIDECTOMY?
Surgical hemorrhoidectomy
is the most effective
treatment for hemorrhoids,
though it is associated w/
the greatest rate of
complications. 

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 WHAT
WHATIS
IS
HEMORRHOIDECTOMY?
HEMORRHOIDECTOMY?

Hemorrhoid Anatomy

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 WHAT
WHATIS
IS
HEMORRHOIDECTOMY?
HEMORRHOIDECTOMY?
A hemorrhoidectomy is performed
in the following settings:

• Symptomatic grade III, grade IV, or

mixed internal and external hemorrhoids
• Where there are additional anorectal conditions
that require surgery
• Strangulated internal hemorrhoids
• Some thrombosed external hemorrhoids
• Where patients who cannot tolerate or
fail minimally invasive procedures

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 WHAT
WHATIS
IS
HEMORRHOIDECTOMY?
HEMORRHOIDECTOMY?
Types of Hemorrhoidectomy:

Closed Hemorrhoidectomy
• surgical procedure most commonly used
to treat internal hemorrhoids.
• It consists of the excision of
hemorrhoidal bundles using a sharp
instrument, such as a scalpel, scissors,
electrocautery, or even laser followed
by complete wound closure with
absorbable suture.

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 WHAT
WHATIS
IS
HEMORRHOIDECTOMY?
HEMORRHOIDECTOMY?
Types of Hemorrhoidectomy:

Closed Hemorrhoidectomy

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 WHAT
WHATIS
IS
HEMORRHOIDECTOMY?
HEMORRHOIDECTOMY?
Types of Hemorrhoidectomy:

Open Hemorrhoidectomy
•  hemorrhoidal tissue is excised in the same
manner as in a closed procedure, but here
the incision is left open.
• Surgeons may opt for open hemorrhoidectomy when the
location or amount of disease makes wound closure
difficult or the likelihood of postoperative
infection high. Often, a combination of open and
closed technique is utilized.

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 WHAT
WHATIS
IS
HEMORRHOIDECTOMY?
HEMORRHOIDECTOMY?
Types of Hemorrhoidectomy:

Stapled Hemorrhoidectomy for Prolapsing Hemorrhoids 

•  Stapled hemorrhoidectomy is mostly used in
patients with grade III and IV hemorrhoids and
those who fail prior minimally invasive treatments.
• A circular stapling device is used to
excise a circumferential ring of excess
hemorrhoid tissue, thereby lifting
hemorrhoids back to their normal
position within the anal canal.

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 WHAT
WHATIS
IS
HEMORRHOIDECTOMY?
HEMORRHOIDECTOMY?
Types of Hemorrhoidectomy:

Stapled Hemorrhoidectomy for Prolapsing Hemorrhoids 

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 WHAT
WHATIS
IS
HEMORRHOIDECTOMY?
HEMORRHOIDECTOMY?
Types of Hemorrhoidectomy:

Rubber Band Ligation

•  A rubber band is placed around the base of
the hemorrhoid inside the rectum. The band
cuts off circulation, and the hemorrhoid
withers away within a few days. 

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 WHAT
WHATIS
IS
HEMORRHOIDECTOMY?
HEMORRHOIDECTOMY?
Types of Hemorrhoidectomy:

Rubber Band Ligation

P r e s e n t a t i o n b y : Ro s a le j o s & R o m a n c a
 WHAT
WHATIS
IS
HEMORRHOIDECTOMY?
HEMORRHOIDECTOMY?
Types of Hemorrhoidectomy:

Lateral Internal Sphincterotomy

•  Lateral internal sphincterotomy or opening
of the inner anal sphincter muscle is
sometimes performed during hemorrhoidectomy
in patients with high resting sphincter
pressures. It is hypothesized to reduce
postoperative pain. It is not used in most
cases.

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 Surgical
SurgicalPreparation:
Preparation:
PRE-OPERATIVE
PRE-OPERATIVE
BEGIN A BOWEL PREPRATION

This process is usually done

at home with a laxative or an
enema and is meant to remove
all fecal matter from the
colon, making surgeries
easier and reducing the risk
of infection.

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 Surgical
SurgicalPreparation:
Preparation:
PRE-OPERATIVE
PRE-OPERATIVE
INSTRUCT PATIENTS TO FAST

Px should not eat or drink or

chew for 8-12 hours before
surgery. Fasting is necessary
before surgery to ensure that
the bowel prep is not ruined and 
helps prevent aspiration, nausea,
and vomiting
.
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 Surgical
SurgicalPreparation:
Preparation:
PRE-OPERATIVE
PRE-OPERATIVE
PATIENT IS PREPARED PSYCHOLOGICALLY
To accept surgical treatment for
his hemorrhoids. All questions
regarding post-operative pain,
the first bowel movement, and so
on, are answered frankly, and the
need for co-operative effort
explained.

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 Surgical
SurgicalPreparation:
Preparation:
PRE-OPERATIVE
PRE-OPERATIVE
PREPARATION BEFORE SURGERY
Complete blood count and
urinalysis and other necessary
laboratory studies are made. An
enema is given. A sedative is
given, preferably a barbiturate.
The perianal area is shaved and
cleansed with an antiseptic
detergent.

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 Surgical
SurgicalPreparation:
Preparation:
PRE-OPERATIVE
PRE-OPERATIVE
PREPARATION BEFORE SURGERY
Immediately before surgery, a
skin antiseptic is applied and a
long-lasting oil soluble
anesthetic is injected
perianally. It relieves muscle
spasm-a principal cause of
postoperative pain and urinary
retention.

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 Surgical
SurgicalPreparation:
Preparation:
INTRA-OPERATIVE
INTRA-OPERATIVE
ANAESTHESIA:
• Spinal anaestheshia or General Anaesthesia
POSITION:
• Lithotomy position
SKIN PREPARED;
• Perineum and anal canal.
Surgeon sits facing perineum

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 Surgical
SurgicalPreparation:
Preparation:
INTRA-OPERATIVE
INTRA-OPERATIVE
PROCEDURE:
• Insert Parkes anal speculum to
display the haemorrhoid to be
operated upon. Grasp the haemorrhoid
at the mucocuteneous junction with a
haemostatic forceps and retract
towards the surgeon.

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 Surgical
SurgicalPreparation:
Preparation:
INTRA-OPERATIVE
INTRA-OPERATIVE
PROCEDURE:
• Incise the skin at the base of the
haemorrhoid with a scissors as a V-shape
incision with the base of the V towards the
haemorrhoid. Extend this incision into the
mucosa either side of the haemorrhoid raising
it off the muscles of the internal sphincter.

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 Surgical
SurgicalPreparation:
Preparation:
INTRA-OPERATIVE
INTRA-OPERATIVE
PROCEDURE:
• The dissection is continued just
beyond the dentate line. Transfix
and ligate the pedicle of the
haemorrhoid with a 2-0 vicryl
suture leaving a long length of
suture material attached. Excise
the haemorrhoid 0.5cm distal to
the ligature.

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 Surgical
SurgicalPreparation:
Preparation:
INTRA-OPERATIVE
INTRA-OPERATIVE
PROCEDURE:
• Repeat the procedure with the other
haemorrhoids. Leave a mucocutaneous
bridge between each haemorrhoid to
reduce any subsequent anal stricture.
At the end place a small paraffin
soaked pack to reduce bleeding within
the anal canal, supported by a
• T- shaped bandage

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 Surgical
SurgicalPreparation:
Preparation:
POST-OPERATIVE
POST-OPERATIVE
• make sure the pt. remains flat in bed to
prevent spinal headache
• rectal bleeding should be checked
frequently
• check v/s every 15 mins.
• When the pt. is able to move his/her
legs and when v/s are stable, the
physician signs him out to the
• recovery room and return to the
ward in the ward.

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 Surgical
SurgicalPreparation:
Preparation:
POST-OPERATIVE
POST-OPERATIVE
• Nurse again instructs the pt. to
remain flat in bed
• V/S should be checked four times
at 1/2 hour intervals
• Inspect dressing frequently,
inform if excessive bleeding occurs or
signs of shock appear
• Narcotic such as morphine sulfate 15
mg is given intramuscularly
before spinal anesthesia wears off to
prevent the severe pain caused by
rectal spasm.
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 Surgical
SurgicalPreparation:
Preparation:
POST-OPERATIVE
POST-OPERATIVE
• The pt. should be in general
diet
• Encouraged to drink plenty
of fluids
• Approximately six hours
after surgery, nurse removes
the pressure dressing.

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 Surgical
SurgicalPreparation:
Preparation:
POST-OPERATIVE
POST-OPERATIVE
• Post-operative care begins
with the application of
oxidized cellulose to the
surgical wounds. It is an
easily applied dressing and
helps to control capillary
oozing.

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 Surgical
SurgicalPreparation:
Preparation:
POST-OPERATIVE
POST-OPERATIVE
• Over this dressing pads are
placed and covered by a
tight pressure dressing
applied by strapping the
buttocks together with
adhesive tape; a T-binder is
tightly applied.

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 Surgical
SurgicalPreparation:
Preparation:
POST-OPERATIVE
POST-OPERATIVE
• Pressure dressings and gluteal
strapping facilitate early
painless ambulation, minimize
capillary bleeding, and help to
prevent perianal skin tags by
reducing swelling of the external
hemorrhoidal plexuses which may
have developed during surgery.

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 Surgical
SurgicalPreparation:
Preparation:
POST-OPERATIVE
POST-OPERATIVE
• Sitz baths are another
commonly offered adjunct
for pain control and
comfort following
anorectal surgery.

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 Surgical
SurgicalPreparation:
Preparation:
POST-OPERATIVE
POST-OPERATIVE
• Topical anesthetics are
commonly used as additional
agents for home pain relief
following anorectal surgery.
Topical lidocaine ointment
can be used alone or in
conjunction with other
agents.

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LABORATORY
LABORATORYTESTS
TESTS
performed
performedbefore
beforesurgery
surgery
• Physical examination
• Visual inspection of your anal canal
and rectum
• Chest x-ray
• Complete blood count
• Serology Urinalysis
• Electrocardiogram (if pt is over 40
y.o)
• Transfusion (if hemoglobin is under
9 g/dL)

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SURGICAL
SURGICALINSTRUMENTS
INSTRUMENTS
OF
OFHEMORRHOIDECTOMY
HEMORRHOIDECTOMY
2 Knife Handle no. 3
1 Metzenbaum Scissors Curved 8"
1 Plain Dissecting Forceps 7"
1 Tissue Forceps 1x2 teeth 7"
4 Mosquito Forceps straight 5"
2 Backhaus Towel Clamp 5"
1 Forester Sponge Forceps, 9.5"
2 Allis Tissue Forceps 6" 4x5 teeth
1 Hirschmann Anoscope 5.5cm Medium
1 Prat Rectal Speculum
1 Sawyer Rectal Speculum
1 FANSLER-IVES Rectal Speculum
1 Mcgivney Hemorrhoidal Ligator Forceps Gun
1 Mcgivney Hemorrhoid Grasping Forceps

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SURGICAL
SURGICALINSTRUMENTS
INSTRUMENTS
OF
OFHEMORRHOIDECTOMY
HEMORRHOIDECTOMY

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SURGICAL
SURGICALINSTRUMENTS
INSTRUMENTS
OF
OFHEMORRHOIDECTOMY
HEMORRHOIDECTOMY

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SURGICAL
SURGICALINSTRUMENTS
INSTRUMENTS
OF
OFHEMORRHOIDECTOMY
HEMORRHOIDECTOMY

For more references:

Watch https://www.youtube.com/watch?v=KOXTBJQo86w
(Available on youtbube)

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 VIDEO
VIDEOCLIP
CLIP
OF
OFHEMORRHOIDECTOMY
HEMORRHOIDECTOMY
(All sources are on youtube)

https://www.youtube.com/wat
ch?v=fQ18G5WIo-0

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 VIDEO
VIDEOCLIP
CLIP
OF
OFHEMORRHOIDECTOMY
HEMORRHOIDECTOMY
(All sources are on youtube)

https://www.youtube.com/wat
ch?v=PnAYUQv7THs

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 VIDEO
VIDEOCLIP
CLIP
OF
OFHEMORRHOIDECTOMY
HEMORRHOIDECTOMY
(All sources are on youtube)

https://www.youtube.com/wat
ch?v=8UkB7H-JRqs

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 VIDEO
VIDEOCLIP
CLIP
OF
OFHEMORRHOIDECTOMY
HEMORRHOIDECTOMY
(All sources are on youtube)

https://www.youtube.com/wat
ch?v=QQLTXz161I0

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PAIN
PAINMANAGEMENT
MANAGEMENT
FOR
FORHEMORRHOIDECTOMY
HEMORRHOIDECTOMY
• The physician may prescribe
narcotics to relieve pain
• Patient should take stool
softener
• Avoid straining during both
defecation and urination
• Soaking in a warm bath can
be comforting
• Temporary difficulties
emptying the bladder

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 POSSIBLE
POSSIBLECOMPLICATIONS
COMPLICATIONS
FOR
FORHEMORRHOIDECTOMY
HEMORRHOIDECTOMY

• Risk associated with

hemorrhoidectomy include
infection, bleeding and
allergic reaction to
anesthetic, stenosis
(narrowing) of the anus,
recurrence of hemorrhoid,
fistula formation, and non-
healing of wounds.

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 POSSIBLE
POSSIBLECOMPLICATIONS
COMPLICATIONS
FOR
FORHEMORRHOIDECTOMY
HEMORRHOIDECTOMY
The following is a partial list of the potential
problems of surgical hemorrhoidectomy:
• Pain
• Urinary retention
• Urinary tract infection
• Constipation
• Fecal impaction
• Hemorrhage
• Infection
• Anal tags
• Mucosal prolapse
• Mucosal ectropion
• Rectal stricture
• Anal fissure

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DISCHARGE
DISCHARGEPLAN
PLAN
FOR
FORHEMORRHOIDECTOMY
HEMORRHOIDECTOMY
Focus: Impaired Skin Integrity

Data: Disruption of skin tissue from incisional sites, Destruction

of skin layers, Thrombosed hemorrhoids, Internal prolapsed
hemorrhoids, Pain, Swelling, Drainage

Action: Assess patient for the presence of hemorrhoids, discomfort

or pain associated with hemorrhoids, diet, fluid intake, and
presence of constipation. Administer topical medication as ordered.

Response: Patient will have intact skin with no signs or

symptoms of rectal prolapse or bleeding

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DISCHARGE
DISCHARGEPLAN
PLAN
FOR
FORHEMORRHOIDECTOMY
HEMORRHOIDECTOMY
Focus: Constipation

Data: Passage of hard, formed stool, Decreased bowel sounds,

Inability to evacuate stool, Severe, exquisite rectal pain,
Abdominal pain, Abdominal distention, Absent bowel sounds, Frequency
of stool is less than normal, Less than the usual amount of stool,
Palpable mass, A feeling of rectal fullness, Flatulence

Action: Monitor diet and fluid intake. Provide bulk, stool

softeners, laxatives, suppositories, or enemas as warranted. Monitor
medications that may predispose patient to constipation. Instruct
patient in activity or exercise programs within limits of the
disease process.

Response: Patient have normal elimination pattern reestablished

and maintained.

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DISCHARGE
DISCHARGEPLAN
PLAN
FOR
FORHEMORRHOIDECTOMY
HEMORRHOIDECTOMY
Focus: Acute Pain

Data: Verbalization of pain, fever, malaise, rectal pain, elevated

wbc, surgical wounds, drains, facial grimacing, crying

Action: Administer analgesics as ordered. Provide restful, quiet

environment. Instruct patient or SO in deep breathing, relaxation
techniques, guided imagery, massage and other nonpharmacologic aids.
Provide cool compress to head prn. Provide backrubs prn.

Response: Patient will achieve relief from aches and pain.

Patient will report pain is controlled or eliminated

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This ends the presentation.

Hope you learn something and

thank you for reading.