Hemorrhoids

Simple Technic of Hemorrhoidectomy with local anesthesia

Dr Bui Khac Thuc

HEMORRHOIDS The internal hemorrhoidal plexus of veins is located in the submucosal space above the valves of Morgagni. The anal canal separates it from the external hemorrhoidal venous plexus, but the two spaces communicate under the anal canal, the submucosa of which is attached to underlying tissue to form the interhemorrhoidal depression.

Whenever the internal hemorrhoidal plexus is enlarged, there is associated increase in supporting tissue mass, and the resultant venous swelling is called an internal hemorrhoid. When veins in the external hemorrhoidal plexus become enlarged or thrombosed, the resultant bluish mass is called an external hemorrhoid. When internal hemorrhoids enlarge, pain is not a usual feature until the situation is complicated by thrombosis, infection, or erosion of the overlying mucosal surface. Most persons complain of bright red blood on the toilet tissue or coating the stool, with a feeling of vague anal discomfort.

The discomfort is increased when the hemorrhoid enlarges or prolapses through the anus: prolapse is often accompanied by edema and sphincteric spasm. Prolapse, if not treated, usually becomes chronic as the muscularis stays stretched, and the patient complains of constant soiling of underclothing with very little pain. Prolapsed hemorrhoids may be detected or thrombosed; the overlying mucous membrane may bleed profusely from the trauma of defecation. External hemorrhoids, because they lie under the skin, are quite often painful, particularly if there is a sudden increase in their mass. These episodes result in a tender blue swelling at the anal verge due to thrombosis of a vein in the external plexus and need not be associated with enlargement of the internal veins. Since the thrombus usually lies at the level of the sphincteric muscles, anal spasm often occurs.

The diagnosis of internal and external hemorrhoids is made by inspection, digital examination, and direct vision through the anoscope and proctoscope. Since such lesions are very common, they must not be regarded as the cause of rectal bleeding or chronic hypochromic anemia until a thorough investigation has been made of the more proximal gastrointestinal tract. Acute blood loss can occasionally be attributed to internal hemorrhoids.

TREATMENT Most hemorrhoids respond to conservative therapy such as sitz baths or other forms of moist heat, suppositories, stool softeners, and bed rest.

Internal hemorrhoids that remain permanently prolapsed are best treated surgically; milder degrees of prolapse or enlargement with pruritus ani or intermittent bleeding can be handled successfully by banding or injection of sclerosing solutions.

External hemorrhoids that become acutely thrombosed are treated by incision, extraction of the clot, and compression of the incised area following clot removal. No surgical procedure should be carried out in the presence of acute inflammation of the anus, ulcerative proctitis, or ulcerative colitis.

Proctoscopy or colonoscopy should always be performed before a patient is subjected to hemorrhoidectomy.

This is a simple technic of Hemorrhoidectomy with Local anesthesia ,this operation may remove the tissue mass of thrombosed hemorrhoids in 30 minutes without general anesthesia and enable to different cas include White Head manner

TECHNIC & MANIPULATION

When veins in the external hemorrhoidal plexus become enlarged or thrombosed, the resultant bluish mass is called external hemorrhoids ,there are three of four resultant bluish mass or external hemorrhoids .Successively the surgeon injecte 2cc of novocaine into one of bluish mass hemorrhoid which is enlarge by ,then the surgeon use bistouri to make dissection to expose the mass of veins ,use clamps to clamp lateral on the root of mass (See Fig 11) with scissor the surgeon cut off the mass above the clamp line. The second step is to use curved needle with catgut 000 or 0000 to make continue sutures knots around the the clamps from A to B then use force to diminish the length of thread ,continue the inverse direction from B to A ( See Fig 12) and finish the last suture.

With the first plexus of hemorrhoid removed and sutured,the surgeon continue to inject 2cc of Novocaine on the second mass of hemorrhoid then follow the two steps in description above

With the second plexus of hemorroid removed and sutured,the surgeon continue to inject 2cc of Novocaine on the third mass of hemorrhoid then......

The last step is to clean the area of dissection by H2O2 and Iodine ,then antiseptic bandage

CONCLUSION This simple operation of hemorrhoidectomy is easy to manipulate under local anesthesia, with short time of recovery .Simple manipulation of suture,fast recovery,easy to practice in private clinic.

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