Haemorrhoids, haemorrhoidectomy, milligan morgan,

1. HEMORRHOIDECTOMY
DR BASHIR YUNUS
SURGERY
AKTH
bbinyunus2002@gmail.com 1

2. OUTLINE
• Definition
• Indications
• Type
• Preoperative preparation
• Anaesthesia
• Position
• Procedure
• Post op. management
• Complication
bbinyunus2002@gmail.com 2

3. Definition
Haemorrhoidectomy is the surgical excision of a haemorrhoid.
Indications;
• Symptomatic grade III, grade IV, or mixed internal and external
hemorrhoids
• Where there are additional anorectal conditions that require surgery
• Strangulated internal hemorrhoids and some thrombosed external
hemorrhoids (weeks after relieve of acute symptoms by conservative
methods)
• Where patients who cannot tolerate or fail minimally invasive
procedures
bbinyunus2002@gmail.com 3

4. Types
• Open Haemorrhoidectomy (Milligan-Morgan haemorrhoidectomy)
• Closed Haemorrhoidectomy
• Stapled Haemorrhoidectomy
bbinyunus2002@gmail.com 4

5. Preoperative preparation
• Patients should ideally be put on a high fibre diet and stool softeners
for several days prior to the procedure, this is to reduce post
operative pain and to reduce the chances of post operative faecal
impaction.
• Lactulose taken for 4 days prior to Haemorrhoidectomy reduces post
operative pain.
• Antibiotic prophylaxis is advisable for all clean-contaminated
operations such as haemorrhoidectomy
• Enema on the day of the operation
• Prophylactic antibiotic (at induction)
bbinyunus2002@gmail.com 5

6. • Anaesthesia; spinal anaesthesia or GA
• Position; lithotomy position
• Skin prepared; perineum and anal canal.
• Surgeon sits facing the perineum.
• 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. 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. 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.
bbinyunus2002@gmail.com 6

7. bbinyunus2002@gmail.com 7

8. • 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.
Post operative management;
• Adequate analgesia, bulk laxative and antibiotics
• Warm sitz bath
• DRE at 5th day to exclude anal stenosis
bbinyunus2002@gmail.com 8

9. Mucocuteneous bridge
bbinyunus2002@gmail.com 9

10. Complications
• EARLY
• Haemorrhage
• Acute urine retention
• Constipation with pain resulting in faecal impaction
• LATE
• Anal stenosis
• Fissure
• Skin tag
• Recurrence
• incontinence
bbinyunus2002@gmail.com 10