Excision of painful distended veins of the anus and rectum.
Hemorrhoids are classified as internal or external, depending on their location. Hemorrhoids are generally associated with local anal problems such as anal ulcers and fistulas, or they may accompany pregnancy. Anesthesia may be regional, local, or general.
Position
Lithotomy, modified lateral (Sims), or jack knife.
Skin Preparation
The buttocks is taped apart with wide adhesive tape on each side of the anus, attaching the other end to the table frame. Only a minimal prep is usually performed.
Packs/ Drapes
Laparotomy pack (jackknife or lateral sims position)
Lithotomy pack (lithotomy position)
Instrumentation
Minor tray
Rectal tray with dilators and rectractor
Sigmoidoscopy instrument (optional)
Supplies/ Equipment
Stirrups
Pillows or roll for positioning
Suction
Blades – (1) #10, (1) #15
Minor basin set
Needle counter
Hemostatic agent
Lubricant
Pressure dressing
Laser (optional)
Procedure Overview
Before beginning the surgical procedure, a sigmoidoscopy may be performed, followed by gentle dilation of the rectum.
The hemorrhoid is grasped with a Penington, Allis, or Kocher clamp.
The proximal portion of the hemorrhoid is excised by scalpel, cautery, or laser. Is the anus is stemotic, the distal internal sphincter may be incised.
A mucous membrane flap and/ or skin flaps may be used to cover the denuded areas.
Bleeders are controlled with ligature ties (3-0 Dexon/ chromic) or by cautery.
Care is taken not to excise too much skin, anoderm, or mucous membrane and to avoid injury to the sphincter mechanism.
Perioperative Nursing Considerations
Be prepared to perform a sigmoidoscopy prior to the procedure.
When electrosurgical unit is used, apply the ground pad after the patient has been placed in the lithotomy position.
Protect the skin under the adhesive tape with tincture of benzoin.
Should laser be used, all safety precautions must be in place prior to the patient’s entry into the procedure room.
