External hemorrhoid excision: Difference between revisions
m (Rossdonaldson1 moved page External Hemorrhoid Excision to External hemorrhoid excision) |
Neil.m.young (talk | contribs) (Text replacement - " pt " to " patient ") |
||
| Line 15: | Line 15: | ||
==Procedure== | ==Procedure== | ||
#Place | #Place patient in side-lying or prone position | ||
#Apply EMLA 1 hr prior to procedure | #Apply EMLA 1 hr prior to procedure | ||
#*Apply tape to each buttock with force directed laterally for better visualization | #*Apply tape to each buttock with force directed laterally for better visualization | ||
| Line 23: | Line 23: | ||
#Control bleeding by tucking corner of a small piece of gauze into the wound and tape buttocks together | #Control bleeding by tucking corner of a small piece of gauze into the wound and tape buttocks together | ||
#*Leave in place for a few hours | #*Leave in place for a few hours | ||
#Apply pressure dressing have | #Apply pressure dressing have patient remove 6-12 hr later when takes first stiz bath | ||
#Patient may apply soothing ointments (preparation H, Anusol HC, Lidocaine ointment)after dressing is removed | #Patient may apply soothing ointments (preparation H, Anusol HC, Lidocaine ointment)after dressing is removed | ||
#Provide f/u in 24-48hr | #Provide f/u in 24-48hr | ||
Revision as of 11:30, 2 July 2016
Indications
- Thrombosis is acute (<48 hr)
- Extremely painful
Contraindications
- Immunocompromise
- Child
- Pregnant woman
- Portal HTN
- Coagulopathy
Equipment Needed
- Scalpel
- Local anesthetic
Procedure
- Place patient in side-lying or prone position
- Apply EMLA 1 hr prior to procedure
- Apply tape to each buttock with force directed laterally for better visualization
- Inject local anesthetic (e.g. bupivacaine 0.5% w/ epi) w/ 30-gauge needle directly into dome of hemorrhoid as a single injection
- Make elliptical incision in overlying skin to expose the thrombosis
- Remove the clot and the overlying skin through the incision site
- Control bleeding by tucking corner of a small piece of gauze into the wound and tape buttocks together
- Leave in place for a few hours
- Apply pressure dressing have patient remove 6-12 hr later when takes first stiz bath
- Patient may apply soothing ointments (preparation H, Anusol HC, Lidocaine ointment)after dressing is removed
- Provide f/u in 24-48hr
Complications
- Continued bleeding
- Recurrence
- Infection
- Fistula
- Abscess
- Skin tags