Hemorrhoidectomy/ operative surgery

HEMORRHOIDECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #hemorrhoidectomy #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...

Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• In this video today, I have discussed Hemorrhoidectomy- Barron’s banding, open and closed hemorrhoidectomy, Stapler hemorrhoidectomy and THD- Transanal Hemorroidal Dearterialisation. So, it is a 4in1 video.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.

1. HEMORRHOIDECTOMY DR.B.Selvaraj MS; Mch ; FICS; Professor of Surgery Melaka Manipal Medical College Melaka 75150 Malaysia OPERATIVE SURGERY

2. HEMORRHOIDECTOMY Barron’s Banding Hemorrhoidectomy - Open- Milligan & Morgan - Closed- Ferguson Stapled Hemorrhoidectomy - PPH- Procedure for Prolapsed Hemorrhoids US Guided Hemorrhoidal Arterial Ligation - THD- Transanal Hemorrhoidal Dearterialisation

3. BARRON’S BANDING INDICATIONS: - 1 st & 2 nd degree hemorrhoids ANESTHESIA: - No need/ Concious sedation - Daycare office procedure POSITION: - Sim’s – Left lateral - Lithotomy

4. BARRON’S BANDING Preparing the applicator and loading it Applying the band to base of internal hemorrhoid

5. SPACE BANDER- Conmed Preparing the bander and deploying it Applying the band to base of internal hemorrhoid

6. OPEN HEMORRHOIDECTOMY INDICATIONS: - 3 rd degree hemorrhoids - Hemorrhoids with other anal pathology like fissure or fistula ANESTHESIA: - GA/Spinal - Epidural/Local POSITION: - Prone Jackknife - Lithotomy Informed consent- risks of surgery: - Injury to anal sphincter / incontinence 1% - Rebleeding 1% - Anal stenosis1% Pre-op preparation: - Colonoscopy to exclude proximal colon pathology - Enema on the evening before and on the day of surgery

7. OPEN HEMORRHOIDECTOMY Position and exposure - Prone jackknife - Lithotmy - Triangle of exposure Making a v cut in the skin - Make V cut with blunt nosed scissors - Dissect off the hemorrhoidal vascular cushion off the sphincter muscles

8. OPEN HEMORRHOIDECTOMY Ligate the vascular pedicle & excise - Transfix all 3 vascular pedicles with 2-O vicryl Final look with enough skin bridge - ‘If it looks like a clover the trouble is over, if it looks like a dahlia, it is surely a failure.’

9. CLOSED HEMORRHOIDECTOMY Clamp hemorrhoidal cushion & Elliptical incision Ligate,excise vascular pedicle & Close mucosal defect- Use of Ligasure

10. CLOSED HEMORRHOIDECTOMY COMPLICATIONS Excise no more than three hemorrhoids at one operative setting. Removal of excessive anal tissue may lead to stricture. Ensure in cases of rectal bleeding that other sources of gastrointestinal bleeding, such as colon cancer and diverticular disease, are excluded before the hemorrhoidectomy . Bleeding if severe and persistent need to be controlled in OT Anal incontinence if you injure the sphincter during the dissection of haemorrhoids Hepatic cirrhosis and other bleeding disorders should be thoroughly corrected, or the planned procedure should be aborted. POST-OP CARE Daily Sitz bath after each bowel movement Digital Rectal Exam at discharge and after one week to prevent adhesions between raw areas Anal pack- surgeon’s preference. I keep non adherent sponge to tamponade for few hours Local application of Lignocaine jelly Oral analgesic tablets as needed Mild oral laxatives for 2 to 3 weeks post-op Patients can be mobilised immediately Time off work- 1 week

11. STAPLED HEMORRHOIDECTOMY The equipment Anal dilatation & fixing anal dilator

12. STAPLED HEMORRHOIDECTOMY Application of Purse-string suture Introduction of Stapler into Anal canal

13. STAPLED HEMORRHOIDECTOMY Taking the suture through the slots Firing the Gun & mucosal doughnut

14. THD- Transanal Hemorrhoidal Dearterialisation The Equipment Various steps of the procedure

15. THD- Transanal Hemorrhoidal Dearterialisation Introducing the gadget & identifying hemorrhoidal artery Ligating the artery & suturing mucosa