Surgical Treatment

Indications for surgical hemorrhoidectomy include advanced third or fourth degree piles, mixed hemorrhoids, extensive thrombosis, ulceration, and gangrene. The choice of surgical procedure depends upon the patient's condition, and surgeon and patient preferences. Similarly, anesthetic choices include local anesthesia plus monitored sedation, regional techniques, and general anesthesia. Traditionally, regional training and culture have influenced the choice of operation. Most surgeons in the United States practice the closed technique, or Ferguson hemorrhoidectomy, where following hemorrhoidal excision, the rectal mucosa and anoderm are closed with an absorbable radial suture line beginning at the apex of each hemorrhoidal complex. Recurrence rates are < 2%. Scissors, electrocoutery, laser, and scalpel may be used; however, none have been proven to be superior over other means of excision. Hemorrhoidectomy using advanced technologies such as harmonic scalpel and ligasure have been reported to have fewer complications and a quicker return to daily living, however, further evaluations are indicated.

Alternatively, surgeons in the United Kingdom, Europe, and many parts of Asia favor the open hemorrhoidectomy technique described by Milligan and Morgan. After excision of the hemorrhoidal complex(es) with overlying skin and rectal mucosa and ligation of the base(s) of the pile(s), surgical wounds are left open to heal by secondary intention. An open wound minimizes the risk for infection, but a longer convalescence period and considerable discomfort may result (Senagore, 2002). This technique is advised in the presence of gangrene where there is a greater risk for infection, or when surgical judgment suggests that closure may be too tight or promotes stricture formation.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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