Haemorrhoidectomy: Open

Lithotomy
Yellowfin boots
EUA/sigmoidoscopy/Flagyl
Grasp external components of the haemorrhoid with a straight artery and internal with curved
Infiltrate with LA/adrenaline
Start with the most significant pile (best to leave the most anterior pile to last as bleeding here can interfere with the posterior dissection) and excision within an elliptical incision using Diathermy. This is aided by the assistant performing counter-traction on the perianal skin. Start well away from perianal skin, ie toward the haemorrhoid side.
Define the limits of the internal sphincter taking care not to excise.
Once a pedicle is fashioned, transfix this using a 3/0 vicryl suture and excise the redundant haemorrhoidal tissue. Leave the sutures long for ease of identification of any bleeding points.
Conduct the haemorrhoidectomy in the classical positions of 4, 7 and 11 o’clock ensuring adequate skin and mucosal bridges.
Once all haemorrhoidal tissue is excised, inspect the pedicles for satisfactory haemostasis.
This is referred to as the Milligan Morgan technique (UK) that leaves the wound cavities open for closure by secondary intent. A primary closure can be performed using 3/0 chromic gut after excising the pedicles in the Ferguson method (US).
Infiltrate with more LA and dress with Spongistan and combine gauze.


Involves dissection of venous saccules off internal sphincter, excision of mucosal, anodermal and cutaneous parts of haemorrhoid and ligation of vascular pedicle
Dissect with scissors, diathermy or laser (No difference b/w scissors and diathermy)

Stool softeners/warm baths/analgesia