Ferguson



Ferguson


Anthony J. Senagore





Preoperative Planning

The decision to proceed to excisional hemorrhoidectomy requires a mutual decision by the physician and patient that medical and nonexcisional options have either failed or are inappropriate. Surgery is typically employed when the primary symptom is
significant, intractable hemorrhoidal prolapse, or alternatively large external skin tags that impair anal hygiene. Preoperative preparation is generally minimal as the patient population is generally healthy and the procedure is typically ambulatory. If the patient is on therapeutic anticoagulation, this should be managed in conjunction with the managing physician to control the risk of hemorrhage postoperatively



  • The procedures are usually performed in the operating theater following preoperative sodium phosphate enemas to clear the distal rectum of stool.


  • The modified Sims’ position is the preferred position by the author for all excisional procedures except for procedure for prolapsing hemorrhoid (PPH) that is optimally performed in lithotomy position.


  • Anesthetic selection is usually left to the anesthesiologist and patient; however, local anesthesia supplemented by the administration of intravenous narcotics and propofol is highly effective and short acting.


  • Avoid spinal anesthesia due to risk of urinary retention.


  • Restrict intraoperative fluids.


  • Administer preemptive analgesia with nonsteroidal anti-inflammatory drugs (NSAIDs) in operating room.


Selection of Excisional Tool


Surgery

Options for excisional hemorrhoidectomy include the following techniques:

Milligan-Morgan hemorrhoidectomy



  • 1. This technique resects the entire enlarged internal hemorrhoid complex; in conjunction with ligation of the arterial pedicle correctly performed the intervening anoderm is preserved, while the distal anoderm and external skin are left open to heal by secondary intention.

Ferguson closed hemorrhoidectomy



  • 2. Proposed as an alternative to the Milligan-Morgan technique with similar experience and efficacy. The technique employs an hourglass-shaped excision of the entire internal/external hemorrhoidal complex centered at the midportion of the anoderm with preservation of the intervening anoderm. Unlike the Milligan-Morgan, the rectal mucosa, anoderm, and perianal skin are closed primarily with an absorbable suture.

Whitehead hemorrhoidectomy

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Jun 12, 2016 | Posted by in GENERAL | Comments Off on Ferguson

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