External Hemorrhoidectomy (Hemorrhoid Excision or Removal)

Surgical Details of Procedure

1. Local anesthestic (usually 1% lidocaine with epinephrine) is injected around the base of each hemorrhoid to be excised or removed if general or spinal anesthesia has not been used.

2. Anoscope is inserted to visualize anal canal and to inspect for masses or other pathology.

3. A self-retaining rectal retractor is placed into the anal canal.

4. A gauze sponge is inserted into the anal canal and then “dragged out” with the surgeon’s fingers to simulate the passage of a bowel movement and to prolapse the hemorrhoids for inspection.

5. A hemorrhoid clamp is used to grasp the hemorrhoids selected for excision and left in place.

6. A straight forceps is used to grasp the hemorrhoid at the anal verge (where it exits from the skin).

7. Simultaneous traction is placed on the hemorrhoid by placing tension on both the forceps and the clamp.

8. A scalpel is then used to carefully excise the hemorrhoid off the external anal sphincter with the triangular-shaped incision starting at the anal verge and running to the pectinate line.

9. The fibrous bands running into the hemorrhoid may be incised without sequelae but the fibers of the external anal sphincter should not be cut.

!0. The skin should be incised to just past the pectinate line.

11. An anchoring suture is placed at the apex of the incision at the pectinate line.

12. A straight clamp is placed on any remaining hemorrhoidal tissue and excised.

13. The mucosa (including the two edges of the pectinate line) and underlying deep veins are reapproximated using an over and over or baseball stitch after the clamp is removed.

14. As the suture is run externally, very small bites are taken in the external anal sphincter.

15. The deep portion of the subcutaneous tissue is closed with a running 2-0 or 3-0 Vicryl suture.

16. The skin is usually left open to heal by secondary intention.

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