rectal instruments

OPERATION FOR INTERNAL HEMORRHOIDS


By • Дек 26th, 2010 • Category: Anus

We perform this operation in cases (Fig. 100) of (a) prolapsing hemorrhoids, (b) profuse bleeding, and (c) inflammatory exacerbation.

Operative technique. Any operation for internal he­morrhoids must be preceded by stretching of the anal sphincter by means of a rectal speculum (Fig. 101,1) which is smoothly inserted several times into the anal canal. The sphincter is further stretched by the surgeon’s index fingers (Fig. 101,2). The anal canal should be dilated on all sides with Allis forceps. A fenestrated Lu-er clamp is then used to bring the first hemorrhoid to the outside (Fig 102,1), after which its neck is incised circumferentially, sutured with silk, tied up tightly (Fig. 102,2), and the hemorrhoid is cut off over the ligature. Two ml of 2 per cent novocain solution are then in­jected into the hemorrhoid base under the ligature (Fig. 103) so as to prevent trophic edema. This proce­dure is used to ligate each of the hemorrhoids in turn. A rubber tube is then introduced into the rectum which is packed with Vishnevsky ointment (see p. 40). The first dressing is applied 3 days after operation under nitrous oxide anesthesia. Subsequently, dressings and baths as usual. Opium tincture is given for 6 days. In cases of large hemorrhoids, it is our practice to seize the first hemorrhoid with two fenestrated Luer clamps si­multaneously (Fig. 104,1). A stout Billroth forceps is then applied to the distal (adjacent to the skin) part of the hemorrhoid base (Fig. 104,1), after which the he­morrhoid is divided vertically between the Luer clamps, while the distal part is cut off over the Billroth forceps and removed together with one of the Luer clamps (Fig. 104,2). The remaining proximal part of the hemorrhoid is sutured, its neck tied up (Fig. 104,3), and the hemorr­hoid is cut off over the ligature and removed together with the other Luer clamp. After that the mucosa lying under the Billroth forceps applied to the distal part of the hemorrhoid base, is sutured around with a long cat­gut thread leaving free loops which are to embrace the forceps (Fig. 104,4). This is now opened and pulled out by the assistant from under the suture which is at once tied with a triple knot. If there is some bleeding an ad­ditional catgut suture should be applied. Two ml of 2 per cent novocain solution are then injected under the hemorrhoid base from each of two punctures. Dressings are applied on the third and fifth day as usual.

In internoexternal hemorrhoids it is our practice firs! to ligate and excise internal hemorrhoids (see Fig. 102,2), and then remove the external ones by excising oval skin flaps (Fig. 105). A dressing is first applied on the third day under general anesthesia, then on the fifth day, and each day thereafter, after a bath. Opium tincture is given for 5 to 6 days.

Operation for internal hemorrhoid

Fig. 100 Operation for internal hemorrhoid:

1. Appearance of internal hemorrhoids.

Fig. 101. 1. Sphincter is stretched with speculum.

2. Sphincter is stretched with both index fingers of the surgeon.

Fig. 102. 1. An internal hemorrhoid is seized with Luer clamps and drawn to the exterior.

2. The hemorrhoidal neck is compressed with Bill-roth forceps and sutured with No. 4 or No. 6 silk liga­ture.

Removal of a large hemorrhoid

Fig. 103. The hemorrhoid has been cut off; 2 ml of 2 per cent novocain solution is injected into its base un­der the ligature.

Fig. 104. Removal of a large hemorrhoid:

1. Two fenestrated clamps have been applied to the hemorrhoid and the distal half of its base is compressed with Bilroth forceps.

2. Part of the hemorrhoid base is dissected with scal­pel or scissors over the Bilroth forceps.

3. The neck of the proximal part of the hemorrhoid is sutured and tied off with silk ligature.



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