Seniclosed ligation and excision
|Study the ill area put under anesthesia and confirm the anal prolapse. Even when it looks like the hemorrhoidal tissues are conncected all around, take the course to divide it into parts to cut off and grasp the main parts of the ill area fully before decid ing on the design of the exision.|
|Give an injection of epinephrine(0.01mg/ml) under the skin covering the part of external hemorrhoids. This process prevents the drainage cut from getting too deep and lessens the amount of bleeding during the surgery. An injection into the internal hemorrhoids is not done generally becaus e it blurs the bordering part of the hemorrhoids.|
|Make an excision of a column with sharp edges at the end from the outer edge of the external hemorrhoids to the anal verge. Make the width of the cut@small at the anal verge and try to make the excision of the anal epithelium which comes after it as small as possible also.|
|After seperating the external hemorrhoids as far as the anal verge , hold the edge of the excision with a clampAand pull it towards the outside of the anus. By pulling the clamp while cutting Treitz's muscle enables the doctor to operate surgery outside the anus.|
|Cut the internal hemorrhoids
in a radial shape as a continuation of the incision of the external part.
Decide the lines of the excision carefully so that you can leave as much
of the normal epithelium. Caution is necessary because when enough epithelium
is not left after the surgery, it may cause anal stenosis.|
|After separating the root
part of the hemorrhoids, use a 2-0 catgut to transfixing deligation. The
catgut will dissolve and fall off after a week, and the period it takes
to dissolve is most appropriate for this method of surgery compared to
the other absorbable suture.|
|Use the string used to
deligate the root part and suture the edge of mucasas with running suture.|
. If enough mucosa exists, the same procedure in 5-6 are as will not cause stenosis.
|Form the uneven grounds
of the drainage woound and stop the bleeding with bipolar electric knife.
Insert a painrelieving suppository into the anus, apply a gauze to stop
the bleeding and end the surgery. The gauze is not left inside the anus
because it will cause pain after s urgery.|