Monday, October 11, 2010



Generally speaking, uncomplicated external and internal hemorrhoids usually are treated by conventional surgery: clamp and cauterization, and ligature operations of hemorrhoids.


This method is used for both internal and external piles [stage 2 and 3 pile] The sphincters are dilated, each pile grasp in turn, the external mucosa-skin folds divided to the vascular pedicle, which is crushed by a clamp applied in the long axis of the bowel. Protecting the skin under the clamp with wet gauze, the pile is slowly burned away by a cauterization at dull red heat. The procedure is repeated with each pile, taking care not to dilate the anus again for fear of hemorrhage. The boric acid ointment is then freely applied on a gauze pad held by a T-bandage.

The steps of Cusach Operation:
Fig.8: Cusach technic of hemorrhoidectomy by the clamp and cautery method.
[a] First step.
[b] Applying the hemorrhoidal clamps. The cautery removes the hemorrhoids.
[c] Eschar following cauterization.

Step 1. Place the patient in the lithotomy position.
Step 2. Grasp the hemorrhoid with a Tuttle forceps. Cut off the skin tabs even with the skin to prevent edema.
Step 3. Place a clamp with the heel directed toward the outer part of the hemorrhoidal tumor. Remove the forceps and excise the pile about ¼ inch from the clamp, leaving a stump which is cauterized thoroughly.
Step 4. Release the clamp gradually and see that stump is not bleeding as it reenters the anus. Apply the same procedure to the other hemorrhoids.
Step 5. Insert into the rectum a small iodoform wick which has been coated with sterile petrolatum; place over this some fluffed gauze.
Step 6. With the patient in proper position, strap the buttocks with adhesive plaster. Permit the end of the wick to project between the two pieces of adhesive plaster. Administer the sedative to the patient before he comes out of the anesthetic. Constipate the patient for 72 hours. At the end of this period give an oil enema and follow with a cathartic.

Ligature and suture operations. [continued]

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