LIGATURE AND SUTURE OPERATION FOR PILES

LIGATURE OPERATION FOR PILES

The pile is exposed and liberated to the vascular pedicle as in the clamp and cauterization method. The pedicle is then ligated or tied with catgut or silk.
The general operative procedure of the ligature operation for ordinary piles is as follows:

Step 1: The patient is placed in the lithotomy position, and the orifice of the anus is thoroughly dilated until it remains open and is easy of access. The rectum is washed out and packed with gauze.

Fig. 9: Operation for piles.

The clamp above grasps the pile in the long axis of the bowel. Interrupted sutures are shown placed in position, the sutures are tied after the pile is removed and the pile clamp released.

Step 2: The piles are seen easily; each one is grasped with forceps [Figure 9]. The mucous membrane of the pedicle of each pile is partly divided with scissors or scalpel; the pile is ligated or tied with stout catgut and then cut off. In the case of large pile, special large clamps are used.

Fig.10: Hemorrhoidectomy. After removing the pile, the crushed base is sutured, as shown in the illustration.

Step 3: When all piles have been removed, the gauze tampon is withdrawn from the rectum. The patient is kept constipated for a day or two.


The complication of operation:

The operation may be followed by hemorrhage, laceration; injury and perforation of the rectum, persistent stricture [narrowing of the rectum], or stenosis [stricture] of the anus

CLAMP AND CAUTERIZATION OPERATION OF PILES

CONVENTIONAL SURGERY OF PILES.

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

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CLAMP AND CAUTERIZATION OPERATION OF PILES

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]

COMPLICATIONS OF LONGO STAPLED OPERATION

POSSIBLE COMPLICATIONS OF LONGO STAPLED HEMORRHOIDECTOMY

Like every operation, certain possible complications might occur with the Longo Stapled hemorrhoidectomy.
Minor complications include minor bleeding, mild pulling sensation in the abdomen or in the rectum in the first few days, retention of urine and mild stricture or narrowing of the rectum.
More serious or major complications include infection inside the abdomen, injury and perforation to the rectum. Fortunately such severe complications are extremely rare: 1 or 2 in over 1000 cases.
Nevertheless, this procedure must be performed with care and attention detail to minimize the risk of severe complications.

LONG-TERM RESULT OF STAPLED OPERATION

Because of the procedure is new, widely used in Europe for just over 2 years, it is difficult to know the long-term recurrence rate. Dr Longo had personally performed over 1400 cases, about 500 with 2 to 6 years follow-up, he reported few cases of recurrence. Patients must make sure that they don’t get into the bad habit of being constipated, straining at stools or sitting on toilets for long period of time especially if they have a strong family history of piles