This document discusses haemorrhoids, including their anatomy, classification, etiology, clinical features, complications, grading, and treatment options. Haemorrhoids are classified as internal or external depending on their location relative to the dentate line. Common causes include straining during bowel movements and sedentary lifestyles. Clinical features may include bleeding, pain, irritation, and prolapse. Treatment ranges from conservative options like lifestyle changes to surgical procedures like rubber band ligation, injection sclerotherapy, and haemorrhoidectomy. Complications of haemorrhoidectomy can include pain, stricture, and incontinence.
HEMORRHOIDECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #hemorrhoidectomy #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• In this video today, I have discussed Hemorrhoidectomy- Barron’s banding, open and closed hemorrhoidectomy, Stapler hemorrhoidectomy and THD- Transanal Hemorroidal Dearterialisation. So, it is a 4in1 video.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Please find the power point on Hemorrhoids. I tried present it on understandable way and all the contents are reviewed by experts and from very reliable references.
HEMORRHOIDECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #hemorrhoidectomy #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• In this video today, I have discussed Hemorrhoidectomy- Barron’s banding, open and closed hemorrhoidectomy, Stapler hemorrhoidectomy and THD- Transanal Hemorroidal Dearterialisation. So, it is a 4in1 video.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Please find the power point on Hemorrhoids. I tried present it on understandable way and all the contents are reviewed by experts and from very reliable references.
Haemorrhoids and its Management: How can Ayurveda have the upper hand...AshishSharma1838
Haemorrhoids are the pathological enlargement of the vascular cushions present in submucosal layer of anal canal which otherwise act as a hermetic seal in maintaining the continence. Ayurveda aim at to treat the hemorrhoids at the basic pathological level and offers a wide range of treatment options ranging from medical management to the use of parasurgical as well as surgical measures.
This presentation gives a fine description about stoma and ostomy. This contains the details regarding types, complications and the advices that you should give to a patient with a stoma.
Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except Groin hernias. In this presentation I have discussed Epigastric, Umbilical, Para umbilical, Incisional, Spigelian and Lumbar hernias.
In many cases, Piles can be treated effectively with diet, good hygiene, and topical medications. In some cases, though, diet and drugs are not enough. People who do not respond to non-surgical treatments might experience long-term relief through surgery.
Haemorrhoids and its Management: How can Ayurveda have the upper hand...AshishSharma1838
Haemorrhoids are the pathological enlargement of the vascular cushions present in submucosal layer of anal canal which otherwise act as a hermetic seal in maintaining the continence. Ayurveda aim at to treat the hemorrhoids at the basic pathological level and offers a wide range of treatment options ranging from medical management to the use of parasurgical as well as surgical measures.
This presentation gives a fine description about stoma and ostomy. This contains the details regarding types, complications and the advices that you should give to a patient with a stoma.
Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except Groin hernias. In this presentation I have discussed Epigastric, Umbilical, Para umbilical, Incisional, Spigelian and Lumbar hernias.
In many cases, Piles can be treated effectively with diet, good hygiene, and topical medications. In some cases, though, diet and drugs are not enough. People who do not respond to non-surgical treatments might experience long-term relief through surgery.
our study and experiences we thus conclude that the stapler haemorrhoidopexy is simple and safe procedure. It is a minimally invasive procedure and it is less associated with post-operative pain bleeding and prolapse. It can be done as the day care surgery.
Basics of laproscopic surgery..
by dr navdeep s kamboj presented at sgrdumsar amritsar.
topics covered--
1 basics of laparoscopy
2 lap cholecystectomy
3 lap appendixcectomy
pneumoperitonem
merits and demerits of laproscopy
ligasure
endoscopy,
laparoscopic instruments
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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5. CLASSIFICATION
Depending on anal origin within anal canal and relation to
dentate line haemorrhoids divided into:
Internal haemorrhoids
External haemorrhoids
Interoexternal haemorrhoids (external extensions of
internal haemorrhoids)
6. Symptomatic anal
cushions
Lie above dentate line
Lie in 3, 7 and 11 o’clock
positions
Develop from embryonic
endoderm
Covered by columnar
epithelium
Not supply by somatic
sensory nerves, so painless
Relate to venous channels of
inferior haemorrhoidal
plexus deep in skin
surrounding the anal verge
Lie below dentate line
Not true haemorrhoids
Develop from embryonic
ectoderm
Covered by squamous
epithelium
Innervated by cutaneous
nerve that supply perianal
area, so painful
Internal haemorrhoids External haemorrhoids
8. Causes of secondary internal haemorrhoids:
( in between 3, 7 and 11 o’clock positions)
Carcinoma of anorectum (MC)
Local, e.g. anorectal deformity, hypotonic anal sphincter
Abdominal, e.g. ascites
Pelvic, e.g. gravid uterus, uterine neoplasm (fibroid,
carcinoma of the uterus or cervix), ovarian neoplasm,
bladder carcinoma
Neurological, e.g. paraplegia, multiple sclerosis
9. ETIOPATHOGENESIS
Straining and constipation
Low fiber diet
Less bulky stool
Straining at defecation
Increased intraanal pressure
Decreased venous return
Enlarged haemorrhoidal venous cushions
10. CLINICAL FEATURES
Bright-red, painless bleeding
Mucous discharge
Prolapse
Peri anal pruritus and irritation
Pain only on prolapse
Acute pain when incarcerated/
strangulated
Thrombosed external haemorrhoids/ perianal haematoma
may present with as sudden onset, olive-shaped, painful
blue subcutaneous swelling at anal margin (‘a 5-day,
painful, self-curing lesion’)
Skin tags (in external haemorrhoids)
11. COMPLICATIONS OF HAEMORRHOIDS
Strangulation and thrombosis
Ulceration
Gangrene
Severe haemorrhage
Portal pyaemia
Fibrosis
Prolapsed strangulated
piles on the left
12. GRADING OF INTERNAL HEMORRHOIDS
Ther Adv Chronic Dis 2017;8(10):141–147
Patients may experience painless bleeding with any grade
13.
14.
15. Per rectal examination
Proctoscopy
Colonoscopy for exclusion of other causes of rectal
bleeding, especially colorectal malignancy
CBC
Coagulation profile
16. TREATMENT
Conservative
Non-surgical
a) Injection sclerotherapy
b) Rubber band ligation
c) Cryotherapy (Lloyd Williams) not often used
d) Infrared photocoagulation (Leicester) not often used
Surgical
a) Open hemorrhoidectomy (Milligan–Morgan)/ MMH- Gold standard
b) Closed hemorrhoidectomy (Ferguson)
c) Diathermy hemorrhoidectomy
d) Laser hemorrhoidectomy
e) LigaSure hemorrhoidectomy
f) Harmonic scalpel hemorrhoidectomy
g) Semi-closed hemorrhoidectomy
h) Submucosal hemorrhoidectomy (technique of parks)
i) Hemorrhoidal artery ligation
j) Farag procedure
k) Stapled hemorrhoidopexy/ PPH
17. CONSERVATIVE TREATMENT
Attempts at normalizing bowel and defaecatory habits:
only evacuating when natural desire to do so arises
adopting a defaecatory position to minimize straining
addition of stool softeners and bulking agents to ease
defaecatory act
proprietary creams can be inserted into rectum at night and
before defaecation
18.
19.
20. INJECTION SCLEROTHERAPY
Aim: to create fibrosis, cause obliteration of vascular
channels and hitch up anorectal mucosa
Submucosal injection of 5% phenol in arachis oil or
almond oil
Left lateral position and under direct vision with a
proctoscope, about 5 mL of sclerosant is injected into
apex of pile pedicle
Procedure is repeated for each pile
Reassessed after 8 weeks
If necessary, repeat injections
Correct site (cross) for
injecting a haemorrhoid
21. Pain upon injection means that needle is in wrong place
Too superficial injections: rapid bulging of mucosa, which
turns septic sequelae
Too deep injections: disastrous consequences, including
pelvic sepsis, prostatitis, impotence and rectovaginal fistula
22. RUBBER BAND LIGATION
Efficacious for more bulky piles, but associated with more
discomfort
Barron’s bander is a commonly available device
Used to slip tight elastic bands onto base of pedicle of each
haemorrhoid
Bands cause ischaemic necrosis of piles, which slough off
within 10 days; this may be associated with bleeding
Three piles may be treated at one session
Process may be repeated after several weeks if necessary
23. When an internal hemorrhoid is present in anorectal canal, an anoscope may be used as a
guide to identify hemorrhoidal complex.
A) With a speculum in place, a ligator is positioned over base of hemorrhoid, isolating it.
Some ligators use forceps, whereas others use suction to draw hemorrhoid taut.
B) Once the ligator is positioned at its base, bands are released
C) After the procedure is completed, the constricting bands remain in place until they
eventually fall off (typically because the tissue distal to the constricting bands sloughs)
24. INDICATIONS FOR HAEMORRHOIDECTOMY
3rd and 4th degree haemorrhoids
2nd degree haemorrhoids that have not been cured by
non-operative treatments
Fibrosed haemorrhoids
Interoexternal haemorrhoids when the external
haemorrhoid is well defined
Presence of anorectal conditions requiring surgery
(fistula, fissure, large skin tag)
Haemorrhoids complicated by strangulation
Patient preference
25. OPEN HEMORRHOIDECTOMY
Milligan–Morgan hemorrhoidectomy (MMH)
Current gold standard for surgical management
Hemorrhoidal tissue and vessels involved are excised with
placement of a suture at hemorrhoid pedicle
But incisions are left open
Often, because of location, technical difficulties, or extensive
disease with gangrenous hemorrhoidal tissue, open
approach required
More useful for avoiding subsequent anal stenosis
26. a) artery forceps applied
b) dissection of left lateral
pedicle
c) transfixion of the pedicle
27. To avoid stricture formation, it
is necessary to ensure that a
bridge of skin and mucous
membrane remains between
each wound
If it looks like a clover, the
trouble is over
if it looks like a dahlia, it is
surely a failureAppearance of anus at
conclusion of operation
28. CLOSED HEMORRHOIDECTOMY
Ferguson hemorrhoidectomy (FH)
Differs from MMH as the wound is sutured primarily
After hemorrhoidal pedicle has been mobilized, an
absorbable suture is usually placed at pedicle site
After hemorrhoidal bundle is excised, mucosal wound and
skin are completely closed with a continuous suture
MMH may be overall better than FH particularly as regards
complication rate
29. (a) Haemorrhoidal tissue is
excised
(b) Bleeding is controlled by
diathermy
(c) Defect is closed with a
continuous suture after first
undermining anoderm on
each side
30. COMPLICATIONS OF HAEMORRHOIDECTOMY
Early
Pain (results from sphincter spasm, damage to nerve endings,
insertion of hemostatic gauzes and damage to mucosa)
Protracted recovery time (a minimum of 4 weeks with MMH)
Acute retention of urine
Reactionary haemorrhage
Late
Secondary haemorrhage (7th – 8th POD)
Anal stricture
Anal fissure
Fecal incontinence
31. CIRCULAR STAPLED HEMORRHOIDOPEXY
Also known as ‘procedure for prolapse and hemorrhoids
(PPH)’ or stapled anopexy/ mucosectomy/ prolapsectomy
Introduced by Longo A in 1998
Employs a circular stapling device, which removes mucosa
and submucosa circumferentially 2-3 cm above dentate line,
anastomosing proximal and distal edges
Interrupting blood supply to remnant hemorrhoidal tissue
Less painful and allows quicker recovery than MMH
High recurrence rate (PPH versus MMH 5.7% vs. 1% at 1 year
and 8.5% vs.1.5% overall)*
*Cochrane Database Syst Rev 2006;(4):CD005393.
32.
33. DIATHERMY HEMORRHOIDECTOMY
With diathermy, coagulation occurs at temp. >150 ℃
Formation of an eschar that seals the bleeding area
Compared with conventional hemorrhoidectomy:
Less bleeding
Shorter operating time
Lower postoperative analgesic requirement, but with similar post-
operative pain
World J Surg Proced 2014; 4(3): 55-65
34. LIGASURE HEMORRHOIDECTOMY (LH)
LigaSure vessel sealing system® (Valleylab) uses a bipolar
electrothermal device without need for sutures, i.e.,
sutureless hemorrhoidectomy
Aim:
avoiding painful diathermy burns in the richly innervated anal canal
allowing better tissue adhesions at the wound site
decreasing incidence of postoperative hemorrhage
Shorter operative time
Postoperative pain and urinary retention
Day-case surgery
Earlier return to work
Additional cost of the disposable device
World J Surg Proced 2014; 4(3): 55-65
35. HARMONIC SCALPEL HEMORRHOIDECTOMY (HSH)
Harmonic scalpel® (J & J, Ethicon) is an ultrasonically-
activated instrument
Vibrates at a rate of 55000 MHz per second
Able to coagulate small- and medium-sized vessels by
converting electrical energy to a mechanical one
Less lateral thermal damage
Benefit of HSH with respect to operative time, blood loss,
postoperative pain, length of hospital stay, and return to
normal activity
Increased cost
36. SUBMUCOSAL HEMORRHOIDECTOMY
(TECHNIQUE OF PARKS)
Designed to reduce postoperative pain and avoid anal and
rectal stenosis
Indicated for 2nd to 4th degree hemorrhoids
It includes hemorrhoidectomy with preservation of anal canal
mucosa, reducing surgical wound dimensions and leading to
a shorter healing time
Mucosa is not included in ligation leads to reduced
postoperative pain
Surgical time is longer
Recurrence rate is higher
Greater risk of bleeding during surgery and postoperatively
World J Surg Proced 2014; 4(3): 55-65
37. A Y-shaped incision is made at mucocutaneous junction,
between upper mucosa of the anal canal and anorectal
junction, as an inverted racket incision
Vascular pedicle is separated from mucosa and sphincter
plane, connecting it afterwards
Mucosa is then closed with running suture, leaving a small
area open in the perianal region for drainage
38. DOPPLER-GUIDED HEMORRHOIDAL ARTERY LIGATION
First described by Morinaga et al in 1995
Performed under sedation and/or LA
Involves a proctoscope with a doppler transducer
integrated in probe
Sequential identification of position and depth of superior
rectal arterial branches (usually 5-7 are found at one level)
Selectively ligated 2-3 cm above dentate line at two levels
1-1.5 cm apart by absorbable sutures via a lateral ligation
window within scope
interference with blood supply suppresses bleeding and
volume of hemorrhoids
Symptomatic relief is usually evident within 6-8 weeks
39. FARAG PROCEDURE
Alternative method to ligate hemorrhoidal artery without
doppler guidance
Piles suture, in which three interrupted sutures are used to
interrupt the blood flow to the prolapsed hemorrhoids
First suture is passed through mucosa at proximal end of
internal hemorrhoids to occlude superior rectal vessels
Second suture is passed into distal end of internal
hemorrhoids above dentate line to interrupt connection
between the internal and external hemorrhoidal plexuses
Third suture between previous two sutures
Not widely accepted (interruption of the blood flow to
hemorrhoidal cushions cause initial painful congestion)
World J Surg Proced 2014; 4(3): 55-65
40. SEMI-CLOSED HEMORRHOIDECTOMY
Involves the pectineal line repair
Internal hemorrhoid is forced outwards, becoming fully exposed
For the repair of rectal mucosa
In upper limit of internal hemorrhoid; 3-4 full-thickness sutures
are made radially, involving mucosa and submucosa
Craniocaudal length of hemorrhoid to be resected
Mucosa and submucosa are cut between the ligations
External part of skin plexus is removed until dentate line with a V-
shaped incision or a racket incision with an external base
Perfect for voluminous and proximally extended internal
hemorrhoids, whose full dissection would cause a very high
resection of the rectal mucosa
World J Surg Proced 2014; 4(3): 55-65