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Hemorrhoidectomy

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  • Internal hemorrhoids: grade III and IV hemorrhoids, symptomatic combined internal and external hemorrhoids, bleeding, incarceration, or failure of conservative management.
  • External hemorrhoids: acute thrombosis < 72 hours post-onset.

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Pilonidal Cyst Excision and Marsupialization

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  • Recurrent acute pilonidal infections.
  • Chronic pilonidal sinus.

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Anorectal Abscess and Fistula

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  • Acute perirectal abscess.
  • Anorectal fistula.

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Hemorrhoidectomy

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Absolute

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  • Anorectal Crohn's disease or Crohn's proctitis.
  • Acquired immunodeficiency syndrome.

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Relative

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  • Portal hypertension.
  • Pregnancy.
  • Coagulopathy.

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Pilonidal Cyst Excision and Marsupialization

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  • The presence of cancer requires additional treatment.

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Anorectal Abscess and Fistula

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  • Multiple fistulous tracts in a patient with Crohn's disease may require additional studies of the colon and sphincter mechanism prior to definitive surgical treatment.

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Hemorrhoidectomy

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  • The patient should be in the prone jackknife position with buttocks taped aside.
  • The procedure is performed under general anesthesia or intravenous sedation with local anesthesia.
  • Left anterolateral positioning and local anesthesia are suggested for pregnant patients.

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Pilonidal Cyst Excision and Marsupialization

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  • The patient should be in the prone jackknife position; lateral decubitus position may also be used.
  • The procedure may be performed under general anesthesia or local anesthesia with intravenous sedation.

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Anorectal Abscess and Fistula

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  • The patient should be in the prone jackknife position with buttocks taped aside.
  • The procedure is performed under general anesthesia, regional anesthesia, or intravenous sedation with local anesthesia.

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Hemorrhoidectomy

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  • Postoperative care includes analgesia, stool softeners, fiber supplementation, and sitz baths.

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Pilonidal Cyst Excision and Marsupialization

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  • Wound care includes daily showers or sitz baths, cleansing of wound, and removal of all hair within 3–4 cm of wound edges. The wound should be packed wet-to-dry with normal saline twice daily.

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Anorectal Abscess and Fistula

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  • Antibiotics are generally not indicted in healthy patients with a simple abscess. Antibiotics should be given for abscesses in patients with immunosuppression, diabetes, valvular heart disease or prosthetic valves, extensive soft tissue cellulitis, and signs of systemic infection or sepsis.
  • Wound care includes sitz baths twice daily and after bowel movements. Following abscess drainage, the cavity is lightly packed with a gauze tape.
  • Patients should receive adequate analgesia and stool softeners.

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Hemorrhoidectomy

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Early

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  • Pain.
  • Urinary retention.
  • Bleeding.
  • Infection.
  • Fecal impaction.

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Late

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  • Anal stricture.
  • Anal tags.
  • Incontinence.
  • Mucosal prolapse.
  • Ectropion.

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Pilonidal Cyst Excision and Marsupialization

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  • Recurrent pilonidal sinus formation.
  • Infection.
  • Bleeding.
  • Delayed wound healing.

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Anorectal Abscess Drainage

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  • Incomplete drainage may lead to recurrent ...

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