Thrombosed External Hemorrhoid Excision Periprocedural Care

Updated: Aug 09, 2017
  • Author: Brett Wallace Lorber, MD, MPH, FACEP; Chief Editor: Erik D Schraga, MD  more...
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Periprocedural Care

Patient Education and Consent

Explain the procedure, benefits, risks, complications, and alternatives to the patient, the patient’s representative, or both. Obtain a signed informed consent. Ask the patient or the patient’s representative if he or she would like others to be present for the procedure.

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Equipment

Equipment required for the procedure includes the following:

  • Direct dedicated lighting
  • Sterile gloves
  • Antiseptic solution with skin swabs
  • Sterile drape
  • Local anesthetic solution (0.5% bupivacaine or 1% lidocaine with epinephrine)
  • Syringe, 5 mL
  • Needles, 18-gauge and 25- or 27-gauge
  • Small forceps for grasping tissue
  • Iris scissors to cut tissue or packing gauze
  • Scalpel blade on a handle, No. 11 or No. 15
  • Multiple gauze squares, 4- × 4-in.
  • Adhesive tape, 2-in.
  • Absorbable suture, 3-0
  • Sterile packing gauze, 0.25-in.
  • Sterile dressing

It is important to have the equipment required for rescue techniques (eg, suturing equipment, silver nitrate) available at the bedside, in case bleeding occurs that is not controlled by direct pressure.

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Patient Preparation

Anesthesia

Pain control is extremely important for excision of a thrombosed external hemorrhoid. Assurance of adequate local anesthesia is important; at times, procedural sedation may be warranted. Local anesthesia for this procedure is discussed further below (see Technique). For more information, see Local Anesthetic Agents, Infiltrative Administration.

Positioning

Place the patient in the prone or lateral decubitus position, with the gurney at a height that accommodates the practitioner. Position the patient prone on the gurney, and use two overlapping sheets to cover the patient’s buttocks. One sheet extends down the legs, and the other extends up the back.

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Monitoring and Follow-up

Return precautions should be given both verbally and in written form. They should include the following:

  • Uncontrolled pain
  • Signs of infection (eg, pus, redness, fever)
  • Moderate-to-severe bleeding (minor bleeding is extremely common)

A wound check is necessary if pain or bleeding persists for more than 36-48 hours postoperatively.

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