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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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Expected Benefits

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  • Resolution of hemorrhoids and symptoms.

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Potential Risks

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  • Common complications include significant postoperative pain, urinary retention, bleeding, incontinence, infection, and anal stenosis.
  • Risk of bleeding is increased with emergent hemorrhoidectomy, during pregnancy, and in patients with portal hypertension or coagulopathy.
  • Rectal perforation, rectovaginal fistula, and retroperitoneal and pelvic sepsis are rare risks of circular stapled hemorrhoidopexy and may be avoided with proper technique.

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Pilonidal Cyst Excision and Marsupialization

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Expected Benefits

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  • Resolution of cyst and infection.
  • Prevention of recurrence.

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Potential Risks

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  • Primary cyst excision with marsupialization requires daily wound scrubbing and strict attention to shaving hair in wound proximity.
  • Time to healing may be several months.
  • Rate of recurrence is approximately 6%.
  • Rate of wound breakdown is 2–3%.

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Anorectal Abscess and Fistula

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Expected Benefits

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  • Resolution of abscess or fistula.

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Potential Risks

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  • Common complications of surgery include:
    • Fistula in ano.
    • Abscess.
    • Incontinence due to iatrogenic sphincter injury.

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  • No special equipment is required for hemorrhoidectomy, pilonidal cyst excision, or the treatment of anorectal abscess and fistula.

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Circular Stapled Hemorrhoidopexy

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  • 33-mm hemorrhoidal circular stapler.

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Hemorrhoidectomy

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  • Thorough preoperative workup to confirm diagnosis, hemorrhoid grade, and symptomatic status is essential before recommending hemorrhoidectomy.
  • If bleeding is the indication for hemorrhoidectomy, examination of the colon and rectum for other potential sources of bleeding may be indicated.
  • In patients with portal hypertension, hemorrhoids must be distinguished from anorectal varices.
  • The rectum may be evacuated with an enema immediately before the operation.

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Pilonidal Cyst Excision and Marsupialization

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  • Digital rectal examination should be performed to evaluate for a presacral tumor.
  • The patient is examined to identify the location of pits and presence of infection or ...

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