Hemorrhoids
- Internal only rubber band at least 1-2cm above dentate line
- Excisional
- Start with the largest and most bothersome hemorrhoid.
- Suture ligate the hemorrhoidal pedicle.
- Take care to dissect hemorrhoidal cushion off of the underlying sphincter muscle to avoid damage to the sphincter complex.
- To remove the hemorrhoidal cushion, use whatever method is preferred by the surgeon—sharply, with cautery, or with various vessel sealing devices.
- Close the excision site or leave it open, again at the surgeon's discretion.
- If excising multiple hemorrhoids, it is necessary to leave adequate skin bridges between excision sites to avoid developing anal stenosis.