What is ambulatory hemorrhoidectomy?
The ambulatory hemorrhoidectomy is performed under local anesthesia. Your surgeon will check up your anus and surrounding tissues and resection of the hemorrhoids. The specimen will be sent to pathology laboratory if necessary. Please check in with operating room reception desk on your scheduled operation day. After operation, you may go home on the same day.

The perioperative nursing care
  1. Preoperative nursing care
    1. Nursing staff will ask you presenting identification card to confirm your identity, and inquiry your medical record and past allergic history. 
    2. Nursing staff will confirm your acceptance of the surgery and anesthesia. If you have any questions please do not hesitate to ask nursing staff.
    3. Remove all your accessories, watch, artificial denture, and wipe lipstick and nail polish. Please hand over your belongings to families or leave all of them in the locker at nursing station before entering operating room.
    4. Wear loose-fit clothing in order to change surgical attires at ease.
  2. Intraoperative nursing care
    1. Nursing staff will help you maintain prone position and use equipment to prevent fall and hurt from positioning injury. We will keep you warm with warm blanket or heat lamp.
    2. Nursing staff will use patches on the appropriate body parts to prevent electrical burns during surgery.
    3. The length of surgery will be around 20-30 minutes.
    4. We will broadcast music during intraoperative phase. If you feel uncomfortable or have any needs please inform nursing staff.
    5. We will maintain your privacy. We will keep your  exposed body parts as minimum as possible during surgery.
  3. Post-operative nursing care:
    1. Nursing staff will clean the area around the surgical site and cover the wound with a sterile dressing.
    2. We will continue to use the warm blanket or heat lamp to keep your warm.
    3. We will provide home care nursing instructions, such as diet and wound care.
       
Home care notifications
  1. After surgery, you can eat solid food but can only begin to intake water  after urination.
  2. Please avoid alcohol, spicy food, and food that makes gas, such as pepper, garlic, peanuts, nuts, etc.
  3. It is common to feel defecation desire constantly due to the gauze filled in the anus. It is very important for female patients that they can only use water to clean the perianal area rather than wipe it after toilet, and then cover it with clean gauze or cotton pad  24 hours after surgery.
  4. You may remove the dressing after 24 hours and begin to take a sitz bath. The gauze filled in the anus will be loosen gradually. You should take a sitz bath with warm water at 41-43 ℃. A sitz bath should be taken 15 minutes after bowel movement and at least 4 times a day. Every time after taking a sitz bath, please dry the wound smoothly and use cotton ball or pad to clean your anus.
  5. Please go to emergency room immediately if the following symptoms present: massive bleeding, feeling difficulty at urination and fever.
  6. Please avoid strenuous exercise which will increase in abdominal pressure. Do not squat or sit for a long time.
  7. It’s important to keep regular bowel movement daily. Avoid rush in defecation or sit on the toilet for  too long.
  8. Eat plenty of high fiber foods such as fruits or vegetables. It might help you to prevent constipation and reduce the risk of hemorrhoid recurrence.
  9. Please take medication following doctor's order. Do not take any medications without doctor’s prescription.
  10. Please visit your doctor one week later.

Reference
  1. Lee, K. L., Wu, H. H., Wang, C. Y., Lo Y. P. (2018). Nursing Project of Utilizing Multimedia to Improve Hemorrhoid Surgery Nursing Education. Yuan-Yuan Nursing, 12(2), 41-49. doi:10.6530/YYN/201807_12(2).0005
  2. Hsiao, M. C., Cheng, L. C., Tian, Y. F., & Chou, C. L. (2016). Managements of an anorectal emergency: experience from a single institution. The Journal of Society of Colon and Rectal Surgeons (Taiwan), 27(4), 179-186. doi:10.6312/SCRSTW.2016.27(4).10515
  3. Yeh, M. L., Chung, Y. C., Hsu, L. C., & Hung, S. H. (2018). Effect of Transcutaneous Acupoint Electrical Stimulation on Post-Hemorrhoidectomy-Associated Pain, Anxiety, and Heart Rate Variability: A Randomized-Controlled Study. Clin Nurs Res, 27(4), 450-466. doi:10.1177/1054773816685745
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