Care of Patient with Perioperative Ambulatory Hemorrhoidectomy

【Major Point】

Before the operation, go to the toilet to empty bladder, remove accessories and nail polish.
During the operation, it is necessary to cooperate to keep the lying posture as still as possible and measure blood pressure and blood oxygen level.
After the operation, do not drink water immediately.
After 24 hours, the dressing can be removed and a warm sitz bath can be started.

What is ambulatory hemorrhoidectomy surgery?
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 purpose of the ambulatory hemorrhoidectomy surgery:
Nurses will provide individualized care according to your condition, provide warmth and privacy protection during the operation, from entering operating room to the end of the operation, and make you to complete the operation safely.

Pre-operative preparation and nursing:
On the day of surgery, bring the health insurance card, operation notice, operation consent form, anesthesia consent form, and other outpatient documents to the operating room.
1. Confirm surgery information for patient safety:
  When you enter the operating room, in order to performing accurate surgery, different medical staff will repeatedly ask your name, birthday, and location and procedure of the operation to confirm all information is consistent with intended operation.
2. Preparation for local anesthesia:
  Ask about your medicine history, allergy, and whether you have a history of hypertension and asthma, as a reference for monitoring vital signs during surgery.
3. Going to the toilet:
  When you hear the announcement entering the operating room, please urinate before entering the operating room.
4. Change the surgical gown:
  You must change into t surgical gowns before entering the operating room. Personal clothing including underwear and socks are not allowed.
5. Remove any accessories:
  Electric coagulation is used to stop bleeding during the operation. To avoid electric burns, metal objects and accessories such as glasses, hairpins, necklaces, rings, amulets, etc. Must be removed from the body before entering the operating room.
6. Remove lipstick or nail polish for monitoring of blood oxygen status.
Intra-operative preparation and nursing:
1. Warmth and Privacy:
  Body exposure will be minimized during the procedure: according to body temperature and warming needs, inflatable thermal equipment or warming blankets will be given.
2. The medical staff will assist you to sleep on the operating table. Please take a comfortable prone position and keep still to prevent falling or causing injury.
3. Disinfection of the surgical site:
  During disinfection, there will be a cold feeling. Please do not touch the disinfection area with your hands to avoid wound infection after surgery.
4. On the skin of calf or a large muscle area, the electrocautery hemostasis circuit is pasted to use electronic coagulation to stop bleeding during surgery.
5. Laying a sterile drape over the surgical site:
  To avoid surgical site infection, place a sterilizes sheet around the surgical site. Medical staff will use oxygen tubes to provide sufficient oxygen, so you don’t have to worry about breathing problems.
6. Administration of local anesthesia:
  Use a smaller needle to inject anesthesia around the surgical site to reduce pain during surgery. During the operation, having sensation of touch and pull is normal. If you feel pain at the surgical site, please notice the medical staff at any time to increase the administration of local anesthetics.
7. Monitor blood pressure and blood oxygen:
  Place a cuff around your arm and clip finger oximeter.
Post operation nursing:
1. Medical staff will clean the area around the surgical site and cover the wound with a sterile dressing.
2. 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.
3. After surgery, you can eat solid food but can only begin to intake water after urination.

Home care notifications:

You may remove the dressing 24 hours after surgery and begin to take a sitz bath. The gauze filled in the anus will be loosened gradually. You should take a sitz bath with warm water at 41-43C. 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.
Please go to emergency room immediately if the following symptoms present: massive bleeding, feeling difficulty at urination and fever.
Please avoid alcohol, spicy food, and food that makes gas, such as pepper, garlic, peanuts, nuts, etc.
Avoid exercise that increases abdominal pressure, and it is not advisable to squat or sit for a long time.
It’s important to keep regular bowel movement daily. Avoid rush in defecation or sit on the toilet for too long.
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.
Please take medication as doctor's order. Do not take any medications without doctor’s prescription. Please visit your doctor one week later.

Reference

Lohsiriwat, V., & Jitmungngan, R. (2022). Strategies to Reduce Post-Hemorrhoidectomy Pain: A Systematic Review. Medicina (Kaunas, Lithuania), 58(3). https://doi.org/10.3390/medicina58030418
Rudiman, R., Hanafi, R. V., Evan, C., & Halim, F. (2023). The efficacy of topical sucralfate in improving pain and wound healing after haemorrhoidectomy procedure: A systematic review, meta-analysis, and meta-regression of randomised clinical trials. International Wound Journal, 20(2), 543-553. https://doi.org/10.1111/iwj.13901
Yang, Y., Feng, K., Lei, Y., Qiu, L., Liu, C., & Li, G. (2023). Comparing the efficacy and safety of different analgesic strategies after open hemorrhoidectomy: A systematic review and network meta-analysis. International Journal of Colorectal Disease, 38(1), 4. https://doi.org/10.1007/s00384-022-04294-5

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