1. Nursing Instruction
  2. Overview
  3. Colon and Rectal Surgery
【Major Point】
  1. Before the operation, go to the toilet to empty bladder, remove accessories and nail polish.
  2. During the operation, it is necessary to cooperate to keep the prone position as still as possible and measure blood pressure and blood oxygen level.
  3. After the operation, do not drink water immediately.
  4. 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 then 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.

What kind of care will I receive during surgery?
Nurses will provide individualized care according to your condition from the moment you enter the operating room until the surgery is completed. They will help keep you warm, protect your privacy, and ensure that you go through the surgery safely and comfortably.
  1. Pre-operative preparation and nursing:
    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, surgical site and procedure of the operation to confirm all information is consistent with intended operation.
    2. Preparation for local anesthesia: Medical staff will ask about your past medication use, and whether you have any history of drug allergies, hypertension, asthma, or other conditions, as a reference for surgical safety.
    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 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.
  2. Intra-operative preparation and nursing:
    1. Warmth and Privacy:Body exposure will be minimized during the procedure. According to your condition and needs, inflatable thermal equipment or warming blankets will be given.
    2. The medical staff will assist you in lying prone 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 the disinfection process, 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:During the disinfection process, you may feel cool. Please do not touch the disinfected area with your hands. The sterile drape will be placed around your surgical site after disinfection to prevent surgical site infection.
    6. Monitoring Blood Pressure and Oxygen Levels:The medical staff will check your blood pressure by using a cuff on your arm and monitor your oxygen levels with a finger sensor. If your oxygen level drops, you will be reminded to take deep breaths and an oxygen tube will be placed to provide enough oxygen for your comfort and safety.
    7. Administration of local anesthesia:Before the surgery, a small needle will be used to inject anesthetia around the surgical area. During the procedure, it is normal to feel sensations such as touching or pulling at the surgical site. If you still fell pain or uncomfort, please inform the medical staff immediately. We will adjust the dose of local anesthesia or provide appropriate treatment based on your symptoms.
3. Post-operative preparation and nursing:
            A. Medical staff will clean your body, the area around the surgical site and cover the wound with a sterile dressing.
            B. 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.
            C. After surgery, you can eat solid food but can only begin to intake water after urination.

Home care notifications:
  1. 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 41-43℃. 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.
  2. Please go to emergency room immediately if the following symptoms present: massive bleeding, feeling difficulty at urination and fever.
  3. Please avoid alcohol, spicy food, and food that makes gas, such as pepper, garlic, peanuts, nuts, etc.
  4. Avoid exercise that increases abdominal pressure, and it is not advisable to squat or sit for a long time.
  5.  It’s important to keep regular bowel movement daily. Avoid rush in defecation or sit on the toilet for too long
  6. 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.
  7. Please take medication as doctor's order. Do not take any medications without doctor’s prescription. Please visit your doctor one week later.

Reference
  1. AlAwadhi, K., Allafi, F. A., Almukaimi, B. A., Alkandari, A., Alenezi, S. A., Alenezi, A., Alenezi, S., Alenezi, S., Alenezi, N., Fahiman, A., Alsalem, A., & Alotaibi, M. (2024). Analgesic Efficacy of EMLA Cream Among Patients Undergoing Hemorrhoidectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Cureus, 16(8), e66423. https://doi.org/10.7759/cureus.66423
  2. Liao, W. C., Cheng, Y. Y., Hsu, C. K., Chiu, Y. C., Chiu, H. Y., Chang, S. C., & Hu, S. H. (2024). Effects of early warm water sitz bath on urinary retention and pain after haemorrhoidectomy: A randomized controlled trial. International Journal of Nursing Studies, 154, 104765. https://doi.org/10.1016/j.ijnurstu.2024.104765
  3. Micheal, J., Sothilingam, N., Schwartz, N. J., Guver, A., D'Adamo, C. R., Lipkin, S., Demos, J., Felton, J., & Wolf, J. H. (2024). Comparison of Post-Hemorrhoid Surgery Pain Profiles in Older and Younger Adults. The Journal of Surgical Research, 301, 572–577. https://doi.org/10.1016/j.jss.2024.07.005




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    Taipei Veterans General Hospital 
    No.201, Sec. 2, Shipai Rd., Beitou District,  3e72dadb9904d06fa0fb3744e4ed2612.png
    Taipei, Taiwan 11217, R.O.C.
    Tel: +886-2-2871-2121 #04
    • Smoking and chewing betel nut significantly induce oral cancer. Obesity will potentially increase the risk of breast cancer and colorectal cancer. Please control body weight and keep away from tobacco and betel nut.
    • Information provided above can’t overcome physician's treatment and replace physician patient relationship.
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