DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Prolapsing hemorrhoids.
POSTOPERATIVE DIAGNOSIS:
Prolapsing hemorrhoids.
PROCEDURE PERFORMED:
Stapled hemorrhoidopexy.
SURGEON: John Doe, MD
ANESTHESIA: Spinal.
ESTIMATED BLOOD LOSS: Minimal.
SPECIMENS: None.
POSTPROCEDURE CONDITION: Good.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old woman who was evaluated for rectal bleeding, which was at times significant. On examination, the patient had prolapsing hemorrhoids. The patient was recommend a stapled hemorrhoidopexy. We discussed alternatives to the procedure, which included excisional hemorrhoidectomy, office-based therapy, and expectant management. We also discussed the risks, which would include, but would not be limited to, recurrent hemorrhoid, bleeding, infection, and pain. The patient demonstrated understanding of all of these and elected to proceed with the procedure.
DESCRIPTION OF OPERATION: The patient was brought to the operating room. After spinal anesthetic had been given, the patient was placed in the prone jackknife position. The buttocks were then taped apart. The perineum was prepped and draped in the usual sterile fashion.
A digital rectal examination was then performed. The patient was noted to have large prolapsing internal hemorrhoids circumferentially. Therefore, the obturator and dilator of the PPH03 stapler were placed in the anal canal and then the obturator was secured to the skin with interrupted 0 Ethibonds. A circumferential 2-0 Prolene suture was then placed submucosally in a pursestring fashion using the operating anoscope approximately 4 cm above the dentate line. A contralateral 2-0 Vicryl was then placed submucosally incorporating the pursestring.
The stapler was then advanced with the anvil fully extended above this pursestring. The pursestring was then tied down and the Prolene was brought out through the left head of the stapler and Vicryl was brought out through the right. With traction on the sutures, the stapler was closed, advancing approximately 4 cm in the anal canal. After achieving the shortest staple height possible, 30 seconds were allowed to be elapsed and then the stapler was fired.
The stapler was then removed, and there were two bleeding points in the posterior midline and in the right anterior location. These were ligated with 3-0 Vicryl suture ligatures. The patient tolerated the procedure well. After Marcaine was injected for postoperative pain relief, the suture line was once again checked for hemostasis and noted to be excellent. The obturator was removed, and the patient was taken to the recovery room in good condition.
