Anorectal emergencies

Table 1 Technical notes for urgent hemorrhoidectomy

Preoperative intravenous antibiotics

Surgery under general anesthesia, regional anesthesia, or intravenous sedation plus perianal infiltration of local anesthetic agent(s)

Prone jackknife position

Manual reduction of prolapsing hemorrhoids

Compression of hemorrhoids to reduce edema

During an operation, use of large-diameter anoscope e.g., Fansler anoscope

Anoderm or mucosa-sparing hemorrhoidectomy (preferably semi-closed technique)

Allowance of at least 1-cm mucosal bridge between surgical wounds and at least 50% of good circumferential mucosa

Use of long-lasting absorbable sutures e.g., polyglactin 910 for mucosal approximation

If applicable, instead of hemorrhoidectomy, plication of hemorrhoid may be applied to small lesions

Oral postoperative antibiotics against anaerobes for 1 wk