By Steven D. Wexner

Grasp options commonly surgical procedure: Colon and Rectal surgical procedure: Anorectal Operations is a quantity in a sequence that provides universal and complex approaches within the significant subspecialities of common surgical procedure. The sequence is overseen by means of Josef F. Fischer, MD, editor of the vintage two-volume reference Mastery of Surgery.

Master suggestions mostly surgical procedure: Colon and Rectal surgical procedure: Anorectal Operations is written through said grasp surgeons, emphasizes surgeries, and is lavishly illustrated with unique full-color drawings. The members totally clarify their most popular suggestions in step by step, completely illustrated element, investigate symptoms and contraindications, provide guidance on preoperative making plans, and talk about results, issues, and follow-up.

Coverage comprises hemorrhoidectomies, anal fistula and sphincter techniques, systems for perineal prolapse and excision of rectal carcinoma, between others.

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Consequently, experience in patient selection and alternative procedures without a stapling device is mandatory. tiJ PREOPERATIVE PLANNING Focusing on patient selection, it is crucial that hemorrhoidal prolapse is reducible. Moreover, patients suHering from large external hemorrhoids or skin tags must be informed that these tags will not be routinely excised with the stapled approach. Informed consent must be obtained considering potential risks, benefits of PPH in the short term, the risk of prolapse recurrence in the long-term course, and alternative treatments (conventional excisional hemorrhoidectomy).

Chapter 3 Harmonic Scalper• 0 SURGERY The Harmonic Scalpel11 Instrument The Harmonic Scalpel11 consists of cutting shears that vibrate at 55,500 Hz, at amplitudes of 60-100 microDB. The vibratory anergy results in disruption of hydrogen bonds that cause denaturing of intracellular proteins. This mechanism results in shearing of the coapted tissue and creation of a sticky coagulum that further assists in hemostasis. The principles of cutting tissue lie in two main modalities: Pressure results from compression (coaptation) of the "active" blade onto a "pressure pad" on the opposite blade of the shears.

Late anal stenosis has been reported in 4-5% of patients after conventional hemorrhoidectomy. Clllptar2 LigaSurelM 3 RESULTS Postoperative Bleeding and Anal Pain Muzi et al. prospectively compared the clinical outcomes of 250 patients with either grade 3 or grade 4 hemorrhoids randomized between LigaSureTM and conventional diathermy hemorrhoidectomy (2). In their study, although not statistically significant, there was a difference between the two groups with respect to postoperative bleeding: postoperative hemorrhage in 3/125 in the LigaSureTM group and 7/125 in the diathermy group.

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