Hemorrhoids

Question 1

the most commonly used sclerosing agents for hemorrhoids

Answer 1

• the most commonly used sclerosing agents are 5% phenol in almond or vegetable oil and sodium tetradecyl sulfate.
• Injection is performed into the submucosa at the apex of a hemorrhoidal cushion, using approximately 1 ml of sclerosing agent.
• Sclerotherapy is appropriately offered to anticoagulated patients or those receiving antiplatelet therapy

Question 2

Difference between open and Closed hemorrhoidectomy

Answer 2

• The most commonly used technique is the closed (Ferguson) hemorrhoidectomy
• This approach is associated with decreased postoperative pain, faster wound healing, and a reduced risk of postoperative bleeding compared to an open (Milligan-Morgan) hemorrhoidectomy

Question 3

Tx of External Hemorrhoids

Answer 3

• Most patients will experience resolution of their symptoms within 72 hours after the onset of symptoms with conservative measures, such as sitz baths, application of lidocaine ointment and stool softeners.
• Acutely tender, thrombosed external hemorrhoids are often surgically removed when pain is excessive and/or fails to respond to expectant management.
• Thrombectomy with evacuation of clot is often performed in the emergency department setting; however, excision of the hemorrhoid is usually a far better option