Perioperative management and precautions for anorectal surgery
1 before surgery
1.1 Patients should truthfully report their medical history, such as high blood pressure; diabetes; heart disease; history of bleeding; especially whether there is currently oral warfarin, aspirin and other drugs that affect blood coagulation, because surgery during oral drugs can significantly increase intraoperative bleeding. The incidence of postoperative bleeding is relatively high, and surgery should be considered after stopping the drug for 1 week. Patients with hypertension and heart disease are more likely to develop disease during and after surgery than usual; patients with diabetes are more likely to be infected after surgery; patients with hemophilia will experience excessive bleeding during and after surgery, requiring special treatment to stop the bleeding.
2.2 Before surgery, the intestines should be cleaned and excrete the feces in the intestines, which is conducive to not having to defecate in the early period (within 2 days) after the surgery, reducing the possibility of pain and bleeding. There are two ways to clean the intestines: one is oral laxatives, and the other is enema. For anal fissures, perianal abscesses, thrombotic hemorrhoids and other anal painful diseases, it is best to use oral medicine to clean the intestines, but you need to take the medicine from the morning, and at the same time take 2000ml of warm water. You must drink it within 1.5 hours, and you can’t take it again at noon. For diet, surgery can only take 2 hours after evacuating watery stools. It takes time for the intestines to absorb water. Therefore, it takes about 5 hours to take oral cleansing drugs. For example, for surgery at 3 pm, you have to start preparations at 10 am. Enema is faster, but not as clean as oral laxatives.
2.1 We basically use sacral canal anesthesia during the operation. The sacral canal anesthesia has the characteristics of complete anesthesia, good anus relaxation, and good results of the operation. But there are also disadvantages. One-quarter of the patients have lower limb weakness and cannot walk. But don’t worry, you can usually recover after 6 hours. Another disadvantage of sacral anaesthesia is postoperative urinary retention, that is, the inability to urinate. Therefore, we require that you do not eat or drink before the first urination after surgery. The infusion rate should be slow. You can stand to urinate after 6 hours, which can significantly reduce urinary retention. The incidence of urinary catheterization requires catheterization if it is impossible to urinate. About 1/10 of those who need catheterization.
2.2 In terms of diet: After the first urination, you can drink as much as you want. You can eat a small amount of rice soup liquid food that night, and the next day will be mainly liquid food, so that food residues are less, which can significantly extend the time from surgery to the first bowel movement. It is beneficial to reduce incision bleeding, pain and infection caused by stool. On the third day, start ordinary eating.
2.3 After the operation, blue urine can appear because we have applied long-acting painkillers after the operation, and the urine will gradually turn to normal color, so don't worry.
2.4 After the operation, after the anesthesia effect disappears, there may be slight pain and congestion in the anus, and it feels like there is stool. Do not defecate at this time, because this is because we placed a drainage tube in the anus after the operation. The purpose is to easily exhaust gas and observe whether there is internal bleeding (most of the bleeding after the operation flows to the rectum and cannot be observed outside the anus), so do not go to the stool, let alone take it out at will, because the exhaust pipe is wrapped around the gauze to suppress the bleeding Once taken out and severe bleeding occurs, it is impossible to stop the bleeding without anesthesia. It needs to be anesthetized to stop the bleeding, which increases the unsafety after the operation. One in 20 patients did not listen to the doctor’s advice and took them out or squatted in the toilet. In fact, they did not have any stool when they squatted in the toilet. Because we had an enema before surgery, where would there be stool? Be sure to cooperate with the doctor.
2.5 Our patients have mild pain after surgery. Very few patients have hyperalgesia and need analgesics, accounting for about 1/20.
2.6 For patients after hemorrhoids surgery, especially those with internal hemorrhoid ligation, start to take paraffin oil after the anal canal is taken out. 40ml a day is conducive to softer stools, smoother bowel movements, and prevents prolonged squatting and excessive Hard. Edema occurs at the edge of the surgical incision, skin tags will form over time, or hemorrhoids will appear in other parts. After ligation of internal hemorrhoids, the ligature should be allowed to fall off naturally. If the stool is dry and hard, the ligature will fall off prematurely and cause bleeding. Normally, it will fall off naturally in 5-7 days.
2.7 For patients with anal fissure, the stool can be dry and hard after the operation, so there is no need to take paraffin oil. Dry and hard stool will further expand the anal canal, delay the healing of the incision, and prevent premature healing of the anus and re-stenosis.
2.8 On the third day after the operation, the traditional Chinese medicine fumigation and washing is started. The traditional Chinese medicine fumigation and washing can remove decayed muscle, promote blood circulation and remove blood stasis, and promote the healing of the incision.
2.9 Except for the ligation of internal hemorrhoids, most of the perianal incisions are made, and it takes about 30 days to heal. Before the healing, there will be leakage. You should take a bath with 1/5000 potassium permanganate warm water every day. Dip dry after the bath. Topically apply hemorrhoid ointment drugs. Clip a piece of gauze in the anus to help absorb the exudate from the wound. At the same time, when changing the gauze, it takes away the necrotic tissue and secretions.
I sincerely hope that you will understand various treatment measures and cooperate with your doctor.
I wish you an early recovery