After administering a local anesthetic, the surgeon digitally dilates the rectal sphincter. He then removes the hemorrhoidal varicosities, either by clamping and cauterization or by ligation and excision. (See Ligating hemorrhoidal tissue, page 378.) He may place a small, lubricated tube in the patient’s anus to drain fluid, blood, and flatus, or he may elect to pack the area with petroleum gauze. Several alternate surgical techniques are also available. (See Hemorrhoid surgical and laser techniques, page 379.)

A relatively quick and simple surgery, hemorrhoidectomy carries only one potentially serious complication: hemorrhage due to the rich vascularity of the region that could be severe enough to cause hypovolemic shock. This risk is greatest during the first 24 hours after surgery and then again after 7 to 10 days when the sutures slough off. Because of this risk, hemorrhoidectomy is contraindicated in patients with blood dyscrasias or certain GI cancers, or during the first trimester of pregnancy.

Risk for infection related to normal bacterial flora at the surgical site. Based on this nursing diagnosis, you’ll establish these patient outcomes. The patient will: