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EUA

Sphincter

Lithotomy

Spinal / LA

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Evaluate

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HemEvert

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Gastroenterology-2019

First Step

Upper most

Gentle

Pull

First Bleeding , most vascular

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  • Evaluation
  • Goal
  • Treatment
  • Secondary and Circumpharencial Haemorrhoids
  • Special issues

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  • gentle downward traction without completely closing babcock forceps

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  • Chromic 00 Stitch at cranial most part

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  • a mock trial will help you to understand movement

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        • assistant role in retracting during insertion and even more important when needle is coming out of opposite end

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        • Proper Lighting is crucial

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Gastroenterology-2019

First Stitch

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Gastroenterology-2019

Just below

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� �

  • Evaluation
  • Goal of treatment
  • Treatment -3
  • Secondary and Circumpharencial Haemorrhoids
  • Special issues

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  • Next important step is
  • to take knot as high as possible
    • Method

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  • Occasionally it may be difficult and may create problem due to

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    • multiple insertion of needle

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    • puncturing vascular pedicel of hemorrhoid

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    • needle come out at wrong place
    • Needle punctures another vascular haemorrhoid

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Gastroenterology-2019

Knot as high as possible

8 of 9

9 of 9

Gastroenterology-2019

All three row