External hemorrhoid excision



  • Immunocompromised patient
  • Pediatric patient
  • Pregnant patient
  • Portal hypertension
  • Coagulopathy

Equipment Needed

  • Scalpel
  • Local anesthetic


  1. Place patient in side-lying or prone position
  2. Apply lidocaine/prilocaine cream 1 hr prior to procedure
    • Apply tape to each buttock with force directed laterally for better visualization
  3. Inject local anesthetic (e.g. bupivacaine 0.5% with epi) with 30-gauge needle directly into dome of hemorrhoid as a single injection
  4. Make elliptical incision in overlying skin to expose the thrombosis
    • Remove the clot and the overlying skin through the incision site
  5. Control bleeding by tucking corner of a small piece of gauze into the wound and tape buttocks together
    • Leave in place for a few hours
  6. Apply pressure dressing have patient remove 6-12 hr later when takes first stiz bath
  7. Patient may apply soothing ointments (preparation H, Anusol HC, Lidocaine ointment) after dressing is removed
  8. Provide follow up in 24-48hr


See Also

External Links