A female patient aged 49 years presented with painful defecation, bleeding per rectum and something coming out per rectum off and on for last one and a half years. She finds it difficult to sit with the mass coming out and has to reduce it manually.
She is badly constipated and has to strain along with passage of hard stool, no mucus or tenesmus
She has acute symptoms for around 18-20 days
Past History: Known case of hypertension on Tab. Telmisartan 20 mg at bed time, has history of stroke with hospitalization for four weeks with paralysis left side of body two years back.
History of hysterectomy 9 years back under spinal anaesthesia was uneventful.
History of drug induced gastritis.
On examination : Per rectum – Painful with external tag with acute on chronic fissure @ 7o clock and prolapsing third degree internoexternal pile
Proctoscopy – Very painful, third degree internal inflammed piles @ 3, 7 and 11o clock
Investigations – A major preoperative profile was performed and a RS / CVS assessment for anaesthesia was asked for
All reports were normal so the patient was advised to keep on hold Aspirin and Clopidogrel for 72 hours and get hospitalized for surgery.
She was offered Hemorrhoidal artery ligation along with rectoanal repair @ 7o clock
Preoperative, postoperative pictures, three months follow up and reports are attached herewith
With so many modalities available, How to decide the best procedure option for a particular patient?