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PubMed1999

[Stapler hemorrhoidectomy. A new alternative to conventional methods].

Conventional, generally accepted methods of hemorrhoidectomy as the methods of choice in the therapy of IIIrd and IVth degree hemorrhoids often involve problems of attaining sufficient mucosa preservation or are technically highly complex. A new surgical procedure, stapler hemorrhoidectomy, is less risky, permits the preservation of more mucosa, and takes significantly less time (only 5 to 15 minutes) than conventional procedures. Especially important is the high degree of acceptance on the part of patients and operators. The operation is based on the principle of a mucosectomy at least 2 cm above the dentate line. A purse-string suture placed 3-4 cm above the dentate line is tied around the stapler shaft (Ethicon Endosurgery SDH 33). Then the resection and stapling of the mucosa are carried out. This procedure effectively reduces mucosa and blocks the end branches of the upper rectal artery, thus stopping venous and arterial blood flow of the hemorrhoidal plexus. During the period April-September 1998 we treated 42 patients with an average age of 55.5 years using stapler hemorrhoidectomy. We treated IIIrd-IVth degree hemorrhoids (in 29% of cases), partial (in 22% of cases) and circular mucosa prolapse (in 49% of cases). The complication rate was 14%; we observed one case of bleeding, two submucosal hematomas, one partially interrupted suture, one short incontinence (I degree after Parks), and one partial recurrence. All complications occurred at the start of application of the new method and could be brought under control with no difficulties; after a short time the patients were without any discomforts whatsoever. In particular, post-operative pain was generally slight, measuring by means of the visual analog scale (VAS) ranging from 0-100. From the day of the operation until the 21st postoperative day the pain score ranged from 0 to 35. The use of analgetics was significantly less, with 50% of the patients not using analgetics on and following the 1st postoperative day. First experiences with stapler hemorrhoidectomy have shown that patients with distinct hemorrhoids and/or mucosa prolapse benefit greatly by this procedure, when indications and operative techniques are correctly used.

Adult↗
PubMedDate not supplied

Stapled hemorrhoidectomy: surgical notes and results.

Recently the surgical treatment of hemorrhoids using a circular stapler device has gained increasing approval. The Longo's procedure reduces the rectal mucosal and hemorrhoid prolapse using a circular stapler to resect transversally a mucosal-submucosal rectal ring in order to restore the correct anatomical relationships of the anal canal structures. The recent availability of a dedicated instrument kit (PPH01 Ethicon Endo-Surgery) allowed an easy diffusion of this technique. From March 1999 to September 2001, 198 patients with III-IV degree hemorrhoids were treated by a single expert surgeon using the dedicated kit instrumentation (PPH01) according to the Longo's technique, adopting some variations from the original procedure: 1) The anal dilator is not fixed to the perianal skin with forceps or stitches but is kept by the assistant. 2) In performing the purse-string suture particular care must be given to the apposition of the stitches at the same level also in the posterolateral side where there is a natural trend to apply the stitches at a lower level; furthermore the last stitch of the purse-string suture must be overlapped to the first one in order to allow a better hemostasis when the knot is tightened. 3) After having performed the purse-string and having resected the mucosa and submucosa, an accurate hemostasis with U-shaped 3/0 vicryl stitches firmly reduces the postoperative bleeding. We recorded pain scores, short- and long-term complications (included moderate-severe pain, persistent pain), recurrences and postoperative hospital stay. The data of the last 40 consecutive patients who underwent stapled hemorrhoidectomy were compared with the data obtained by 40 consecutive patients who underwent Milligan-Morgan diathermic hemorrhoidectomy for III-IV degree non-circumferential hemorrhoids by the same surgeon. In the 198 stapled hemorrhoidectomy cases the rate of postoperative moderate-severe pain and persistent pain were 6% and 2.5% respectively, the rate of short-term and long-term bleeding were 4.5% and 3.5%, the recurrence rate was 2.5%. The mean postoperative stay was 1.6 days. The stapled group had significantly lower postoperative moderate-severe pain, bleeding and soiling than the Milligan-Morgan group.

Electrocoagulation↗
PubMedDate not supplied

[Scientific background and clinical implementation: three new proposals in coloproctology].

OBJECTIVE: The Authors underline three clinical problems in coloproctology: the surgical access to the anal canal, the lacking aspects of the actual classification of hemorrhoids, the difficult choice of the surgical treatment in case of coexisting III degrees and IV degrees degree of hemorrhoids. They propose a new anal retractor which enables the surgeon to better calibrate all the surgical procedures inside the anal canal and to operate alone without the help of another operator. A new computerized software is able to rapidly guarantee a numeric score for hemorrhoids which is repetable before and after treatment of the disease. The Authors present a new surgical technique defined of transfixed stichtes for the resolution of the most advanced stage of hemorrhoids. PATIENTS AND METHODS: The new anal retractor was used in fifthy consecutive patients operated on for proctological problems. A quickly computerized score coming from the new classification PATE 2000 Sorrento was evaluated in one hundred patients, while the surgical technique of transfixed stichtes was utilized in fifthy. RESULTS: All the surgical procedures performed with the new device were concluded without complications. The highest values of the score from PATE 2000 Sorrento always fit with the surgical treatment of the disease, while transfixed stitches gave dysuria in five patients, but a better quality of life was referred by 38 over 50 patients treated. CONCLUSIONS: The Authors underline in this paper the results of the clinical implementation of these three new solutions in colon-proctology.

Adult↗
PubMed1985

Symposium on outpatient anorectal procedures. Alternatives to surgical hemorrhoidectomy.

Hemorrhoids are an extremely common affliction. The prevalence ranges from 1 in 25 to 1 in 30 individuals. There was a 20% decrease in the number of hemorrhoidectomies performed between 1978 and 1982. Alternatives to formal hemorrhoidectomy are injection sclerotherapy and rubber-band ligation. High-fibre diets and bulk laxatives are effective in relieving the symptoms of hemorrhoids, easing defecation and regulating bowel habit and can be used liberally. Bleeding hemorrhoids can be treated by diet alone, or by injection or rubber-band ligation. Prolapsing hemorrhoids are best treated by rubber-band ligation. The relatively few patients in whom these more conservative measures fail can be considered for hemorrhoidectomy.

Adult↗
PubMed1993

Changes in women's physical health during the first postpartum year.

OBJECTIVE: To examine changes in women's physical health during the first postpartum year. DESIGN: Participants completed surveys at 1, 3, 6, 9, and 12 months post partum. PARTICIPANTS AND SETTING: Four hundred thirty-six first-time mothers who gave birth at one of two St Paul, Minn, hospitals during a 12-month period and who met the criteria for the study. MAIN OUTCOME MEASURES: Physical symptoms and number of illness days experienced within the previous 2 weeks. RESULTS: Physical problems seen at a higher prevalence at 1 month post partum included breast symptoms, vaginal discomfort, fatigue, hemorrhoids, poor appetite, constipation, increased sweating, acne, hand numbness or tingling, dizziness, hot flashes, and illness days. Several of these disorders--hemorrhoids, dizziness, fatigue, and constipation--persisted beyond 1 month and were joined by other "late" problems, including respiratory symptoms, sexual concerns, and hair loss. Women who returned to the work force noted more symptoms of respiratory infections, and women with vaginal deliveries had a higher prevalence of hemorrhoids, vaginal discomfort, pain with intercourse, difficulty reaching orgasm, sinus problems, and acne. CONCLUSIONS: Recovery from childbirth often requires more than the 6 weeks traditionally allotted, and postpartum health appears to be affected by delivery type and work status.

Adult↗
PubMed2002

Stapled vs excision hemorrhoidectomy: long-term results of a prospective randomized trial.

HYPOTHESIS: Stapled hemorrhoidectomy offers several advantages over excision hemorrhoidectomy, including reduced postoperative pain, a reduced hospital stay, and an earlier recovery time. Furthermore, stapled hemorrhoidectomy is associated with lower hemorrhoidal recurrence on long-term follow-up. DESIGN: A randomized prospective trial. Patients were blinded to the operation technique used. Follow-up occurred at 1 and 3 weeks and 12 months postoperatively. SETTING: A university hospital providing primary, secondary, and tertiary care. PATIENTS: Forty patients with second- and third-degree hemorrhoid disease were randomized to undergo either stapled or excision hemorrhoidectomy. Two patients were excluded. All patients were subject to a follow-up examination. INTERVENTIONS: Stapled hemorrhoidectomy (Longo technique) vs excision hemorrhoidectomy (Ferguson technique). MAIN OUTCOME MEASURES: Operating time, postoperative pain (measured by the visual analog scale), hospital stay, histologic features, morbidity, defecation habit, continence, recovery time (return to work), and hemorrhoid recurrence at 1 year. RESULTS: Stapled vs excision hemorrhoidectomy was associated with a significantly reduced operating time (30 vs 43.25 minutes; P<.001), reduced postoperative pain scores (visual analog score) on the first 4 postoperative days (day 1: 2.7 vs 6.3; day 2: 1.7 vs 6.3; day 3: 0.8 vs 5.4; and day 4: 0.5 vs 4.8, where 0 indicates no pain, and 10, maximum pain; P < or = .001), and an earlier return to work (6.7 vs 20.7 days;P =.001). There were no differences for stapled vs excision hemorrhoidectomy in length of hospital stay (2.4 vs 2.1 days), complications (3 [15%] of 20 patients vs 5 [25%] of 20 patients), and recurrence rate (1 [5%] of 20 patients vs 1 [5%] of 20 patients). CONCLUSIONS: Stapled hemorrhoidectomy is associated with reduced postoperative pain, earlier recovery time and return to work, and a similar recurrence rate compared with the excision technique. Provided further clinical trials confirm these findings, stapled hemorrhoidectomy may become a future gold standard.

Adult↗
PubMed1986

Management of acute rectal problems in leukemic patients.

In the interval 1944-1983, 54 patients with leukemia and acute rectal pathology were seen at our institution, including: 25 patients with perirectal abscesses and/or fistulas (PF/F), 16 patients with acutely prolapsed or thrombosed hemorrhoids, 11 patients with anal fissures with or without hemorrhoids, and 2 patients with perianal excoriations. In the past, concerns have been raised about development of septicemia secondary to diagnostic or therapeutic instrumentation. In only 4 of 54 cases did the clinical course clearly suggest digital examination or instrumentation of the rectum may have caused bacteremia though 13 of 54 patients had positive blood cultures for gram negative organisms at some time during their course of which 7 were clearly coliform. Most (42/54) patients were treated initially by sitz baths, suppositories, and stool softeners and/or antibiotics. We observed five patients only and treated two by radiotherapy. Eleven patients required surgical intervention for thrombosed hemorrhoids and perirectal abscess and/or fistulas. Eight other patients with PA/F drained spontaneously. Poor healing after surgical or spontaneous drainage was documented in only one case. This study suggests that sitz baths, suppositories, antibiotics, and judicious surgical drainage (where needed) form the core of therapy for these patients.

Abscess↗
PubMed1991

The role of lasers in hemorrhoidectomy.

Eighty-eight patients who received treatment for hemorrhoids were randomized into two groups. Group A received the Nd-YAG laser phototherapy for internal hemorrhoid combined with the CO2 laser for external hemorrhoid. Group B was treated with closed Ferguson hemorrhoidectomy. The need of narcotic injections for pain relief was 11 percent in group A vs. 56 percent in group B (P less than 0.001). The incidence of postoperative urinary retention was 7 percent in group A, vs. 39 percent in group B (P less than 0.05). No enema was required postoperatively in group A, vs. 9 percent in group B; 84 percent of the patients in group A were discharged on the second postoperative day, vs. 83 percent of the patients in group B discharged on the fifth postoperative day. The cost was 20 percent less in the former group. The overall complications in both groups were insignificant in difference, except prolonged wound healing in group A was noted. One year follow-up showed satisfactory results. Laser treatment is considered one of the alternatives to conventional treatment, but the surgeon needs to be aware of laser hazards.

Adult↗
PubMed1991

Hemorrhoidectomy during pregnancy: risk or relief?

Acute hemorrhoidal crisis can occur in the pregnant female. When medical therapy fails to relieve pain, operative intervention may be necessary. The surgeon, however, may be reluctant to operate due to potential complications to the mother and fetus. From July 1983 to July 1989, hemorrhoidectomy was performed in 25 of 12,455 pregnant women (0.2 percent) who delivered in our institution. Twenty-two women were in their third trimester, 80 percent were multiparous, and each had a remote history of hemorrhoidal symptoms, including intermittent pain, bleeding, and protrusion. Closed hemorrhoidectomy was performed under local anesthesia. The surgery was directed at removing only symptomatic disease, which included three quadrants in 14 patients, two quadrants in seven patients, and one quadrant in four patients. All patients experienced relief of intractable pain the day after surgery, except one patient who required a hemostatic packing during the immediate post-operative period. There were no other maternal or fetal complications. Subsequent follow-up for anorectal disease ranged from 6 months to 6 years. Six (24 percent) patients required additional hemorrhoid treatment. Hemorrhoidectomy in selected pregnant patients is safe in our experience.

Adult↗
PubMed2001

Early and late (ten years) experience with circular stapler hemorrhoidectomy.

PURPOSE: We present a retrospective clinical study concerning the preliminary experience with the circular stapler in the treatment of hemorrhoids. Early results, complications, and long-term follow-up are revisited. METHODS: Fifty-six consecutive patients with second-, third-, and fourth-degree hemorrhoids were included in the study. Data about operation, early postoperative results, and follow-up at one, two, and four weeks were collected. Patients were also contacted by phone after a long-term follow-up (mean, 33 (range, 5-120) months). RESULTS: Every operation attempted was successfully terminated. The length of the operation was less than 15 minutes. No major bleeding or anastomotic disruption occurred. Six patients (13 percent) who underwent spinal or epidural anesthesia had urinary retention. One patient (1.7 percent) had minor bleeding, and four patients (7.1 percent) experienced transient edema of the anastomotic ring after the operation. None needed further treatments. The mean analgesic requirement was 1.4 (range, zero to eight) ketorolac 30-mg injections; 23 patients (41 percent) received no analgesics, and seven patients (12 percent) required a single extra dose of opiates (10 mg morphine cloridrate). Length of hospital stay was between 0 and 11 (mean, 2.7) days, but 20 patients (35 percent) received an additional operation for coexisting surgical disease. At one week, almost all patients experienced little pain at digital inspection and little bleeding after defecations. No anastomotic leakage, wound infection, or healing delay was found. Three patients (5.3 percent) experienced wound edema and pain during defecation. Two weeks later, one patient (1.7 percent) suffered from painful defecation and ten patients (17 percent) reported minor bleeding, but all returned to normal activities. No pain during defecation, bleeding, stenosis, soiling, incontinence, or other anal symptoms were found at one month after the operation, and all patients were well. All patients were contacted by phone 5 to 120 (mean, 33) months later, and all were pleased with the results of this procedure. There were no symptomatic recurrences. DISCUSSION: Our study confirms the feasibility of circular stapler hemorrhoidectomy in the treatment of hemorrhoids. Complications and postoperative pain were minimal. There were no recurrences during long-term follow-up. CONCLUSION: Mechanical hemorrhoidectomy is a promising new option in the treatment of all patients eligible for a surgical approach.

Adult↗
PubMed2000

Closed vs. open hemorrhoidectomy--is there any difference?

PURPOSE: The aim of this study was to compare closed (Ferguson) hemorrhoidectomy to open (Milligan-Morgan) hemorrhoidectomy regarding postoperative conditions, complications, and long-term results. METHOD: This was a randomized study of 77 patients with second-degree or third-degree hemorrhoids suitable for hemorrhoidectomy. In 39 patients the Milligan-Morgan procedure was used, and in 38 patients the Ferguson procedure was used. Details of operations, postoperative complications, and length of postoperative stay were recorded. Pain was assessed from a visual analog scale and by registration of postoperative analgesic medication. Follow-up was done at three weeks, six weeks, and by visit or telephone interview after at least a year. RESULTS: No statistically significant differences were found between the two methods regarding complications, pain, or postoperative stay. There were four reoperations for bleeding, all after Milligan-Morgan operations. At follow-up after three weeks 86 percent of the Ferguson patients had completely healed wounds, and none had signs of infection. Of the Milligan-Morgan patients, only 18 percent had completely healed wounds, and symptoms of delayed wound healing were significantly more frequent. One patient had a superficial wound infection. After one year more than 10 percent in each group had recurrent hemorrhoids with symptoms. CONCLUSION: Both methods are fairly efficient treatment for hemorrhoids, without serious drawbacks. The closed method has no advantage in postoperative pain reduction, but wounds heal faster, and the risk of wound dehiscence seems exaggerated.

Adult↗
PubMed1999

Local thermal stimulation relaxes hypertonic anal sphincter: evidence of somatoanal reflex.

PURPOSE: Although it is generally believed that warm perineal baths reduce pain resulting from anal fissure, complicated hemorrhoids, or anal surgery, the exact mechanisms remain unclear. Because hypertonicity of the internal anal sphincter contributes to increasing pain in these conditions, it has been postulated that warm perineal baths could help to relax the anal sphincter, hence reducing pain. It is our purpose to demonstrate response of the anal sphincter to local thermal stimulation via a somatoanal reflex. METHODS: Continuous anorectal manometry tracings were obtained from 15 healthy volunteers, 22 patients with hemorrhoid, and 20 patients with anal fissure. Local thermal stimulation was achieved by applying a heat pad on the right infragluteal region (local area), and subsequently on the right first interphalangeal region (control area). RESULTS: Obvious response to local thermal stimulation was shown by 13.3 percent of volunteers, 36.4 percent of patients with hemorrhoid, and 60 percent of patients with fissure. Heat-sensitive patients who responded to local thermal stimulation were divided to two groups, those with ultraslow waves and those without ultraslow waves. In patients with ultraslow waves, the amplitude of ultraslow waves decreased significantly after local thermal stimulation, with amplitude before local thermal stimulation, (mean +/- standard deviation) 66.2 +/- 30.6 mmHg, and during local thermal stimulation, 43.2 +/- 22.3 mmHg, respectively, P = 0.003. By contrast, in patients without ultraslow waves, the tonic pressure measured before local thermal stimulation and during local thermal stimulation was 74.2 +/- 23.5 and 60.5 +/- 18.5 mmHg, respectively, P = 0.001. The response began at approximately three minutes after local thermal stimulation when the skin temperature was 42.1 +/- 0.3 degrees C. No anal response was observed when the heat pad was applied to the control area. The maximum resting pressure of the heat-sensitive patients was significantly higher than that of the nonresponding patients (97.3 +/- 0.1 vs. 76.9 +/- 23.3 mmHg; P = 0.012). CONCLUSIONS: Local thermal stimulation evokes relaxation of the hypertonic internal anal sphincter through a somatoanal reflex, thus providing an easy and feasible method of clinical application.

Adult↗
PubMedDate not supplied

One thousand cryohemorrhoidectomies: an overview.

One thousand cryohemorrhoidectomies were performed during the past seven years with the result that one-third of our patients were relatively pain-free while two-thirds complained of severe to minimal pain. The recurrence rate was about 11 per cent but the true incidence was 6.3 per cent. Unpleasant anal discharge, occurring in patients with prolapsed hemorrhoids, can be prevented by ligation prior to freezing. Overall, 90 per cent of our patients were satisfied with the procedure while 6.6 per cent underwent repeated surgery. Comparative analyses were made with other studies and it is fair to say that cryosurgery has definite advantages for selected cases of hemorrhoids, but it is not a panacea for all hemorrhoidal disease.

Adult↗
PubMed2006

Simple harmonic scalpel hemorrhoidectomy utilizing local anesthesia combined with intravenous sedation: a safe and rapid alternative to conventional hemorrhoidectomy.

BACKGROUND: Harmonic Scalpel(R) hemorrhoidectomy (HSH) is an established surgical therapy for the treatment of symptomatic grade III and IV hemorrhoids. Hemorrhoid surgery is still being performed as an inpatient procedure with general or regional anesthesia in many centers today. There was a trend toward performing hemorrhoid surgery as an ambulatory procedure using local anesthesia supplemented with intravenous sedation. The aim of the current study was to evaluate the safety and efficacy of HSH performed with combination local anesthesia and intravenous sedation in an ambulatory surgical center. MATERIALS AND METHODS: A retrospective review was performed on the clinical charts of all patients undergoing HSH in an ambulatory surgical center from 2001 to 2005. All hemorrhoidectomies were attempted under propofol/ketamine intravenous sedation and local anesthesia in the prone position. A simple, open technique without routine suture was used. RESULTS: During the study period, 180 patients (70 females) underwent HSM. Mean procedure and total operating room time were 12 and 28 min, respectively. One patient (0.6%) was converted to general endotracheal anesthesia. Ten patients (5.6%) required post anesthesia care unit (PACU) observation. All patients were discharged home after the procedure. Postoperative complications occurred in 19 patients (10.6%). There were no reoperations and the total readmission rate was 3.7%. CONCLUSION: HSH performed with a combination of intravenous sedation and local anesthesia is safe and effective in the ambulatory surgery setting. The combined technique was associated with a rate of complications comparable to published series utilizing conventional hemorrhoidectomy techniques. Added benefits include shorter hospital stay and a potential for cost savings.

Adolescent↗
PubMed2003

Botulinum toxin for the treatment of secondary chronic anal fissure.

BACKGROUND: Botulinum toxin A (BT-A) injection into internal or external anal sphincter causes relaxation of the anal sphincters, enhancing microcirculation at the fissure site and promoting fissure healing. There are no such observations in patients with secondary anal fissure. METHODS: Six patients with fissures after surgical or nonsurgical treatment of hemorrhoids and four patients with ulcerative colitis received injections of BT-A on both edges of the fissure (total dose, 25 U Botox). RESULTS: In the week following BTA injection, patients with fissure after hemorrhoids treatment had relief of fissure symptoms, but one month later the fissures still existed. They then received an additional 25 U Botox. One month after the second BT-A injection, all fissures were healed. The patients with ulcerative colitis had only symptomatic improvement after BT-A injection. CONCLUSION: BT-A therapy seems effective for the treatment of chronic anal fissure after surgical or nonsurgical treatment of hemorrhoids.

Adult↗
PubMed2005

A modified anoscope to facilitate the purse-string suture for stapled hemorrhoidopexy.

Stapled hemorrhoidopexy is an alternative method to conventional surgical procedures for third-degree hemorrhoids. It has many advantages such as less pain, faster recovery and earlier return to work. Nevertheless, many reports mentioned the persistence of postoperative pain, hemorrhage, recurrence, sphincter injury, and pelvic sepsis. The complications mostly arose during the purse-string phase of the procedure. The internal hemorrhoids and loose rectal mucosa can fill the inside of the anoscope, obstruct the operation field and restrict the maneuverability of the needle holder. To overcome this difficulty, a specially designed anoscope may be used. The purse-string anoscope of the PPH 01 kit (Ethicon Endo-Surgery, Cincinnati, USA) was modified to overcome the obstruction of the staple line by internal hemorrhoids and rectal mucosal prolapse. Stapled mucosectomy with this modified anoscope was performed in 9 patients. The surgical procedure lasted approximately 25 min and the patients healed uneventfully, even though 4 of them had been operated on by surgeons in their first attempts with stapled hemorrhoidopexy. By using a modified anoscope, ideal purse-string suturing may become easier, intraoperative time may be shortened, and the learning curve may be reduced.

Adult↗
PubMed2006

Low hemorrhoidopexy staple line does not improve results and increases risk for incontinence.

BACKGROUND: The ability of stapled hemorrhoidopexy (SH) to cure hemorrhoidal symptoms appears to depend on patient characteristics and operative technique. We assessed the association between outcome of SH and patients' characteristics and procedure parameters (associated procedure, suture line height, doughnut size, presence of malpighian tissue or smooth muscle in specimen). METHODS: A total of 68 consecutive patients (56 males) were prospectively operated by 3 different surgeons. Hemorrhoids were grade II (6%), grade III (76%) or grade IV (18%). RESULTS: At a mean 32-week follow-up (range, 9-77), symptoms had resolved in 77% of patients, independently of any operative or clinical parameter. New onset anal incontinence occurred in 11 men (17%): all had urgency, with flatus and liquid stool incontinence in two, and flatus incontinence and mucus soiling in one. Univariate analysis revealed that persistent incontinence was associated with a staple line <6.5 mm from the dentate line, doughnut height <22 mm, and congestive external hemorrhoids; it was also operator dependent (p<0.05). At the 4-week follow-up, 19% of patients had persisting symptoms but only 8% had a demonstrable mucosal prolapse. CONCLUSION: Although the success rate of SH may not be influenced by technical variations, risk for moderate incontinence is elevated when the stapled line is low.

Adult↗
PubMed2001

Whitehead's hemorrhoidectomy. A useful surgical procedure in selected cases.

At the present time Milligan-Morgan's operation is the most diffusely employed and is widely considered to be the most effective of the various surgical techniques for the treatment of hemorrhoids. In this study we report our experience with Whitehead's radical hemorrhoidectomy. In a 5-year period, 1450 patients with hemorrhoids were treated at our Coloproctologic Unit. We routinely carry out the Milligan-Morgan operation. Nevertheless, in 26 patients the Milligan-Morgan operation was judged to be impossible to perform, in that the prolapsed hemorrhoids were completely irreducible and it was not possible to distinguish and separate the three piles. These patients thus underwent Whitehead's radical hemorroidectomy. All the patients who underwent Whitehead's operation were discharged within the fifth post-operative day. No episodes of incontinence were observed in any patient. The patients were followed for three years after the operation. In only one case did we verify an anal substenosis three months after the operation, which resolved after the use of anal dilators for one month. The stenosis did not recur in the course of follow-up. There were no cases of mucosal ectropion. In conclusion, the type of hemorrhoidectomy which a surgeon performs is primarily based on the surgeon's experience and training. Nevertheless, a competently performed Whitehead's hemorrhoidectomy can give satisfying results. These results are explained by improved knowledge of the anatomy of the anal region and a more accurate surgical technique. On the basis of our experience we believe that Whitehead's hemorrhoidectomy still has its place in selected cases with precise indications.

Hemorrhoids↗