Circular hemorrhoidectomy in advanced hemorrhoidal disease

Istituto di Chirurgia Generale e di Oncologia Chirurgica dell'Universita di Milano, Ospedale Policlinico IRCCS, Milan, Italy.
Hepato-gastroenterology (Impact Factor: 0.93). 01/1998; 45(22):969-72.
Source: PubMed


Milligan-Morgan's hemorrhoidectomy has a high recurrence rate (> 10%) in patients with circular IV grade hemorrhoids. In such cases a circular hemorrhoidectomy with complete elimination of residual piles, and anoplasty might be more successful. The aim of this retrospective study was to compare the results of circular hemorrhoidectomy using the Hopital Leopold Bellan (HLB) technique (Paris) with the reported results of other techniques in patients with advanced hemorrhoidal disease.
From January 87 to December 96, 100 consecutive patients with circular IV grade hemorrhoids underwent radical hemorrhoidectomy. Mean hospital stay was 4 days (range 3-7). Patients were strictly controlled in the postoperative period and in cases of early fibrosis anal dilators were used.
Eighty one percent of patients had a complete recovery. The recurrence rate was 4%. The cumulative rate of early and late complications was 34%. Early and late hemorrhages were more frequent than in traditional hemorrhoidectomy, while the incidence of anal stenosis was the same.
The HLB operation is the best choice for patients with advanced circular hemorrhoids because of its radicality and good results. The postoperative morbidity of HLB hemorrhoidectomy is higher than traditional hemorrhoidectomy; nevertheless, all complications are tractable without extension of hospital stay.

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    • "For the HLB operation we used the previously described technique [8]. Briefly, the HLB circular hemorrhoidectomy differs from the Milligan-Morgan operation in the following ways: (1) exposure of 4 radial points of the circular mucohemorrhoidal prolapse with 3 to 4 clamps for each pile (the last placed in healthy rectal mucosa); (2) dissection of the anal skin until the submucosa containing the mucohemorrhoidal tissue, up to the last clamp with preservation of the internal anal sphincter; (3) resection of the prolapsed tissue, after transfiction above the proximal clamp with Vicryl 0 (Ethicon, Inc., Somerville, New Jersey); (4) creation of 4 thin (5 to 7 mm) mucocutaneous bridges and their lateral dissection with complete elimination of the residual piles; and (5) restoration of the 4 bridges that must be separated from the internal sphincter, adjusted, shortened, and eventually reimplanted. "
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    ABSTRACT: This randomized prospective study compared the outcome of circular hemorrhoidectomy according to the Hospital Leopold Bellan (HLB) technique (Paris) with Longo stapled circumferential mucosectomy (LSCM) in two homogeneous groups of patients affected by circular fourth-degree hemorrhoids with external mucosal prolapse. From December 1996 to December 1999, 80 consecutive patients with fourth-degree hemorrhoids and external mucosal prolapse were randomly assigned to two groups. Forty patients (group A: 18 men, 22 women, mean age 50.5 years, range 21 to 82) underwent HLB hemorrhoidectomy, and 40 patients (group B: 15 men, 25 women, mean age 51.0 years, range 29 to 92) underwent LSCM. Before surgery, all patients were selected with a standard questionnaire for symptom evaluation, full proctological examination, flexible rectosigmoidoscopy, dynamic defecography, and anorectal manometry. No significant differences among the two groups were found. All patients were controlled with follow-up questionnaire and with clinical examination at 1, 2, 4, 12, and 54 weeks after the operation. A postoperative manometry was performed 3 months after surgery. The length of the operation was significantly lower in group B (25 +/- 3.1 SD versus 50 +/- 5.3 minutes, P <0.001). Mean hospital stay was 3 +/- 0.4 days in group A and 2 +/- 0.5 days in group B (P <0.01). Mean duration of inability to work was 8 +/- 0.9 days in group B and 15 +/- 1.4 days in group A (P <0.001). Postoperative pain was significantly lower in group B (P <0.001). Mean length of follow-up was 20 +/- 8.0 months in group A and 20 +/- 7.8 months in group B. Late complications were similar in the two groups, with 0%, at present, recurrence rate. Our results confirm that both operations are safe, easy to perform, and effective in the treatment of advanced hemorrhoids with external mucosal prolapse. However, the LSCM seems to be preferable owing to the fewer postoperative complications, easier postoperative management, and shorter time to return to work. A longer follow-up is required to confirm the true efficacy of this surgical method.
    The American Journal of Surgery 07/2001; 182(1):64-8. DOI:10.1016/S0002-9610(01)00654-7 · 2.29 Impact Factor
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    ABSTRACT: Used in the treatment of gross circumferential hemorrhoidal prolapse. Whitehead hemorrhoidectomy is technically more demanding and has slightly more complications than four-quadrant hemorrhoidectomy. The former, however, offers a radical cure and is the better operation whereas the latter is often associated with considerable remaining skin tags and areas of residual hemorrhoidal tissue. Following the Whitehead operation, we have observed fewer complications in older patients compared to younger patients. Case notes and follow-up data of all patients who underwent a Whitehead hemorrhoidectomy in the period October 1995 to November 1999 were reviewed, and clinical presentation and outcome were analyzed. The study group consisted of 11 patients (8 males, 3 females), of median age 58 years (range, 41–,75 years). The median operation time was 30 min (range, 15–40 min). The median hospital stay was 3 days (range, 2–15 days). There was only early and one late complication, both with minimal related morbidity. In both these patients, appropriate treatment resulted in complete recovery. All othera patients had an uneventful course with no residual symptoms at the last visit. Elderly patients may be less prone to developing significant sphicter spasm due to a generally more lax sphincter tone. Therefore, they may be at less risk of suture line ischemia, breakdown and stenosis.
    Techniques in Coloproctology 08/2000; 4(2):79-81. DOI:10.1007/s101510070013 · 2.04 Impact Factor
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