The direct relation between safe hemorrhoidectomy and anal canal anatomy

Abstract

Hemorrhoids are a common anal disorder that affects both men and women of all ages. One out of ten patients with hemorrhoidal disease, requires surgical treatment. However, hemorrhoidectomy is related to complications that can be present early or late postoperatively. In the present manuscript, the safe surgical technique which emphasizes to the identification of the ligament of Parks (Trietz's muscle) is described. A total of 145 patients with grades III and IV hemorrhoids, underwent Milligan-Morgan or Ferguson's hemorrhoidectomy. The mucosal ligament of Parks was located to all patients and was used as a key anatomical structure through the excision of the hemorrhoids. Its detection guides surgeons during hemorrhoidectomy. Finally, since the ligament of Parks represents a constantly identifiable landmark, it leads to simple and reliable identification of the internal sphincter and minimizes the potentiality of postoperative complications. Hereby, surgeons' thorough knowledge of the anatomy of the anal canal is a cornerstone of safe hemorrhoidectomy.