Three Hundred Consecutive Cases of Haemorrhoids Cured by Excision

Whitehead, Walter

doi:10.1136/bmj.1.1365.449

Cited by 41 publications

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“…The "surgical interventions" are divided into two groups: techniques that include fixation of the hemorrhoidal cushions without removing the hemorrhoids (clamping, such as the procedure for prolapsed hemorrhoids -PPH) [4][5][6][7] and techniques that include the removal of tissues and hemorrhoidal arteries (hemorrhoidectomy). The second group includes several techniques, according to the method of tissue removal: open techniques (Milligan-Morgan 8 and its variations) 2,4,[9][10][11][12][13] , closed techniques (Ferguson 14 and its variations) 2,4,[15][16][17][18] , amputative techniques (Whitehead 19,20 and its variations) 4,21 , semi-closed techniques (Sokol 4,22 , Ruiz-Moreno 4,23 , René-Obando 24 and René-Obando-Reis Neto 4 ), submucosal techniques (Parks 25 ) 4,26 and association of RBL with resection of external hemorrhoids (Santos 4,27 ) ( Table 2).…”

Section: Surgical Interventionsmentioning

confidence: 99%

“…However, the surgical time is longer, the recurrence rate is higher and it involves greater risk of bleeding during the surgery and postoperatively. Whitehead 19,20 presented a series of 300 patients that, in 1887, were submitted to the technique that he developed, with good results. The surgery starts with the perianal skin elevation with Allis clamps to expose the terminal portion of the anal canal.…”

Section: Submucosal Technique Of Parks 25mentioning

confidence: 99%

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Surgical complications in 2,840 cases of hemorrhoidectomy by Milligan-Morgan, Ferguson and combined techniques

Santos¹,

Coutinho²,

Meyer³

et al. 2012

J. Coloproctol. (Rio J.)

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The analysis of 2,840 cases of hemorrhoidectomy by open techniques of Milligan-Morgan (2,189 cases), Ferguson (341 cases) and mixed (310 cases) in 11,043 patients with hemorrhoidal disease (HD) allowed the following conclusions. The patients' acceptance of surgical indication for hemorrhoidectomy was 25.7%. Hemorrhoidectomy was more common among women (53.8%) than men (46.2%), and more accepted by women (26.5%) than men (24.8%). Hemorrhoidectomy was more common in patients of the fourth (27.7%), fifth (21.9%) and third (21.0%) decades of age. Most patients who agreed to undergo hemorrhoidectomy were those of the second (38.2%), eighth (35.9%) and ninth (34.5%) decades of age. The overall incidence of surgical complications was 3.0% (87 cases): anal stenosis (1.8%), bleeding (0.8%), worsening of anal hypotonia (0.2%), sepsis (0.1%) and systemic complications (0.1%), with no difference among the techniques used. The incidence of surgical complications by Milligan-Morgan technique was 3.0%-stenosis (1.9%), bleeding (1.9%), worsening of anal hypotonia (0.2%) and systemic complications (0.04%). The incidence of surgical complications by Ferguson's technique was 3.5%-stenosis (1.7%), bleeding (0.6%), worsening of anal hypotonia (0.6%) and sepsis (0.6%). And the incidence of surgical complications by mixed techniques was 2.5%-stenosis (1.0%), bleeding (0.3%), worsening of anal hypotonia (0.3%), sepsis (0.3%) and systemic complications (0.3%). The incidence of surgical complications according to gender was 3.0% among women and 3.2% among men, with higher incidence of stenosis in women (2.0%) and hemorrhage in men (1.1%). Surgical complications were more observed in the eighth (5.1%) and seventh (3.8%) decades of age. The incidence of anal stenosis was 1.8%, being 64.0% without hypotonia and 66.0% without anal fissure (66.0%), with annular stenosis as the most common anatomical shape (70.0%). Anal stenosis was more common among women (2.0%) presenting mean age of 38.2 years, with no relation to age decades. The most common technique for anal stenosis was single anotomy without sphincterotomy (46.0%). All cases of anal bleeding had surgical ligation of all hemorrhoidal pedicles, no matter if the bleeding site was found or not.

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Section: Surgical Interventionsmentioning

confidence: 99%

Section: Submucosal Technique Of Parks 25mentioning

confidence: 99%

Surgical complications in 2,840 cases of hemorrhoidectomy by Milligan-Morgan, Ferguson and combined techniques

Santos¹,

Coutinho²,

Meyer³

et al. 2012

J. Coloproctol. (Rio J.)

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“…The Whitehead haemorrhoidectomy was described in 1887 [20]. It comprises a circumferential excision of all haemorrhoidal tissue.…”

Section: Formulation Of Guidelinesmentioning

confidence: 99%

Evidence‐based practice in haemorrhoidectomy

Cheetham

Phillips

2001

Colorectal Disease

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Objective Haemorrhoidectomy has proven long-term ef®cacy in the treatment of haemorrhoids, albeit at the price of increased pain and complications compared with other modalities. This study reviews the literature and describes best practice in the surgical treatment of haemorrhoids.Methods A Medline search was conducted using the keywords haemorrhoids or haemorrhoidectomy to identify clinical trials comparing different surgical treatments for haemorrhoids. ResultsMany studies were small and follow up was often short-term only. Surrogate measures such as post-operative pain scores and changes in anorectal physiology were commonly assessed in preference to ef®cacy in symptom reduction. Haemorrhoidectomy may be safely performed under general, local or regional anaesthesia according to patient ®tness and local practice. Results of randomized controlled trials indicate that there open and closed techniques of haemorrhoidectomy are equivalent. There is no evidence to support the practice of laser haemorrhoidectomy. Diathermy haemorrhoidectomy achieves good haemostasis and permits an anal dressing to be omitted, but is not superior to conventional techniques. The use of preoperative lactulose and post-operative oral metronidazole is supported by randomized controlled trials.Conclusion Haemorrhoidectomy is currently the most effective treatment for prolapsing haemorrhoids. There is little evidence to support the use of one surgical technique over another. With attention to detail and adjuncts to reduce post-operative pain, haemorrhoidectomy may be performed as day surgery.

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“…Surgical management is indicated following the failure of nonoperative treatment options. Surgical resection can be achieved using conventional hemorrhoidectomy techniques [ 4 – 7 ] or via stapled hemorrhoidopexy also known as the procedure for prolapsed hemorrhoids (PPH) first described by Antonio Longo in 1998 [ 8 ]. The goal of PPH is the removal of abnormally enlarged hemorrhoidal tissues followed by a reduction of the remaining hemorrhoidal tissue into its normal anatomic site within the anal canal.…”

Section: Introductionmentioning

confidence: 99%

Proctitis after stapled hemorrhoidopexy is an underestimated complication of a widely used surgical procedure: a retrospective observational cohort study in 129 patients

Ambe

Wassenberg

2015

Patient Saf Surg

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BackgroundHemorrhoidal disease is highly prevalent in the western world. Stapled hemorrhoidopexy also known as the procedure for prolapsed hemorrhoids (pph) has been shown to be superior to conventional hemorrhoidectomy with regard to postoperative pain, length of hospital stay and early return to work. Proctitis following stapled hemorrhoidopexy has not been reported previously. Herein, we report our experience with proctitis in patients following stapled hemorrhoidopexy and question if proctitis could be a complication of stapled hemorrhoidopexy.Materials and methodsA retrospective analysis of the data of patients undergoing stapled hemorrhoidopexy with the PPH03 in the coloproctology unit of the department of surgery of a primary care hospital in Germany within a 5-year period was performed. All cases were managed and followed up by a single attending surgeon with expertise in coloproctology.Results129 patients were included for analysis including 21 cases with grade 2, 103 cases of grade 3 and 5 cases of grade 4 hemorrhoids. The median duration of surgery was 20 min. 17 complications including two recurrences were recorded. Post-pph proctitis was recorded in 14 cases (10.9 %). Post-pph proctitis was not associated with gender, extent of hemorrhoidal disease, BMI and ASA (p >0.05). All cases recovered within 4 weeks following management with nonsteroidal anti-inflammatory drugs and suppositories.ConclusionProctitis could be a complication of stapled hemorrhoidopexy with a good response to conservative treatment with suppositories.

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Three Hundred Consecutive Cases of Haemorrhoids Cured by Excision

Cited by 41 publications

References 0 publications

Surgical complications in 2,840 cases of hemorrhoidectomy by Milligan-Morgan, Ferguson and combined techniques

Surgical complications in 2,840 cases of hemorrhoidectomy by Milligan-Morgan, Ferguson and combined techniques

Evidence‐based practice in haemorrhoidectomy

Proctitis after stapled hemorrhoidopexy is an underestimated complication of a widely used surgical procedure: a retrospective observational cohort study in 129 patients

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