Generic placeholder image

Reviews on Recent Clinical Trials

Editor-in-Chief

ISSN (Print): 1574-8871
ISSN (Online): 1876-1038

Review Article

Excisional Haemorrhoidectomy: Where Are We?

Author(s): Giuseppe Sena*, Gaetano Gallo, Giuseppina Vescio, Antonio Carpino, Elia Diaco, Matteo Papandrea, Mario Trompetto and Giuseppe Sammarco

Volume 16, Issue 1, 2021

Published on: 19 March, 2020

Page: [54 - 59] Pages: 6

DOI: 10.2174/1574887115666200319153439

Price: $65

Abstract

Haemorrhoidal disease (HD) is defined as the symptomatic enlargement and/or distal displacement of anal cushions and is one of the most frequent and ancient anorectal conditions. Bleeding, during or after defecation, is the most common symptom. The color of the blood is typically bright red covering the outer surface of the stools. The severity of HD is based on the degree of the prolapse. There are several excisional surgery treatments. In this review, we describe the most common techniques such as Milligan and Morgan, Parks, Ferguson and Whitehead technique.

Despite significant improvements in conservative treatments, excisional haemorrhoidectomy techniques are the most effective treatment for III- and IV degree.

Keywords: Haemorrhoidal disease, excisional haemorroidectomy, complications, milligan and morgan technique, parks technique, ferguson technique, whitehead technique.

Graphical Abstract
[1]
Lohsiriwat V. Hemorrhoids: From basic pathophysiology to clinical management. World J Gastroenterol 2012; 18(17): 2009-17.
[http://dx.doi.org/10.3748/wjg.v18.i17.2009] [PMID: 22563187]
[2]
Beck DE. Hemorrhoidal disease. Fundamentals of anorectal surgery. 2nded. London. 1998.
[3]
Gallo G, Sacco R, Sammarco G. Epidemiology of Hemorrhoidal Disease. Hemorrhoids Coloproctology. Cham: Springer 2018; Vol. 2: pp. 3-7.
[http://dx.doi.org/10.1007/978-3-319-53357-5_1]
[4]
Cohen Z. Alternatives to surgical haemorrhoidectomy. Can J Surg 1985; 28: 230-1.
[PMID: 2986805]
[5]
Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology 1990; 98(2): 380-6.
[http://dx.doi.org/10.1016/0016-5085(90)90828-O] [PMID: 2295392]
[6]
Thomson WHF. The nature of haemorrhoids. Br J Surg 1975; 62(7): 542-52.
[http://dx.doi.org/10.1002/bjs.1800620710] [PMID: 1174785]
[7]
Hyung Kyu Yng. The pathophysiology of hemorrhoids.Hemorrhoids. Yng HK, Ed. Berlin, Heidelberg: Springer-Verlag 2014; pp. 15-24.
[http://dx.doi.org/10.1007/978-3-642-41798-6_3]
[8]
Loder PB, Kamm MA, Nicholls RJ, Phillips RK. Haemorrhoids: Pathology, pathophysiology and aetiology. Br J Surg 1994; 81(7): 946-54.
[http://dx.doi.org/10.1002/bjs.1800810707] [PMID: 7922085]
[9]
Serra R, Gallelli L, Grande R, et al. Hemorrhoids and matrix metalloproteinases: A multicenter study on the predictive role of biomarkers. Surgery 2016; 159(2): 487-94.
[http://dx.doi.org/10.1016/j.surg.2015.07.003] [PMID: 26263832]
[10]
Goligher JC, Duthie HL, Nixon HH. Surgery of the anus, rectum and colon. London: Bailliere Tindall 1984; Vol. 5: pp. 98-149.
[11]
Gallo G, Martellucci J, Sturiale A, et al. Consensus statement of the Italian society of colorectal surgery (SICCR): Management and treatment of hemorrhoidal disease. Tech Coloproctol 2020; 24(2): 145-64.
[http://dx.doi.org/10.1007/s10151-020-02149-1] [PMID: 31993837]
[12]
Sammarco G, Trompetto M, Gallo G. Thrombosed external haemorrhoids: A clinician’s dilemma. Rev Recent Clin Trials 2019; 14(4): 232-4.
[http://dx.doi.org/10.2174/1574887114666190927163646] [PMID: 31560294]
[13]
Abramowitz L, Godeberge P, Staumont G, Soudan D. Société Nationale Françoise de Colo-Proctologie (SNFCP). Clinical practice guidelines for the treatment of hemorrhoid disease. Gastroenterol Clin Biol 2001; 25(6-7): 674-702.
[PMID: 11673735]
[14]
Lestar B, Penninckx F, Kerremans R. The composition of anal basal pressure. An in vivo and in vitro study in man. Int J Colorectal Dis 1989; 4(2): 118-22.
[http://dx.doi.org/10.1007/BF01646870] [PMID: 2746132]
[15]
Wolkomir AF, Luchtefeld MA. Surgery for symptomatic hemorrhoids and anal fissures in Crohn’s disease. Dis Colon Rectum 1993; 36(6): 545-7.
[http://dx.doi.org/10.1007/BF02049859] [PMID: 8500370]
[16]
Ho YH, Lee J, Salleh I, Leong A, Eu KW, Seow-Choen F. Randomized controlled trial comparing same-day discharge with hospital stay following haemorrhoidectomy. Aust N Z J Surg 1998; 68(5): 334-6.
[http://dx.doi.org/10.1111/j.1445-2197.1998.tb04766.x] [PMID: 9631904]
[17]
Marti MC. Loco-regional anesthesia in proctological surgery. Ann Chir 1993; 47(3): 250-5.
[PMID: 8333721]
[18]
Meunier JF, Samii K. General or locoregional anesthesia: which to choose for a patient at risk?. Presse Med 1999; 28(3): 143-8.
[PMID: 10026724]
[19]
Vinson-Bonnet B, Coltat JC, Fingerhut A, Bonnet F. Local infiltration with ropivacaine improves immediate postoperative pain control after hemorrhoidal surgery. Dis Colon Rectum 2002; 45(1): 104-8.
[http://dx.doi.org/10.1007/s10350-004-6121-4] [PMID: 11786772]
[20]
Milligan ETCMC, Jones LE, Officer R. Surgical anatomy of the canal anal and the operative treatment of haemorrhoids. Lancet 1937; (2): 1119-24.
[http://dx.doi.org/10.1016/S0140-6736(00)88465-2]
[21]
Moult HP, Aubert M, De Parades V. Classical treatment of hemorrhoids. J Visc Surg 2015; 152(2)(Suppl.): S3-9.
[http://dx.doi.org/10.1016/j.jviscsurg.2014.09.012] [PMID: 25311960]
[22]
Bessa SS. Diathermy excisional hemorrhoidectomy: A prospective randomized study comparing pedicle ligation and pedicle coagulation. Dis Colon Rectum 2011; 54(11): 1405-11.
[http://dx.doi.org/10.1097/DCR.0b013e318222b5a9] [PMID: 21979186]
[23]
Gallo G, Realis Luc A, Clerico G, Trompetto M. Diathermy excisional haemorrhoidectomy - still the gold standard - a video vignette. Colorectal Dis 2018; 20(12): 1154-6.
[http://dx.doi.org/10.1111/codi.14430] [PMID: 30298969]
[24]
Ferguson JA, Mazier WP, Ganchrow MI, Friend WG. The closed technique of hemorrhoidectomy. Surgery 1971; 70(3): 480-4.
[PMID: 5568533]
[25]
Ferguson JA, Heaton JR. Closed hemorrhoidectomy. Dis Colon Rectum 1959; 2(2): 176-9.
[http://dx.doi.org/10.1007/BF02616713] [PMID: 13652788]
[26]
Ganchrow MI, Mazier WP, Friend WG, Ferguson JA. Hemorrhoidectomy revisited--a computer analysis of 2,038 cases. Dis Colon Rectum 1971; 14(2): 128-33.
[http://dx.doi.org/10.1007/BF02560059] [PMID: 5558212]
[27]
Ho YH, Cheong WK, Tsang C, et al. Stapled hemorrhoidectomy--cost and effectiveness. Randomized, controlled trial including incontinence scoring, anorectal manometry, and endoanal ultrasound assessments at up to three months. Dis Colon Rectum 2000; 43(12): 1666-75.
[http://dx.doi.org/10.1007/BF02236847] [PMID: 11156449]
[28]
Muldoon JP. The completely closed hemorrhoidectomy: a reliable and trusted friend for 25 years. Dis Colon Rectum 1981; 24(3): 211-4.
[http://dx.doi.org/10.1007/BF02962338] [PMID: 7227137]
[29]
Parks AG. The surgical treatment of haemorrhoids. Br J Surg 1956; 43(180): 337-51.
[http://dx.doi.org/10.1002/bjs.18004318002] [PMID: 13293338]
[30]
Higuero T, Abramowitz L, Castinel A, et al. Guidelines for the treatment of hemorrhoids (short report). J Visc Surg 2016; 153(3): 213-8.
[http://dx.doi.org/10.1016/j.jviscsurg.2016.03.004] [PMID: 27209079]
[31]
Murie JA, Sim AJ, Mackenzie I. The importance of pain, pruritus and soiling as symptoms of haemorrhoids and their response to haemorrhoidectomy or rubber band ligation. Br J Surg 1981; 68(4): 247-9.
[http://dx.doi.org/10.1002/bjs.1800680409] [PMID: 6971687]
[32]
Du T, Quan S, Dong T, Meng Q. Comparison of surgical procedures implemented in recent years for patients with grade III and IV hemorrhoids: A network meta-analysis. Int J Colorectal Dis 2019; 34(6): 1001-12.
[http://dx.doi.org/10.1007/s00384-019-03288-0] [PMID: 30929052]
[33]
Ho YH, Buettner PG. Open compared with closed haemorrhoidectomy: Meta-analysis of randomized controlled trials. Tech Coloproctol 2007; 11(2): 135-43.
[http://dx.doi.org/10.1007/s10151-007-0343-0] [PMID: 17510742]
[34]
Bhatti MI, Sajid MS, Baig MK. Milligan-Morgan (Open) Versus Ferguson Haemorrhoidectomy (Closed): A systematic review and meta-analysis of published randomized, controlled trials. World J Surg 2016; 40(6): 1509-19.
[http://dx.doi.org/10.1007/s00268-016-3419-z] [PMID: 26813541]
[35]
Hosch SB, Knoefel WT, Pichlmeier U, et al. Surgical treatment of piles: prospective, randomized study of Parks vs. Milligan-Morgan hemorrhoidectomy. Dis Colon Rectum 1998; 41(2): 159-64.
[http://dx.doi.org/10.1007/BF02238242] [PMID: 9556238]
[36]
Mott T, Latimer K, Edwards C. Hemorrhoids: Diagnosis and treatment options. Am Fam Physician 2018; 97(3): 172-9.
[PMID: 29431977]
[37]
Roe AM, Bartolo DC, Vellacott KD, Locke-Edmunds J, Mortensen NJ. Submucosal versus ligation excision haemorrhoidectomy: a comparison of anal sensation, anal sphincter manometry and postoperative pain and function. Br J Surg 1987; 74(10): 948-51.
[http://dx.doi.org/10.1002/bjs.1800741022] [PMID: 3664229]
[38]
Nienhuijs S, de Hingh I. Conventional versus LigaSure hemorrhoidectomy for patients with symptomatic Hemorrhoids. Cochrane Database Syst Rev 2009; 1(1): CD006761.
[http://dx.doi.org/10.1002/14651858.CD006761.pub2] [PMID: 19160300]
[39]
Milito G, Cadeddu F, Muzi MG, Nigro C, Farinon AM. Haemorrhoidectomy with Ligasure vs conventional excisional techniques: meta-analysis of randomized controlled trials. Colorectal Dis 2010; 12(2): 85-93.
[http://dx.doi.org/10.1111/j.1463-1318.2009.01807.x] [PMID: 19220374]
[40]
Mastakov MY, Buettner PG, Ho YH. Updated meta-analysis of randomized controlled trials comparing conventional excisional haemorrhoidectomy with LigaSure for haemorrhoids. Tech Coloproctol 2008; 12(3): 229-39.
[http://dx.doi.org/10.1007/s10151-008-0426-6] [PMID: 18679571]
[41]
Sakr MF. LigaSure versus Milligan-Morgan hemorrhoidectomy: A prospective randomized clinical trial. Tech Coloproctol 2010; 14(1): 13-7.
[http://dx.doi.org/10.1007/s10151-009-0549-4] [PMID: 19997953]
[42]
Xu L, Chen H, Lin G, Ge Q. Ligasure versus Ferguson hemorrhoidectomy in the treatment of hemorrhoids: A meta-analysis of randomized control trials. Surg Laparosc Endosc Percutan Tech 2015; 25(2): 106-10.
[http://dx.doi.org/10.1097/SLE.0000000000000136] [PMID: 25738704]
[43]
Bulus H, Tas A, Coskun A, Kucukazman M. Evaluation of two hemorrhoidectomy techniques: Harmonic scalpel and Ferguson’s with electrocautery. Asian J Surg 2014; 37(1): 20-3.
[http://dx.doi.org/10.1016/j.asjsur.2013.04.002] [PMID: 23726831]
[44]
London NJ, Bramley PD, Windle R. Effect of four days of preoperative lactulose on posthaemorrhoidectomy pain: Results of placebo controlled trial. Br Med J (Clin Res Ed) 1987; 295(6594): 363-4.
[http://dx.doi.org/10.1136/bmj.295.6594.363] [PMID: 3115449]
[45]
Bansal H, Jenaw RK, Mandia R, Yadav R. How to do open hemorrhoidectomy under local anesthesia and its comparison with spinal anesthesia. Indian J Surg 2012; 74(4): 330-3.
[http://dx.doi.org/10.1007/s12262-012-0438-3] [PMID: 23904726]
[46]
Carapeti EA, Kamm MA, McDonald PJ, Phillips RK. Double-blind randomised controlled trial of effect of metronidazole on pain after day-case haemorrhoidectomy. Lancet 1998; 351(9097): 169-72.
[http://dx.doi.org/10.1016/S0140-6736(97)09003-X] [PMID: 9449871]
[47]
Gallo G, Mistrangelo M, Passera R, et al. Efficacy of mesoglycan in pPain control after excisional hemorrhoidectomy: A pilot comparative prospective multicenter study. Gastroenterol Res Pract 2018; 2018: 6423895.
[http://dx.doi.org/10.1155/2018/6423895] [PMID: 29743886]
[48]
Denis J, Dubois N, Ganansia R, du Puy-Montbrun T, Lemarchand N. Hemorrhoidectomy: Hospital Leopold Bellan procedure. Int Surg 1989; 74(3): 152-3.
[PMID: 2606616]
[49]
Boccasanta P, Venturi M, Orio A, et al. Circular hemorrhoidectomy in advanced hemorrhoidal disease. Hepatogastroenterology 1998; 45(22): 969-72.
[PMID: 9755991]
[50]
Senagore AJ, Singer M, Abcarian H, et al. Procedure for Prolapse and Hemmorrhoids (PPH) Multicenter Study Group. A prospective, randomized, controlled multicenter trial comparing stapled hemorrhoidopexy and Ferguson hemorrhoidectomy: Perioperative and one-year results. Dis Colon Rectum 2004; 47(11): 1824-36.
[http://dx.doi.org/10.1007/s10350-004-0694-9] [PMID: 15622574]
[51]
MacRae HM, McLeod RS. Comparison of hemorrhoidal treatment modalities. A meta-analysis. Dis Colon Rectum 1995; 38(7): 687-94.
[http://dx.doi.org/10.1007/BF02048023] [PMID: 7607026]
[52]
Nisar PJ, Acheson AG, Neal KR, Scholefield JH. Stapled hemorrhoidopexy compared with conventional hemorrhoidectomy: systematic review of randomized, controlled trials. Dis Colon Rectum 2004; 47(11): 1837-45.
[http://dx.doi.org/10.1007/s10350-004-0679-8] [PMID: 15622575]
[53]
Bonardi RA, Rosin JD, Stonesifer GL Jr, Bauer FW. Bacteremias associated with routine hemorrhoidectomies. Dis Colon Rectum 1976; 19(3): 233-6.
[http://dx.doi.org/10.1007/BF02590908] [PMID: 817876]
[54]
Parikh SR, Molinelli B, Dailey TH. Liver abscess after hemorrhoidectomy. Report of two cases. Dis Colon Rectum 1994; 37(2): 185-9.
[http://dx.doi.org/10.1007/BF02047546] [PMID: 8306843]
[55]
Liffmann KE, Houle DB. Septic pulmonary embolus with empyema following hemorrhoidectomy. Am J Proctol 1964; 15: 55-8.
[PMID: 14123470]
[56]
Pattison RM, Cooke RP, James SE. Bacteroides fragilis infection of a knee prosthesis after haemorrhoidectomy. Lancet 1995; 346(8982): 1097.
[http://dx.doi.org/10.1016/S0140-6736(95)91769-1] [PMID: 7564802]
[57]
Zaheer S, Reilly WT, Pemberton JH, Ilstrup D. Urinary retention after operations for benign anorectal diseases. Dis Colon Rectum 1998; 41(6): 696-704.
[http://dx.doi.org/10.1007/BF02236255] [PMID: 9645737]
[58]
Petros JG, Bradley TM. Factors influencing postoperative urinary retention in patients undergoing surgery for benign anorectal disease. Am J Surg 1990; 159(4): 374-6.
[http://dx.doi.org/10.1016/S0002-9610(05)81274-7] [PMID: 2316800]
[59]
Mortensen PE, Olsen J, Pedersen IK, Christiansen J. A randomized study on hemorrhoidectomy combined with anal dilatation. Dis Colon Rectum 1987; 30(10): 755-7.
[http://dx.doi.org/10.1007/BF02554621] [PMID: 3308368]
[60]
Mathai V, Ong BC, Ho YH. Randomized controlled trial of lateral internal sphincterotomy with haemorrhoidectomy. Br J Surg 1996; 83(3): 380-2.
[http://dx.doi.org/10.1002/bjs.1800830327] [PMID: 8665199]
[61]
Abbasakoor F, Nelson M, Beynon J, Patel B, Carr ND. Anal endosonography in patients with anorectal symptoms after haemorrhoidectomy. Br J Surg 1998; 85(11): 1522-4.
[http://dx.doi.org/10.1046/j.1365-2168.1998.00887.x] [PMID: 9823915]
[62]
van Tets WF, Kuijpers JH, Tran K, Mollen R, van Goor H. Influence of Parks’ anal retractor on anal sphincter pressures. Dis Colon Rectum 1997; 40(9): 1042-5.
[http://dx.doi.org/10.1007/BF02050926] [PMID: 9293932]
[63]
Ommer A, Wenger FA, Rolfs T, Walz MK. Continence disorders after anal surgery--a relevant problem? Int J Colorectal Dis 2008; 23(11): 1023-31.
[http://dx.doi.org/10.1007/s00384-008-0524-y] [PMID: 18629515]
[64]
Ho YH, Seow-Choen F, Goh HS. Haemorrhoidectomy and disordered rectal and anal physiology in patients with prolapsed haemorrhoids. Br J Surg 1995; 82(5): 596-8.
[http://dx.doi.org/10.1002/bjs.1800820507] [PMID: 7613923]
[65]
Andrews E. Disastrous results following Whitehead’s operation and the so-called American operation. Columbus Med J 1895; 15: 97-106.

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy