Haemorrhoidectomy

There has been increasing tendency to avoid surgical excision of haemorrhoids because it is perceived as a painful procedure with prolonged recovery.

While injection sclerotherapy and rubber band ligation have been shown to be effective in the short term, long term data on recurrant problems is not available. There is a perception that these are only temporising measures and that the patient will most likely experience further problems later on. On the other hand it is rare to see patients who have undergone haemorrhoidectomy return with further problems (this may of course be because they do not want to go through such pain and suffering again ;-).

Indications for haemorrhoidectomy;

• Large external haemorrhoids accompanined by symptoms
  • Pruritis
  • Pain
  • Swelling
• Significant prolapse
• Significant external component

Pre-operative laxitives reduce post operative pain. [LBW87]

Post-operative metronidazole reduce post operative pain. [CKMP98]

There are many different types of haemorrhoidectomy, some of these are listed here;

• Open `Milligan Morgan' haemorrhoidectomy
• High ligation `Park's haemorrhoidectomy'
• Closed `Ferguson' haemorrhoidectomy
• Rarely used procedures;
  • `Peter Lords' haemorrhoidectomy, with clamps
  • `Whitehead' haemorrhoidectomy for circumferential haemorrhoids
• `Longo' stapled haemorrhoidectomy, or the procedure for prolapse and haemorrhoids (PPH)

Of these the most commonly performed procedure are the open `Milligan-Morgan' haemorrhoidectomy, a modification of this where the defects are sewn together called the `Ferguson' and the recently introduced procedure for prolapse and haemorrhoids (PPH), which is claimed to be less painful.