Circular hemorrhoidectomy in advanced hemorrhoidal disease.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Istituto di Chirurgia Generale e di Oncologia Chirurgica dell'Universita di Milano, Ospedale Policlinico IRCCS, Milan, Italy.
P
P
Boccasanta
M
M
Venturi
A
A
Orio
G
G
Salamina
M
M
Reitano
U
U
Cioffi
A
A
Floridi
M
M
Strinna
A
A
Peracchia
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative