title: Submucosal anoderm-preserving hemorrhoidectomy revisited: a modified technique for the surgical management of hemorrhoidal crisis.
abstract: Submucosal hemorrhoidectomy (Parks' procedure) is a recognized method for treating acute hemorrhoidal crisis. Anoderm preservation has been stressed in various techniques described for elective or emergency excisional hemorrhoidal management. Mucopexy techniques have been proven useful as an adjunct to minimally resectional techniques. A modified submucosal technique with anoderm preservation and mucopexy was applied to 45 patients who presented on an emergency basis with hemorrhoidal crisis. External piles were minimally removed, the minimum possible amount of diseased mucosa was excised, a linear incision was used at the anoderm to enter the subanodermal/mucosal plane to achieve the submucosal excision, and a mucopexy was added at the approximation of the mucosal flaps. Postoperative morbidity was minimal and pain after the procedure remained at acceptable levels. This technique allows for an excision limited to the pathology with important anatomic tissue preservation. This results in conservation of the sensitive and useful anoderm, a decreased risk of stenosis, and addresses the mucosal prolapse. The level of postoperative pain with this technique is acceptable and long-term follow-up reveals a high degree of patient satisfaction.
authors.affiliation: Colorectal Unit, 1st Department of Propaedeutic Surgery, Athens Medical School, Athens, Greece.
authors.forename: George E
authors.initials: GE
authors.lastname: Theodoropoulos
authors.forename: Nikolaos V
authors.initials: NV
authors.lastname: Michalopoulos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Linardoutsos
authors.forename: Ioannis
authors.initials: I
authors.lastname: Flessas
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tsamis
authors.forename: George
authors.initials: G
authors.lastname: Zografos
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery; D015331:Cohort Studies; D004630:Emergencies; D005260:Female; D061865:Hemorrhoidectomy / Q000009:adverse effects / Q000379:methods*; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D013536:Suture Techniques; D016896:Treatment Outcome