Minimal open hemorrhoidectomy
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The original operation for open hemorrhoidectomy as described by Milligan–Morgan is no longer used. There is a great variation in how the operation is described in clinical trials. A number of modifications have been proposed attempting to reduce postoperative pain. An anatomical plane for the dissection was first described by Loder and Phillips . They encountered small fibers passing from the internal sphincter to the anal cushions and emphasized the importance of dividing these fibers close to the cushions leaving an intact surface over the internal sphincter. Gerjy et al. described a subdermal fascia continuing into a membrane covering the internal sphincter, which was easily identified after incision of the skin of the pedicle . In addition, Loder and Phillips were the first to suggest diathermy dissection and coagulation . A better knowledge of hemorrhoidal vascular anatomy, demonstrating, how the arterial supply to the hemorrhoids crosses the rectal wall,...
The authors would like to express our gratitude to Claus Juul, Head of Department for his support and to the study secretary Stina Linding Johansen, R. N. Grete Bangsgaard Koester and R. N. Sonja Smed, whose effort and support made it possible to carry out this study.
Compliance with ethical standards
Conflict of interest
Gunnar Olaison received in 2013 grants from SacoMed (the Danish distributor of THD) to attend a course on the operative technique in Transanal Haemorrhoidal Dearterialization (THD). The other authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
For this type of study, formal consent is not required.
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