Minimal open hemorrhoidectomy

  • H. D. Roervik
  • A. Heiner Campos
  • L. Ilum
  • K. F. Herlak Styr
  • G. K. McKinstrey
  • B. Brandstrup
  • G. OlaisonEmail author
Trick of the Trade


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 [1]. 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 [2]. In addition, Loder and Phillips were the first to suggest diathermy dissection and coagulation [1]. 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.

Ethical approval

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.

Informed consent

For this type of study, formal consent is not required.


  1. 1.
    Loder PB, Kamm MA, Nicholls RJ, Phillips RK (1994) Haemorrhoids: pathology, pathophysiology and aetiology. Br J Surg 81(7):946–954CrossRefGoogle Scholar
  2. 2.
    Gerjy R, Nyström PO (2011) Något om konsten att skära hemorrojder. Svensk Kirurgi 69(2):86–88Google Scholar
  3. 3.
    Seow-Choen F, Ho YH, Ho YH, Ang HG, Goh HS (1992) Prospective, randomized trial comparing pain and clinical function after conventional scissors excision/ligation vs. diathermy excision without ligation for symptomatic prolapsed haemorrhoids. Dis Colon Rectum 35(12):1165–1169CrossRefGoogle Scholar
  4. 4.
    Bessa SS. Diathermy Excisional H (2011) A prospective randomized study comparing pedicle ligation and pedicle coagulation. Dis Colon Rectum 54(11):1405–1411CrossRefGoogle Scholar
  5. 5.
    Roervik H, Styr K, Ilum L, André H, Campos K, Styr K, Ilum L, McKinstry GL, Brandstrup B, Olaison G (2018) The haemorrhoidal disease symptom scores and short health scale(HD): new tools to evaluate symptoms and health-related quality of life in haemorrhoidal disease. Dis Colon Rectum. CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of SurgeryHolbæk HospitalHolbækDenmark
  2. 2.Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark

Personalised recommendations