Hemorrhoidectomy by amputation and anoplasty

Conclusions

Hemorrhoidectomy by amputation and anoplasty is far more radical than any conventional hemorrhoidectomy. Smoothness of the postoperative stage is one of its greatest assets; this, however, is not sufficient reason for such extensive surgery if the hemorrhoids can be treated with a less sophisticated method. When comparing my results in cases of complicated hemorrhoids, such as those associated with prolapse of the rectal mucosa, extensive deformity of the anal outlet, multiple skin tags, “doughnut” external hemorrhoids (Figs. 12 and 13), and extensive thrombosis, with those of the ligature and excision procedure, it is clear that the anatomic reconstruction obtained by amputation and anoplasty is more satisfactory. There is no reason, however, to use a method such as amputative hemorrhoidectomy, which requires a careful technic and great experience in the management of the structures of the anal canal, in the treatment of non-complicated hemorrhoids. In my practice, of 752 hemorrhoidectomies performed, only 199 were done by amputation and anoplasty. I advocate this method for the complicated cases which merit its use, for it provides good reconstruction of the anatomy, and in my experience its functional results are comparable to those obtained with excision and ligature.

When radical hemorrhoidectomy is needed to remove disease elements responsible for local symptoms, if the patient appears satisfied with immediate as well as late results, I believe that the technical problems involved with this method, no matter how difficult they may appear, are worth the effort.