Journal of Gastrointestinal Surgery

, Volume 18, Issue 4, pp 808–815 | Cite as

Circular vs. Three-Quadrant Hemorrhoidectomy for End-Stage Hemorrhoids: Short- and Long-Term Outcomes of a Prospective Randomized Trial

  • Maia A. Qarabaki
  • Gela A. Mukhashavria
  • Gia G. Mukhashavria
  • Nodari G. Giorgadze
Original Article

Abstract

Purpose

Circumferential excisional hemorrhoidectomy (CEH) enables the surgeon to remove the encircling hemorrhoids completely. The purpose of this study is to compare the efficacy of CEH with that of Ferguson hemorrhoidectomy (FH) for end-stage hemorrhoids.

Methods

Between February 1998 and December 2011, a prospective randomized trial was conducted with 688 patients who presented with end-stage hemorrhoids and underwent FH or CEH at our center.

Results

The patient demographics, mean operative times, lengths of hospital stay, and cumulative rates of postoperative complications were similar in the study groups. Significant differences were revealed in the incidence of postoperative hemorrhage (9 vs. 0 patients in the FH and CEH groups, respectively; p = 0.002) and in the tendency to form anal stricture (15 vs. 32 patients in the FH and CEH groups, respectively; p = 0.02). However, all cases of anal strictures were easily managed by digital dilatations. At a mean follow-up of 7.4 (range, 1–14) years, accessible patients from the CEH group remained symptom free, whereas 126 of 308 patients in the FH group indicated that they had recurrent hemorrhoidal symptoms.

Conclusion

Without increasing postoperative complications, CEH demonstrates an advantage compared with FH, with regard to reducing the rate of recurrence to 0 through complete hemorrhoid removal.

Keywords

Fourth-degree hemorrhoids Ferguson hemorrhoidectomy Circular hemorrhoidectomy 

Supplementary material

11605_2013_2424_Fig8_ESM.jpg (32 kb)
ESM 1

(JPEG 32 kb)

11605_2013_2424_MOESM1_ESM.tif (4.1 mb)
High resolution image (TIFF 4210 kb)
11605_2013_2424_Fig9_ESM.jpg (134 kb)
ESM 2

(JPEG 133 kb)

11605_2013_2424_MOESM2_ESM.tif (6 mb)
High resolution image (TIFF 6154 kb)
11605_2013_2424_Fig10_ESM.jpg (95 kb)
ESM 3

(JPEG 95 kb)

11605_2013_2424_MOESM3_ESM.tif (10.8 mb)
High resolution image (TIFF 11013 kb)
11605_2013_2424_Fig11_ESM.jpg (38 kb)
ESM 4

(JPEG 38 kb)

11605_2013_2424_MOESM4_ESM.tif (4.5 mb)
High resolution image (TIFF 4605 kb)
11605_2013_2424_Fig12_ESM.jpg (16 kb)
ESM 5

(JPEG 16 kb)

11605_2013_2424_MOESM5_ESM.tif (2 mb)
High resolution image (TIFF 2023 kb)
11605_2013_2424_Fig13_ESM.jpg (3 kb)
ESM 6

(JPEG 2 kb)

11605_2013_2424_MOESM6_ESM.tif (470 kb)
High resolution image (TIFF 470 kb)
11605_2013_2424_Fig14_ESM.jpg (3 kb)
ESM 7

(JPEG 3 kb)

11605_2013_2424_MOESM7_ESM.tif (491 kb)
High resolution image (TIFF 490 kb)
11605_2013_2424_Fig15_ESM.jpg (30 kb)
ESM 8

(JPEG 29 kb)

11605_2013_2424_MOESM8_ESM.tif (4.1 mb)
High resolution image (TIFF 4159 kb)

References

  1. 1.
    Ortiz H, Marzo J, Armendariz P. Randomized clinical trial of stapled haemorrhoidopexy versus conventional diathermy haemorrhoidectomy. Br J Surg. 2002; 89 (11) 1376–1381.PubMedCrossRefGoogle Scholar
  2. 2.
    Golinger J.G. Surgery of the anus, rectum and colon. London, 1975.Google Scholar
  3. 3.
    Ortiz H, Marzo J, Armendariz P, De Miquel M. Stapled hemorrhoidopexy vs. diathermy excision for fourth-degree hemorrhoids: a randomized, clinical trial and review of the literature. Dis Colon Rectum. 2005; 48 (4) 809–815.PubMedCrossRefGoogle Scholar
  4. 4.
    Boccasanta P, Venturi M, Orio A, Salamina, et al. Circular hemorrhoidectomy in advanced hemorrhoidal disease. Hepatogastroenterology. 1998; 45(22):969–72.PubMedGoogle Scholar
  5. 5.
    Sakr MF, Moussa MM. LigaSure hemorrhoidectomy versus stapled Hemorrhoidopexy: a prospective, randomized clinical trial. Dis Colon Rectum. 2010; 53(8):1161–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Tjandra JJ, Chan MK. Systematic review on the procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy). Dis Colon Rectum. 2008; 51(2):253–4.CrossRefGoogle Scholar
  7. 7.
    Whitehead W. The surgical treatment of hemorrhoids. Br Med J 1882; 1:148–150.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Pincho M, Kleinubing H Jr, Ferreira LC, Santiago A. Abnormal advanced hemorrhoidal disease: the need of a staged resection. Dis Colon Rectum. 2009; 52(8):1501.CrossRefGoogle Scholar
  9. 9.
    Mukhashavria GA, Qarabaki MA. Surgical technique tailored to advanced haemorrhoids. Tech Coloproctol. 2009; 13:151–155.PubMedCrossRefGoogle Scholar
  10. 10.
    Mukhashavria GA, Qarabaki MA. Circumferential excisional hemorrhoidectomy for extensive acute thrombosis: a 14-year experience. Dis Colon Rectum. 2011; 54:1162–1169.PubMedCrossRefGoogle Scholar
  11. 11.
    Ferguson JA, Heater JR. Closed hemorrhoidectomy. Dis Colon Rectum. 1959; 2:176–179.PubMedCrossRefGoogle Scholar
  12. 12.
    Devien CV. Death to Whitehead, hurray for Toupet! or total circular hemorrhoidectomy revisited. Its technique, their indications and their results. Ann Chir. 1994; 48(6):565–71.PubMedGoogle Scholar
  13. 13.
    Rand AA. Whitehead's radical circumferential hemorrhoidectomy modified by sliding skin-flap grafts. Surg Clin North Am. 1972; 52:1031–1045.PubMedGoogle Scholar
  14. 14.
    Wolff BG, Culp CE. The Whitehead hemorrhoidectomy. An unjustly maligned procedure. Dis Colon Rectum. 1988 Aug;31(8):587–90.PubMedCrossRefGoogle Scholar
  15. 15.
    Burchell MC, Thow GB, Manson RR. A “Modified Whitehead” Hemorrhoidectomy. Dis Colon Rectum. 1976; 19(3):225–232.PubMedCrossRefGoogle Scholar
  16. 16.
    Devien CV, Pujol JP. Total circular hemorrhoidectomy. Int Surg. 1989; 74(3):154–157.PubMedGoogle Scholar
  17. 17.
    Brisinda G., Vanella S., Cadeddu F, et al. Surgical treatment of anal stenosis. World J Gastroenterol. 2009; 15(16):1921–1928.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Eu KW, Teoh TA, Seow-Choen F, Goh HS. Anal stricture following haemorrhoidectomy: early diagnosis and treatment. Aust N Z J Surg. 1995; 65: 101–103.PubMedCrossRefGoogle Scholar
  19. 19.
    Pescatori M. Closed vs. open hemorrhoidectomy: associated sphincterotomy and postoperative bleeding. Dis Colon Rectum. 2000; 43:1174–1175.PubMedCrossRefGoogle Scholar
  20. 20.
    Palazzo FF, Francis DL, Clifton MA. Randomized clinical trial of Ligasure versus open hemorrhoidectomy. Br J Surg. 2002; 89:154–157.PubMedGoogle Scholar
  21. 21.
    Wang JY, Lu CY, Tsai HL. Randomized controlled trial of LigaSure with submucosal dissection versus Ferguson hemorrhoidectomy for prolapsed hemorrhoids. World J Surg. 2006; 30:462–466.PubMedCrossRefGoogle Scholar
  22. 22.
    Van de Stadt J, D'Hoore A, Duinslaeger M, Chasse E, Penninckx F. Long-term results after excision haemorrhoidectomy versus stapled haemorrhoidopexy for prolapsing haemorrhoids; a Belgian prospective randomized trial. Acta Chir Belg. 2005; 105(1):44–52.PubMedGoogle Scholar
  23. 23.
    Candela G, Varriale S, Di Libero L, et al. Manetta F, Maschio A, Giordano M, Pizza A, Sciascia V, Napolitano S, Santini L. The gold standard in the treatment of haemorrhoidal disease. Milligan-Morgan haemorrhoidectomy vs Longo mucoprolapsectomy: comparing techniques. Minerva Chir. 2007; 62(3):151–159.PubMedGoogle Scholar
  24. 24.
    Nisar PJ, Acheson AG, Neal KR, Scholefield JH. Stapled hemorrhoidopexy compared with conventional hemorrhoidectomy: systematic review of randomized, controlled trials. Dis Colon Rectum. 2004; 47(11):1837–45.PubMedCrossRefGoogle Scholar
  25. 25.
    Jayaraman S, Colquhoun PH, Malthaner RA. Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery. Dis Colon Rectum. 2007 Sep; 50(9):1297–305.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Maia A. Qarabaki
    • 1
    • 3
  • Gela A. Mukhashavria
    • 1
  • Gia G. Mukhashavria
    • 1
  • Nodari G. Giorgadze
    • 2
  1. 1.Coloproctological Center of GeorgiaTbilisiGeorgia
  2. 2.David Tatishvili Medical CenterTbilisiGeorgia
  3. 3.TbilisiGeorgia

Personalised recommendations