Limited hemorrhoidectomy

Abstract

PURPOSE: Three-column excision has traditionally been the preferred treatment for symptomatic hemorrhoidal disease in patients failing nonoperative treatments. There are few data evaluating focused surgical management of only the symptomatic hemorrhoidal complexes by limited hemorrhoidectomy. The purpose of this study was to evaluate patient outcome after one-quadrant or two-quadrant hemorrhoidectomy for symptomatic hemorrhoids. METHODS: We retrospectively studied patients undergoing a one-quadrant or two-quadrant hemorrhoidectomy as initial surgical treatment of symptomatic columns from April 1987 to July 1993. Patients undergoing a traditional three-quadrant hemorrhoidectomy during the same time period were used as controls. Statistical analysis was used to determine significance. RESULTS: There were 115 evaluable patients who had undergone a one-quadrant or two-quadrant hemorrhoidectomy. One hundred thirty-three three-quadrant patients were studied as the control group. The mean follow-up was 8.1 years and 7.2 years for the limited and three-quadrant hemorrhoidectomy group, respectively. The majority of patients (96 percent limited and 98 percent three-quadrant) experienced initial relief of symptoms after surgery. There was no significant difference between the two groups in the development of recurrent anorectal symptoms (34 percent limited and 29 percent three-quadrant), in the need for additional medical therapy (11.3 percent limited and 15.8 percent three-quadrant), or in the need for additional interventional therapy (2.9 percent limited and 0.8 percent three-quadrant). No patients in either group required additional surgical hemorrhoidectomy. CONCLUSIONS: The majority of patients with hemorrhoidal disease requiring excision can be managed effectively by focused treatment of the problematic columns. With this approach fewer than 2 percent of patients will require further procedural intervention of their hemorrhoidal disease.