Surgical treatment of III-IV hemorroids: a prospective, randomized study of a technical variant oh Whitehead's hemorroidectomy

Aims: A technical variant of Whithead haemorrhoidectomy is described. This technique consists in three semilunar incisions at points corresponding to the three primary piles at 3, 7 and 11 o'clock, detachment of the vascular structures of the anorectal mucosa, ligation by means of a transfixion stitch and reconstruction of the mucocutaneous plane with interrupted absorbable sutures. Patients and methods: The authors report the results of a prospective, randomised study of this technical variant comparing it with the standard Whithead technique in 210 patients divided into two groups (103 and 107 pts., respectively). Results: Both postoperative pain and early postoperative complications were significantly lower in the patients operated on using the modified technique. Seven days postoperatively there were distinct reductions in the incidences of soiling (27.1% vs 14.6%; P<0.001), and itching (48.6% vs 34.9%; P<0.001). The results on postoperative day 14 were also satisfactory with the variant technique. Conclusions: The modified technique described would appear to be valid and effective in the surgical treatment of haemorrhoids, yielding statistically significant improvements in results. It is therefore a procedure to be recommended in all cases of third- and fourth-degree haemorrhoids not associated with intercurrent diseases of a non-haemorrhoidal nature, amongst other things because of its extreme simplicity