Whitehead's Operation: Should We Abandon It?

ABSTRACT

PURPOSE: Total prolapse of internal hemorrhoids around the entire anal circumference still remains as a challenging problem. Whitehead's circumferential hemorrhoidectomy is one of the surgical options. To elucidate efficacy of Whiteheads operation, we analyzed the surgical outcomes of Whiteheads operation. METHODS: The medical records of 165 consecutive patients who underwent Whiteheads operation for end-stage hemorrhoids were retrospectively reviewed. The mean operation time, the mean blood loss, and the mean hospital stay were examined. Also the types of complications were identified. All patients were followed for extended periods and in May 2003 they were asked to appraise their satisfaction (mean follow-up duration was 45.5 months, 12~93 month range). RESULTS: The mean operation time was 21.5+/-5.3 minutes, the mean blood loss was 50.5+/-22.0 cc, and the average hospital stay was 5.5+/-1.5 days. Early postoperative complications were fecal incontinence (60.6%) and voiding difficulty (53.3%). These problems were spontaneously resolved within 2 weeks. Pain was the most difficult problem, and all patients required a parenteral opioid for relief of pain. The only late complication was anal stenosis. Objectively, anal stenosis was found in 66 patients; however, 22 patients (13.3%) complained of defecation difficulty. Among them, only 4 patients required surgical treatment. The average score of satisfaction according to the patients themselves was 4.0+/-2.2, 0 being no satisfaction and 5 being complete satisfaction. CONCLUSIONS: The Whitehead operation, if performed properly for the selected patients, still remains as one of the best surgical options for end-stage hemorrhoids.