Closed hemorrhoidecetomy for treatment of hemorrhoids [with special emphasis on the Jack Knife position]

ABSTRACT

Many procedures have been devised for the treatment of hemorrhoids. Most of them remove the hemorrhoidal tissue, non deal with the raw area left after removal of the hemorrhoidal tissue leaving it exposed to fecal matter, sweat, friction, causing severe pain and discomfort. Closed hemorrhoidectomy has been advocated by Ferguson and Heaton in 1959 is a trouble free operation. Closed hemorrhoidectomy was done for 50 patients with different degrees of piles except first degree. Another 50 patients operated upon by the classical hemorrhoidectomy described by Millican and Morgan in 1937, leaving the wound open after excision of the hemorrhoidal tissue. This work was done in Sohag University hospital. In the closed group complete closure of the wound with full restoration of the anorectal mucosa and skin was done. The closed hemorrhoidectomy operation provided a significant reduction in the number and severity of the previously known typical postoperative complications of open hemorrhoidectomy operation [pain after surgery and defecation, edema of perianal tissue, bleeding at postoperative period, blood discharge at defecation, urinary retention and dysuria, etc.]. Complete closure of the wound showed healing by primary intention in most patients. Still more impressive is the decrease in the number of cases of bleeding in the first consequent defecation. Follow up of these patients was done post operatively al 1 and 2 weeks and 1 and 2 months. Late complications [anal stenosis, long periods of healing, anal fissure or skin tags] were not recorded in the closed group. This study showed that closed hemorrhoidectomy is an effective and safe operation and has great advantages over the open method, and is suitable for routine hemorrhoidectomy