Long Term Follow-up for Modified Whitehead Hemorrhoidectomy

ABSTRACT

PURPOSE: Walter Whitehead introduced new method for treating circumferential hemorrhoids with good results for the first time in 1882, but his procedure has been neglected by most surgeons because of complications, such as anal stricture, incontinence, ectropion, etc. METHODS: We retrospectively inves tigated and analyzed 52 cases involving modified Whitehead hemorrhoidectomies (WH) and 60 cases involving submucosal hemorrhoidectomies (SH) performed at Seoul Adventist Hospital from Jan. 1989 to Dec. 1994. We only selected patients whose follow-up durations were more than 5 years. The chi-square test and t-test were used for the statistical analysis. RESULTS: The results are as follows 1) The sex ratio of males to females was 1.36 to 1 in the WH group and 1.31 to 1 in the SH group. 2) The peak age was in the 4th decade (40.0% in the WH group and 35.0% in the SH group), the mean age was 39.1 years in the WH group and 37.3 years in the SH group, and the age distribution ranged from 17 years to 75 years in both groups. 3) The average postoperative hospital stay was 9.83 days in the WH group and 8.43 days in the SH group (p=0.001). 4) The average follow up duration was 71.3 months in the WH group and 76.9 months in the SH group. 5) In the WH and the SH groups, the postoperative complications were, respectively, recurrence (1.9%0%, p=0.281), defecation difficulty (7.7%1.7%, p=0.124), incontinence (1.9%3.3%, p= 0.645), ectropion (1.9%0%, p=0.281), anal pain (15.4%8.3%, p=0.245), and anal bleeding (9.6% 13.3%, p=0.540). 6) Some patients complained about complications 7 years after the operation. These were 1 defecation difficulty and 1 incontinence in the WH group and 1 defecation difficulty and 2 incontinences in the SH group. CONCLUSIONS: The results of a long term follow-up for postoperative complications after a modified Whitehead operation were no worse than those for a submucosal hemorrhoidectomy. Thus, if one uses proper surgical technique, one should be able to get better results: fewer complications and more complete healing of the hemorrhoid.