Anoderm-preserving, completely closed hemorrhoidectomy with no mucosal incision

This study evaluates and reports on a technique of hemorrhoidectomy in which mucosa is not incised. Two thousand patients underwent nonmucosal hemorrhoidectomy from 1987 to 1997 in a personal series. The principles of surgery were as follows. The skin incision is the same as for routine hemorrhoidectomy, but an incision of exactly the right length is required to keep the procedure completely closed. A 2 to 3 mm width of anoderm is usually excised, but the anoderm may also be preserved by making only an incision. No incision is made in the mucosa, and the internal hemorrhoids are grasped with a Pean's forceps and mass ligated with No. 7 silk. The anoderm and skin incision are completely closed by continuous suturing with coated Vicryl 5-0. None of the 2,000 patients treated by the nonmucosal incision hemorrhoidectomy method experienced either anal stenosis or postoperative bleeding that required emergency treatment. Wound healing and recuperation time were shorter, by approximately one week, in the subset of 500 patients who underwent completely closed surgery. The success of this method lies in minimum excision of the anoderm and the avoidance of making a dead space beneath the sutured anoderm. A stool softener is valuable for postoperative management of bowel movements.