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Descriptions of Haemorrhoid Surgery Techniques

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Descriptions of haemorrhoid surgery

Descriptions of haemorrhoid surgery

Operative techniques

  • Open (Milligan-Morgan technique): dissection of the haemorrhoid and ligation of the vascular pedicle, wounds are left open to heal naturally
  • Closed
    • Conventional closed (Ferguson’s technique): the wound is closed with a continuous suture to promote healing
    • Stapled: reduces the prolapse of haemorrhoidal tissue by excising a band of the prolapsed anal mucosa membrane above the dentate line, using a specific circular stapling device. This interrupts the blood supply to the haemorrhoids and reduces the potential for available rectal mucosa to prolapse. May also be referred to as stapled haemorrhoidopexy or stapled anopexy
    • Submucosal (Park’s technique): removes the vascular pedicle corresponding to every haemorrhoidal nodule and preserves the overlying mucosa, which is then accurately reconstructed

Dissection techniques

  • Conventional scissors
  • Diathermy: uses high current bipolar electrocautery for cutting and haemostasis
    • Ligasure™ vessel sealing system: complete haemostasis is achieved by reforming the collagen and elastin in vessel walls to form an autologous seal
  • Harmonic Scalpel: ultrasonically-activated scalpel, associated with decreased thermal damage to tissue and facilitated dissection within tissue planes
  • Radiofrequency bistoury: cuts and coagulates tissues in an atraumatic manner, using radio waves (maximum temperature 80 °C). Eliminates diffuse bleeding because all vessels of 1.5–2 mm diameter are coagulated on the sectioning line, thus haemostasis is controlled
  • Laser: concentrates the energy from electromagnetic radiation into a narrow beam that can be used for cutting, and causes very little damage to the surrounding tissue. It has a coagulative haemostatic effect that allows a dry operative field and obviates the need for ligation or diathermy

Adjuncts to surgery

  • Sphincterotomy: part of the internal sphincter muscle is cut, which relieves the tension of the muscle
  • Anal dilator: widens the anal canal if it has become narrowed because of tightness or spasm in the muscles (anal sphincters) that control the opening and closing of the anus