CIRCULAR HEMORRHOIDECTOMY IN ADVANCED HEMORRHOIDAL DISEASE

BACKGROUND/AIMS: Milligan-Morgan's hemorrhoidectomy has a high recurre nce rate (> 10%) in patients with circular IV grade hemorrhoids. In su ch cases a circular hemorrhoidectomy with complete elimination of resi dual piles, and anoplasty might be more successful. The aim of this re trospective study was to compare the results of circular hemorrhoidect omy using the Hopital Leopold Bellan (HLB) technique (Paris) with the reported results of other techniques in patients with advanced hemorrh oidal disease. METHODOLOGY: From January 87 to December 96, 100 consec utive patients with circular IV grade hemorrhoids underwent radical he morrhoidectomy. Mean hospital stay was 4 days (range 3-7). Patients we re strictly controlled in the postoperative period and in cases of ear ly fibrosis anal dilators were used. RESULTS: Eighty one percent of pa tients had a complete recovery. The recurrence rate was 4%. The cumula tive rate of early and late complications was 34%. Early and late hemo rrhages were more frequent than in traditional hemorrhoidectomy, while the incidence of anal stenosis was the same. CONCLUSIONS: The HLB ope ration is the best choice for patients with advanced circular hemorrho ids because of its radicality and good results. The postoperative morb idity of HLB hemorrhoidectomy is higher than traditional hemorrhoidect omy; nevertheless, all complications are tractable without extension o f hospital stay.