Limited hemorrhoidectomy - Results and long-term follow-up

PURPOSE: Three-column excision has traditionally been the preferred treatme nt for symptomatic hemorrhoidal disease in patients failing nonoperative tr eatments. There are few data evaluating focused surgical management of only the symptomatic hemorrhoidal complexes by limited hemorrhoidectomy. The pu rpose of this study was to evaluate patient outcome after one-quadrant or t wo-quadrant hem orrhoidectomy for symptomatic hemorrhoids. METHODS: We retr ospectively studied patients undergoing a one-quadrant or two-quadrant hemo rrhoidectomy as initial surgical treatment of symptomatic columns from Apri l 1987 to July 1993. Patients undergoing a traditional three-quadrant hemor rhoidectomy during the same time period were used as controls. Statistical analysis was used to determine significance. RESULTS: There were 115 evalua ble patients who had undergone a one-quadrant or two-quadrant hemorrhoidect omy. One hundred thirty-three three-quadrant patients were studied as the c ontrol group. The mean follow-up was 8.1 years and 7.2 years for the limite d and three-quadrant hemorrhoidectomy group, respectively. The majority of patients (96 percent limited and 98 percent three-quadrant) experienced ini tial relief of symptoms after surgery. There was no significant difference between the two groups in the development of recurrent anorectal symptoms ( 34 percent limited and 29 percent three-quadrant), in the need for addition al medical therapy (11.3 percent limited and 15.8 percent three-quadrant), or in the need for additional interventional therapy (2.9 percent limited a nd 0.8 percent three-quadrant). No patients in either group required additi onal surgical hemorrhoidectomy. CONCLUSIONS: The majority of patients with hemorrhoidal disease requiring excision can be managed effectively by focus ed treatment of the problematic columns. With this approach fewer than 2 pe rcent of patients will require further procedural intervention of their hem orrhoidal disease.