Sutureless closed hemorrhoidectomy: a new technique

Abstract

Objective: To compare a new technique of radical hemorrhoidectomy using an electrothermal device originally devised to seal vessels in abdominal operations, with the conventional open Milligan-Morgan procedure performed with diathermy.

Summary background data: Hemorrhoidectomy is one of the most commonly performed anorectal operations. Two well-established methods, the "open" Milligan-Morgan excision and the "closed" Ferguson technique, both carry risks of postoperative bleeding, urinary retention, and late anal stenosis. The convalescence is similarly long and difficult after both operations. The quest for an improved technique of radical excision of hemorrhoids is justified.

Methods: In this case-control study, two groups of patients were alternatively allocated into study and control groups. In the study group (n = 40), an electrothermal system was used. The tissue fusion produced by this device consists of melting of collagen and elastin. This technique essentially achieves a sutureless closed hemorrhoidectomy. The operative time, postoperative complications, and time off work were compared with the group undergoing conventional Milligan-Morgan hemorrhoidectomy (control group, n = 40).

Results: The operative time and time off work were significantly shorter in the study group. There were also fewer postoperative complications in this group.

Conclusions: The "tissue-welding" properties of this device and the shape of the electrode handpiece may be successfully applied to the performance of an operation most appropriately described as a "modified sutureless closed hemorrhoidectomy." This pilot study shows that this new technique is simple and safe, significantly shortens the operation, and is followed by a significantly easier and shorter recovery.

Figure 1. Exposure of the hemorrhoidal complex using a Chelsea-Eaton operating anoscope.

Figure 2. Preparation of the internal and external components of the hemorrhoidal complex for application of the sealing electrode. Note the lateral countertraction.

Figure 3. First application of the electrode beneath the external hemorrhoid or skin tag.

Figure 4. The external hemorrhoid is partially detached by cutting through the resulting “seal zone.”

Figure 5. A second application of the electrode on the internal hemorrhoid and the inferior hemorrhoidal vascular pedicle completes the excision of the entire complex.

Figure 6. Completed sutureless closed hemorrhoidectomy. The “welded” mucosal line is seen, and the whitish area represents the coagulated inferior hemorrhoidal vascular pedicle.