TY - JOUR
AU1 - Gold, D M
AB - Since the original description of the Milligan–Morgan haemorrhoidectomy in 1937, other surgical approaches have been described. Despite these alternative methods the Milligan–Morgan continues to hold its place as the procedure of choice and is almost certainly, even now, the most commonly performed operation for advanced haemorrhoidal disease. Why have other procedures not come to the fore? The Parks and Whitehead procedures offer a more radical approach. They are easy operations to draw, but technically difficult and often bloody. The Ferguson approach simply closes the wounds of the Milligan–Morgan. Frequently they break down and no advantage is conferred. All of these procedures were aimed at the haemorrhoids themselves. The Longo procedure was different1. It aimed to avoid surgery directly to the anal canal and haemorrhoids, by excising a cuff of lower rectal mucosa including its submucosal vascular supply; with the incorporation of small islands of muscularis propria into the staple line, the reduced mucosa was fixed to the underlying tissue. The resulting effect was haemorrhoidal shrinkage and reduction, with significantly less postoperative pain and a shorter recovery. However, there were case reports of serious complications such as retroperitoneal sepsis requiring stoma formation. Such complications are enough to discourage the majority of cautious surgeons. Morinaga's approach2, transanal haemorrhoidal dearterialization/Doppler-guided haemorrhoidal artery ligation with mucopexy, is incisionless. It is aimed at accurate identification and ligation of the haemorrhoidal arteries rather than excision, reducing the cushions to their anatomical location with subsequent scar fixation and shrinkage. The literature attests to its success, with a symptom reduction rate of 85–90 per cent or more. Patient satisfaction is high and complications minimal. Still, there is resistance. Conference chatter confirms scepticism toward the published outcomes or even the need for the Doppler. Adoption is slow. This elegant paper confirms the anatomy of the vascular supply to the haemorrhoids, their source, course, depth and consistency. It directs the procedure to the appropriate height from the anorectal junction, further improving the chances of success. It confirms Morinaga's original hypothesis. 1937 was a long time ago. References 1 Longo A . Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device: a new procedure. Proceedings of the 6th World Congress of Endoscopic Surgery, June 3, 1998. Mundozzi Editore : Rome , 1998 ; 777 – 784 . Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC 2 Morinaga K , Hasuda K, Ikeda T. A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter . Am J Gastroenterol 1995 ; 90 : 610 – 613 . Google Scholar PubMed OpenURL Placeholder Text WorldCat Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
TI - Assessment of haemorrhoidal artery network using colour duplex imaging and clinical implications (Br J Surg 2012; 99: 112–118)
JF - British Journal of Surgery
DO - 10.1002/bjs.7722
DA - 2012-01-01
UR - https://www.deepdyve.com/lp/oxford-university-press/assessment-of-haemorrhoidal-artery-network-using-colour-duplex-imaging-Te4WIjYlrl
SP - 119
EP - 119
VL - 99
IS - 1
DP - DeepDyve
ER -