The Indications and Limits of Ligature and Excision Method for Hemorrhoids

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  • Matsuda Y.
    Medical corporation for gastro-intestinal division, Mastuda Hospital

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  • 痔核治療法の適応と限界　　２．結さつ切除術の変遷および適応と限界

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Abstract

Operative treatment for hemorrhoids is now mainly done by a ligation and excision method, dating back to Frederick Salmon who was a founder of St. Mark's Hospital. The present ligation and excision method involves stripping the muco-cutaneous portion up to the anal canal, and ligating all internal hemorrhoids or protruding mass, then cutting off of its distal portion, hence a new protrusion is prevented by the longitudinal scar.<BR>This operation has been changing toward wound closing, and numerous methods have been devised by each doctor. As the indication of this operation is exceedingly wide, it can also be applied to various types of hemorrhoids, rectal mucosal prolapse, procidentia recti (Tuttle 1 grade), anal skin tag, large peri-anal tumor, Whitehead anus, etc. There is no contra-indication for the ligation and excision method ; even if we encounter a severe case, we can overcome it by technical means. However, unless the basic principle is followed, various complications such as anal stenosis, skin tag, and prolonged wound healing may result post-operatively. The closed method of this operation is popular in Europe and America, and it is suitable for day surgery because of prompt wound healing and early return to work. Recently, the closed method is spreading in Japan, and also it is preferred by patients as meeting their needs. Although this operation is an established method, further development is desired.

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