Anorectoplasty for hemorrhoidal surgery

T HIS paper was stimulated in part by the interest displayed in the panel discussion of complications of anorectal surgery presented at the 1954 meeting of the American ProctoIogic Society. During that discussion there was reference to the inclusion of raw surfaces in hemorrhoidal surgery for the purpose of drainage, and the role played by raw surfaces in relation to postoperative pain. This report is flased on a five-year series of about 700 cases. The procedure empIoyed in these cases is best described as “anorectopIasty,” one purpose of \vhich is to eliminate raw surfaces. It has been stated that no one surgical technic so far devised assures a uniformIy satisfactory operative cure in all cases of complicated hemorrhoids. InnumerabIe technics have been proposed for the removal and cure of internal hemorrhoids; they probably far outnumber those described for any other invoIved field or organ. I wish to describe a technic for radica1 cure of hemorrhoids, and comment on its advantages and disadvantages. Also, the anorectal status of IOO cases subjected to the procedure wiII be reviewed, \vith reports of the condition from two months to one year after operation. This procedure is indicated for the removal of all types of internal hemorrhoids whether or not associated with rectal prolapse, anal ulcer or chronic anorectal infection. Uncomplicated anorectal hstufa in the presence of surgical hemorrhoids is not a contraindication. It is an elective procedure; however, it is contraindicated in acute prolapse with diffuse thrombosis. Preparation qf Patient. The operative site should be as free from inflammatory reaction as possible. The freedom from untoward reaction postoperatively is influenced in anorectal surgery, as in tonsil or gallbladder surgery, by the absence of infection at the time of operation. The patient is prepared for surgery by the use of a high protein and low carbohydrate diet, elimination of chemica1 irritants from the proxima1 gastrointestina1 cana and by Iocal appIication of bacteriostatic agents calculated to control any infection present. The period of preparation wiI1 depend upon the amount of apparent IocaI infection present and may rc