Total hemorrhoidectomy: The whitehead hemorrhoidectomy and modifications

Abstract

The concept of removing "the complete ring of pile-bearing mucous membrane" was introduced by Manchester surgeon Walter Whitehead in 1882 [1], and five years later he published his personal series of 300 patients [2]. The total hemorrhoidectomy described by Whitehead suffered early criticism due to a high incidence of complications reported by others using his technique. Favorable outcomes have been reported, however, by many authors employing both Whitehead's original procedure and its modifications. Today, 125 years after its description, the concept of total hemorrhoidectomy still prevails in many centers. The fundamental difference between total hemorrhoidectomy and more traditional hemorrhoidectomies (such as the Milligan-Morgan or the Ferguson operations) is that the entire segment of dilated anal cushions and its overlying mucosa (and in some descriptions, skin) is circumferentially excised, rather than single hemorrhoids being selectively excised. It follows that the indication for total hemorrhoidectomy is circumferential, converging piles, where a traditional hemorrhoidectomy would leave a large amount of hemorrhoidal tissue behind. © Springer-Verlag London Limited 2009.