대한대장항문학회

Conventional hemorrhoidectomy is still the main stairway to the treatment of the third<br>or the fourth degree hemorrhoids. Among the various methods of hemorrhoidectomy,<br>open hemonhoidectomy is claimed to decrease postoperative pain and wound infection,<br>but to have disadvantage of long period of wound healing. Semi-closed<br>hemorrhoidectomy has the advantage of rapid wound healing without increased risk of<br>wound infection, but more painful postoperative course than open hemorrhoidectomy is<br>suggested. To assess this conventional concept, two hundreds of patients were randomly<br>allocated to either an open hemorrhoidectomy(Group 4, Operated by modified Goligher<br>method, n=100) or a semi-closed hemorrhoidectomy(Group B, Operated by modified<br>Nesselrod method, n=100), and postoperative results were analyzed. In group 4, the<br>average time for disappearance of wound edema was 4.9days, average time for<br>disappearance of wound pain was 9.0days, average time for painless defecation was 14.1<br>days, average time for complete wound healing was 28.4days. The main complications<br>were overgranulation, skin tag, anal discharge and pruritus. The overgranulation requires<br>curettage, the skin tags were resected under local anesthesia. Anal discharge and<br>pruritus were spontaneously disappeared after the healing of the wound. In group B, the<br>average time for disappearance of wound edema was 6.1 days, average time for<br>disappearance of wound pain was 6.3days, average time for painless defecation was<br>9.2days, average time for complete wound healing was 20.7days. The main complications<br>were skin tags, more prevalent than group 4, requiring resection under local anesthesia.<br>No infectious complications were noted in both groups. Consequently, the old concept<br>that open hemorrhoidectomy has advantage of less painful postoperative course than<br>semiclosed hemorrhoidectomy cannot be accepted. Semi-closed hemorrhoidectomy offers<br>more rapid loss of pain and more rapid healing of the wound than open<br>hemorrhoidectomy, without increased risk of infectious complications.<br>In conclusion, semi-closed hemorrhoidectomy is superior method to open<br>hemorrhoidectomy in third or fourth degree hemorrhoids.<br>