Closed hemorrhoidectomy

Over 200 years ago, the French anatomist, Petit, ¹ first attempted to eradicate hemorrhoids without denuding the lower anal canal of its mucosa. The technique, modified by many surgeons and popularized in the United States by Ferguson² and Fansler³ involves saving the anoderm, removing hemorrhoidal tissue, and replacing the anoderm into its normal position. The advantages over open hemorrhoidectomy are that the anal canal is covered with its own anoderm, postoperative dilatations are not required and primary healing is secured, resulting in much less discomfort for the patient. Frykman (unpublished) modified the partially closed technique of Fansler to a completely closed technique. Fansler advocated closing the wound only to the dentate line; however, Frykman extended closure to include the undercut and mobilized perianal skin. The same technique, used by the author’s group of surgeons for 40 years, is described in this chapter.