Madam, We mad with interest a short report published in your November issue titled "Immediate Haemorrhoidectomy for Thrombosed Fourth Degree Haemorrhoids1”. The Author has compared the results of immediate haemorrhoidectomy and conservative treatment. Unfortunately, be did not mention the treatment that we have found simple and effective in thrombosed, prolapsed haemorrholds.
Head and Gudgeon2 reported instant pain relief if only one of the strangulated haemorrhoids was excised, We have seen in our practice that in majority of cases, only one of the prolapsed haemorrhoid gets thrombosed. Excision of that haemorrhoid is simple and safe. In selective cases, we have done this under local anaesthetic. One does not have to worry abou; mucocutaneous bridges and anal stenosis does not thrombosed haemorrhoids3, internal sphincterotomy4 and anal dilatation5 have been described, but we have not practised these options in prolapsed, thrombosed haemorrhoids.
S. Razi Muhammad and F. U. Baqai
Department of Surgery, Baqai University of Health Sciences, Karachi.
1. Elusoji, S. 0. Immediate haemorrhoidectomy for thrombosed, fourth degree haemorrhoids. J. Pak. Med. Assoc., 1994;44:264-265.
2. Heald, R. J. and Gudgeon. A. M. Limited haemorrhoidectomy in the treatment of acute strangulated haemorrhoids. Br. J. Surg., 1986;73: 1002.
3. Grosz, C. R. A. Surgical treatment of thrombosed, external haemorrhoids. Dis. Colon Rectum, 1990;33 :249-250.
4. Roover, D. M., Hoofwijk, A. G. and Van Vroonhoven, T. J. Lateral internal sphinoterotomy in the treatment of fourth degree haemorrhoids. Br. J. Surg., 198976:1181-1183.
5. Hancock, B. 0. Haemorrhoids. Br. Med. J., 1992;304: 1042-1044.
Madam, The aim of the paper was to emphasize the. safety of immediate haemorrhoidcctomy and its advantages over conservative treatment in patients with thrombosed fourth degree haemorrhoid.
Other procedures lilce simple incision of thrombosed haemorrhoid, internal sphincterotomy and anal dilatation were not considered in the study. Excision of only one of the prolapsed haemorrhoid is indeed simple and safe but it means that the patient may need surgery later on for the then Various other procedures like simple incision of uncomplicated haemorrhoids. I strongly feel that if it is better to carry out the standard haemorrhoidectomy on all the prolapsed haemorrhoids (thrombosed ornot) so as to solve the patients perianal problems once and for all and this is what! compared with conservative management in my study.
S. 0. Elusoji
Dept. of Surgery, U.B.T.H., Benin City, Nigeria.