Surgical technique tailored to advanced haemorrhoids.

A modified Whitehead operation, circumferential excisional haemorrhoidectomy (CEH), is described. This procedure is suitable for large, circular, internal haemorrhoids, notably when they are associated with huge external haemorrhoids. Briefly, CEH involves complete enucleation of external/internal haemorrhoidal complexes from the subanodermal skin and submucosa with reconstruction of the anal canal using a mucoanodermal flap and undermined healthy skin. Since the unaffected anorectal tissues are completely preserved, there is no increased tendency for intractable postoperative complications and/or poor functional results. Short-, medium- and long-term results demonstrate the feasibility and reliability of this technique for treating end-stage haemorrhoids.