Preserving Treitz's muscle in hemorrhoidectomy.

A new, improved approach to closed and semiclosed hemorrhoidectomy is described, in which the amount of excision is reduced. The operation has evolved from refinement of the excision and ligation technique, which may be considered too extensive a procedure. Treitz's muscle, lying on, penetrating in, and surrounding the internal and sphincter, is considered normal function tissue and is not excised. Its preservation permits easy approximation and suture of the wound edges to their normal, supple underlying tissue, avoiding direct fixation to the more rigid internal and sphincter. Residual hemorrhoidal tissue beneath the edges, if present, is also sewed to Treitz's fibromuscular tissue. Flat closed and semiclosed wounds with normal supple folding and without narrowing of the anal canal result. In a consecutive series of 100 patients, primary healing was observed in 80 per cent of the patients. Sixty four per cent experienced no pain on defecation. The functional result, with a normally pliant anorectal lining and anchorage to the preserved Treitz's muscle, is excellent. The procedure represents an accurate reconstruction of a normal state with respect to anatomy and function.