EP917 - A Refined Hybrid Hemorrhoidectomy Technique Combining Ferguson and Parks' Operations with Ultralow Rates of Postoperative Urinary Retention and Opioid Use

Purpose/Background: Although hemorrhoidectomy is the most effective surgical method for symptomatic hemorrhoidal disease, with the lowest long-term recurrence rate, the associated complications—such as pain, urinary retention, and potential hospitalization—make it less attractive to most patients.

Methods/Interventions: To evaluate the use of a modified hemorrhoidectomy that combines Ferguson and Parks' Operations with limited anoderm removal, protection of the internal sphincter, pedicle control, submucosal dissection for the removal of the hemorrhoidal plexus and reconstruction of the anoderm, aiming to decrease complications and postoperative pain. A retrospective analysis of consecutive patients who underwent hemorrhoidectomy performed by a single experienced colorectal surgeon

Results/Outcomes: From October 2022 to September 2023, this study included 80 consecutive patients with symptomatic hemorrhoidal disease who underwent hemorrhoidectomy at Lin Kou Chang Gung Memorial Hospital.
None of the patients experienced urinary retention. Pain episodes were primarily managed with oral medications, with only 4 patients (5%) requiring additional opioid analgesics due to moderate pain (pain score >5) postoperatively. Only one patient required opioid analgesics for 30 days postoperatively. The average postoperative hospital stay was 1 day. Four patients (5%) visited the emergency department: 3 (3.8%) for postoperative hemorrhage and 1 (1.2%) for an anal abscess. Patients with postoperative hemorrhage were managed non-surgically. Two patients (2.5%) developed anal fissures during follow-up, requiring subsequent surgical management.

Conclusion/Discussion: The modifications resulted in a 0% rate of postoperative urinary retention and minimal hospitalization, with an average stay of just 1 day. Patients who presented to the emergency department with postoperative hemorrhage were successfully managed non-surgically. These modifications significantly reduced peripheral tissue damage while preserving adequate anoderm to minimize discomfort and support better healing. The careful implementation of this approach enabled the effective removal of symptomatic hemorrhoidal tissue.

The Modified Hemorrhoidectomy Technique Combining Ferguson and Parks' Operations
This modified hemorrhoidectomy method demonstrates: (a) a mixed hemorrhoid case, (b) dissection and separation of the plexus from the internal sphincter, (c) a clamp-controlled technique for internal sphincter protection and limited anoderm removal while using an electrocautery device to remove the plexus, (d) suture ligation for hemorrhoid pedicle control, (e) submucosal dissection to remove the remaining hemorrhoidal plexus, and (f) closure of the anoderm.

Images of a Mixed Hemorrhoid Case
The images from left to right are preoperative, postoperative, one week and three weeks after the surgery.