THE NEW PROCEDURE FOR RECONSTRUCTION OF EXTENSIVE CIRCUMFERENTIAL HEMORROIDS (FOUR FLAP)

According to the type of procedures, excision of extensive and circumferential hemorroids can distored the anal canal and caused anal stricture and mucosal ectropion formation.The whitehead technique of hemorroidectomy has developed a requtation as undesirable procedure. The chief criticisms have been disturbance of continence, formation of an ectropion, poor healing, stricture formation and prolapse. However with the new modification suggested firstly by authors, these complications were rare or do not occur. In this study 95 patients underwent four flap anal reconstruction (FFAR), performed by authors between 1989 and 1996. All of patients had circumferential prolapsing and bleeding hemorroids and mucosa with or without thrombosis. Postoperative complications included abscess in one case(1%), flap detachment in 9.8%, flap loss in 3.1%, fissure in 10.6%, anal stricture in 3.1% and high stricture in one case(1%). There were no recurrences and there was no ectropion formation. Total morbidity without early and temporary complications was 4.1%. This study suggested that a new modified whitehead technique named FFAR has become the authors’ procedure of choice for circumferential prolapsing and bleeding hemorrhoids.