Milligan-Morgan hemorrhoidectomy - general and visceral surgery

After palpation inspect the anal canal and verify the indication. Carefully insert the anal retractor.

Tip:

• If the sphincter is very tense, dilate gently before introducing the retractor.

Grasp the pile with a Kocher forceps and retract it outward. With diathermy (e.g. electric needle cautery) start the dissection of the pile from the outside in clearly lateral to the anocutaneous line. Then extend radial incision proximally to just inside the dentate line. At the same time dissect the hemorrhoidal tissue off the internal anal sphincter muscle underneath. The muscle is completely spared.

Suture ligate the hemorrhoidal artery proximally and excise the dissected hemorrhoidal tissue. Dissect the segment is prepared as narrow as possible to preserve enough anoderm. Leave a sufficiently large drainage triangle distad for secondary healing.