Hemorrhoidectomy according to Milligan-Morgan

After palpation of the anal canal, inspection and confirmation of the indication follow. Careful insertion of the anal retractor.

Tip: If the sphincter is very tight, gentle dilation should be performed before inserting the retractor.

The hemorrhoidal cushion is grasped with a Kocher clamp and luxated outward. Using the electrocautery (e.g., electric needle), the preparation of the hemorrhoid begins from the outside, distinctly lateral to the linea ano cutanea. Then, a radial incision is made proximally just above the linea dentata. Simultaneously, the hemorrhoidal tissue is dissected from the underlying internal anal sphincter muscle, ensuring the muscle is completely preserved.