The Whitehead hemorrhoidectomy. An unjustly maligned procedure.

The Whitehead technique of hemorrhoidectomy has developed a reputation as an undesirable procedure since its description in 1882. The chief criticisms have been considerable blood loss, disturbance of continence, formation of an ectropion, and poor healing of the mucocutaneous junction followed by stricture formation. Five hundred fifty-six patients underwent a modified Whitehead hemorrhoidectomy, performed by one author (C.E.C.), between 1963 and 1983. Seventy-two of these patients had unclaimed follow-up letters, leaving 484 patients available for review. Four hundred forty of these patients were followed for over three years. Postoperative complications included fistula or abscess in 1.1 percent, flap loss in 6.9 percent, and a nonhealing wound in one patient. There were no recurrences and there was no ectropion formation, or "Whitehead deformity." Mortality was zero and total morbidity, including 7.2 percent flap detachment, was 12.2%. A modified Whitehead technique has become the authors' procedure of choice for circumferential prolapsing and bleeding hemorrhoids and mucosa.