The use of the modified Whitehead procedure as an alternative to the closed Ferguson hemorrhoidectomy

The Whitehead technique of hemorrhoidectomy is not in widespread use. Complications such as stricture and ectropion discourage surgeons. A modification of the original technique with the use of various advancement flaps, however, preserves the anorectal skin and reestablishes the dentate line. The aim of this study was to compare and contrast the results of a modified Whitehead procedure with those of a conventional closed hemorrhoidectomy. A retrospective case-control study was carried out. The case notes of 110 patients who had undergone the modified Whitehead procedure were compared with age- and sex-matched controls. All patients underwent hemorrhoidectomy at the Mayo Clinic between 1984 and 1993. The two groups were well matched. Urinary retention was more common after modified Whitehead compared with closed hemorrhoidectomy. Suture line dehiscence occurred in 3% of the patients who underwent the modified Whitehead procedure. Wet anus or ectropion was not observed. Further hemorrhoidectomy was needed in 3% of the closed patients compared with none in the Whitehead group. In conclusion, a modified Whitehead hemorrhoidectomy can be carried out with low morbidity, comparable to that of the closed procedure, and with good long-term results.