Submucosal reconstructive hemorrhoidectomy (Parks' operation): a 20-year experience

Fourth-degree hemorrhoids remain a challenging condition to treat surgically. Prior research has shown that traditional hemorrhoidectomy techniques often result in high complication rates. It was already known that patients with prolapsed dentate lines face significant postoperative risks. No prior work had resolved the balance between effective hemorrhoid removal and preserving anal sphincter function. This gap motivated exploration of alternative surgical approaches. Submucosal reconstructive hemorrhoidectomy, as described by Parks, has not gained widespread adoption. That uncertainty drove investigation into its long-term efficacy and safety profile. The lack of large-scale follow-up data limited clinical adoption of this method.

The study aimed to evaluate the long-term outcomes of submucosal reconstructive hemorrhoidectomy as described by Parks. Fourth-degree hemorrhoids with external components pose a specific clinical challenge. The researchers sought to assess complication rates and functional outcomes over extended follow-up. A 20-year experience was analyzed to determine the procedure's viability. The motivation stemmed from the need for effective alternatives to traditional hemorrhoidectomy. The study focused on patients with prolapsed dentate lines and external hemorrhoids. The goal was to determine if this method could reduce recurrence and incontinence risks. The analysis aimed to inform surgical decision-making for complex hemorrhoidal cases.

The study reviewed surgical records from 640 patients treated between 1983 and 2002. Patients underwent rectosigmoidoscopic evaluation preoperatively. Colonoscopy or barium enema was performed for patients over 35 or with suspected pathology. Anorectal manometry measured anal resting pressure and sphincter length. Internal sphincterotomy was performed in cases of high anal resting tone. Postoperative outcomes were tracked for complications and functional results. A postal questionnaire assessed long-term follow-up outcomes. The median follow-up duration was 7.3 years for 374 respondents.

Fourth-degree hemorrhoids were present in 80% of cases treated. Postoperative bleeding occurred in 2.9% of patients, with 0.9% requiring reintervention. Severe pain was reported by 1.4% of patients, and fecal impaction occurred in 0.5%. Suture disruption occurred in 0.3% of cases. Urinary retention required bladder catheterization in 11.6% of patients. Among 374 respondents with ≥3-year follow-up, 32% were lost to follow-up. Pain during defecation was reported by 2.9% of follow-up patients. Six patients (1.6%) developed skin tags or recurrence. Gas incontinence occurred in 0.8% of cases, and anal fistula in 0.5%.

The authors suggest that submucosal reconstructive hemorrhoidectomy remains a viable option for fourth-degree hemorrhoids. The procedure may be suitable when the dentate line prolapses outside the anus. External circumferential hemorrhoids appear to be a specific indication. The study shows acceptable complication rates for this surgical approach. No prior work had resolved the long-term functional outcomes of this method. The authors propose that this technique preserves anal sphincter function effectively. The 7.3-year median follow-up supports its durability as a treatment option. The results suggest this method could be considered for selected complex hemorrhoidal cases.