Who's afraid of the dentate line? The Whitehead hemorrhoidectomy

Between January 1, 1970 and January 1, 1980, 1,002 hemorrhoidectomies, of which 356 were modified Whitehead procedures, were performed at a University of Illinois-affiliated hospital. Follow-up data were obtained from 295 of these patients, with times ranging from 5 to 12 years. Five patients experienced postoperative contractures. Of these, three required a second procedure and one required a third. There were no cases of fecal incontinence or rectal seepage. After review of the literature, I concluded that (1) the poor record of the Whitehead hemorrhoidectomy is due to the confusing and oftentimes misleading terminology of the anorectal anatomy found in early texts, and (2) this technique, or one of its modifications, is a viable treatment option for patients with circumferential, prolapsing, mixed hemorrhoids.