Problems of cryohemorrhoidectomy

One thousand cryohemorrhoidectomies were performed in the past 7 years (1973-1979). Ninety percent of the patients were satisfied with the technique; approximately one-third of the patients experienced severe to moderate pain and 11% had recurrences or related problems. The majority of patients with postoperative pain were in the younger age group and two-thirds of the recurrences occurred in males. Our data suggest that there is a close relationship between complications and anal pressure. These facts lead us to believe that patients with high anal pressure are prone to recurrence and postoperative pain--for these patients one must not only remove the hemorrhoidal mass but also lower the anal pressure by internal sphincterotomy. On the basis of these assumptions, we have operated on 200 patients using internal sphincterotomy along with hemorrhoidectomy; early results have been promising. We recommend cryohemorrhoidectomy limited to those who have prolapsing internal hemorrhoids without significant constipation or external engorgement which is indicative of high anal pressure.