Colorectal

Haemorrhoidectomy (Ferguson Closed)

OPERATION: Haemorrhoidectomy (Ferguson Closed Method)
ANAESTHETIC: General / spinal anaesthesia. Local infiltration with adrenaline-containing solution.
POSITION: Lithotomy

INDICATION:
Symptomatic grade III / IV haemorrhoids. Failed conservative and office-based management. [Combined haemorrhoidal disease at primary positions].

PROCEDURE:
WHO Checklist performed. Perineum prepared and draped. Examination under anaesthesia — haemorrhoids at primary positions confirmed: right anterior, right posterior, left lateral. [Additional components noted].

Haemorrhoidal complexes marked at each primary position ensuring adequate mucocutaneous bridges to prevent stenosis. Local infiltration with adrenaline-containing solution to aid haemostasis and define dissection planes.

First haemorrhoid: V-shaped incision through perianal skin at external component. Dissection in the submucosal plane, clearly identifying and preserving the internal anal sphincter throughout. Haemorrhoidal plexus mobilised from the sphincter to its mucosal pedicle. Pedicle suture-ligated with 2-0 absorbable suture.

Wound closed from apex to dentate line with continuous absorbable suture incorporating the submucosal dead space (Ferguson technique — primary closure). Wound closed to anal verge.

Second and third haemorrhoids excised and closed identically. Adequate mucocutaneous bridges confirmed between all three wounds.

Haemostasis confirmed at all sites.

FINDINGS:
Grade [III / IV] haemorrhoids at right anterior, right posterior, and left lateral positions. Internal sphincter preserved throughout. Adequate anal bridges maintained.

EBL: Minimal. COMPLICATIONS: None.

POST-OPERATIVE INSTRUCTIONS:
Regular analgesia. High fibre diet and adequate hydration. Stool softener to avoid constipation. Sitz baths. Outpatient review at 4–6 weeks.