# Modified Circular Hemorrhoidectomy for Stage IV Hemorrhoids With Terminal Prolapse: A Case Series

## TL;DR

A modified surgical technique for severe hemorrhoids with terminal prolapse shows promising results in three patients, offering effective treatment with fewer complications.

## Contribution

The study introduces a modified circular hemorrhoidectomy technique that preserves mucosal bridges and reduces postoperative complications.

## Key findings

- All three patients experienced complete resolution of symptoms with no recurrence or major complications.
- The modified technique improved functional outcomes and patient satisfaction.
- The procedure demonstrated technical feasibility and balanced radical excision with anatomical preservation.

## Abstract

Stage IV hemorrhoids with terminal prolapse present a significant surgical challenge, often requiring innovative approaches to achieve optimal outcomes. This case series highlights the efficacy of modified circular hemorrhoidectomy, a refined technique incorporating mucosal bridge preservation, in three patients with severe circumferential hemorrhoidal disease. The procedure, adapted from the traditional Whitehead hemorrhoidectomy, addresses both internal and external components while minimizing postoperative complications such as anal stenosis and mucosal ectropion. All three patients experienced complete resolution of complaints, with no recurrence or major complications during follow-up. The modified technique not only demonstrated technical feasibility but also improved functional outcomes and patient satisfaction. This series underscores the potential of modified circular hemorrhoidectomy as a valuable surgical option for stage IV hemorrhoids with terminal prolapse, offering a balance between radical excision and preservation of anatomical integrity. Further studies are warranted to validate these findings and establish their role in modern hemorrhoidal disease management.