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August 5, 1968

Removal of Hemorrhoids

Author Affiliations

Brooklyn, NY

JAMA. 1968;205(6):469. doi:10.1001/jama.1968.03140320163026

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To the Editor:—  We were surprised and somewhat dismayed at "Non-operative Ligation Treatment of Internal Hemorrhoids" (204:375, 1968).We have used Barron ligation technique since the ligator became commercially available. This is considerably longer than the 18 months mentioned in the article. In our practice of colon and rectal surgery, the patient who has only internal hemorrhoids as a cause of symptoms is a distinct rarity. Anal ulceration, fistula, hypertrophied papillae, and cryptitis frequently coexist with internal hemorrhoids in symptomatic individuals. Hemorrhoids which traverse the anal canal and are distal to the pectinate line are far more likely to cause symptoms than are pure internal hemorrhoids.The article states that hemorrhoidectomy is "extremely unpleasant" for the patient. However, it is our experience that nine out of ten patients undergoing anorectal surgery make some variation of the statement, "If I'd known that this was all there was to it, I