A 68-year-old man has fourth-degree hemorrhoids not responding to conservative treatment. His preferred definitive treatment that removes the hemorrhoidal tissue permanently is:

• A Milligan-Morgan hemorrhoidectomy ✓
• B Injection sclerotherapy
• C Rubber band ligation
• D Stapled hemorrhoidopexy (PPH procedure)

Explanation

Fourth-degree hemorrhoids (permanently prolapsed, irreducible) require surgical hemorrhoidectomy for definitive treatment. Milligan-Morgan (open) hemorrhoidectomy excises the hemorrhoidal tissue with open wounds left to heal by secondary intention and has the lowest long-term recurrence rate. Injection sclerotherapy and rubber band ligation are for first and second-degree hemorrhoids. Stapled hemorrhoidopexy (PPH) is suitable for third-degree hemorrhoids and has higher recurrence rates for fourth-degree disease, making excisional hemorrhoidectomy the preferred choice.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.