Immediate haemorrhoidectomy for thrombosed fourth degree haemorrhoids.

Madam, We mad with interest a short report published in your November issue titled "Immediate Haemorrhoidectomy for Thrombosed Fourth Degree Haemorrhoids”. The Author has compared the results of immediate haemorrhoidectomy and conservative treatment. Unfortunately, be did not mention the treatment that we have found simple and effective in thrombosed, prolapsed haemorrholds. Head and Gudgeon reported instant pain relief if only one of the strangulated haemorrhoids was excised, We have seen in our practice that in majority of cases, only one of the prolapsed haemorrhoid gets thrombosed. Excision of that haemorrhoid is simple and safe. In selective cases, we have done this under local anaesthetic. One does not have to worry abou; mucocutaneous bridges and anal stenosis does not thrombosed haemorrhoids, internal sphincterotomy and anal dilatation have been described, but we have not practised these options in prolapsed, thrombosed haemorrhoids.