Proper principles and practices in the surgical management of hemorrhoids.

THE TERN[ "HEMORRHOID" iS derived f rom the Greek (haima blood; rhoos = flowing) and was first used by Hippocrates in his treatises.n 2 T h e word "pile" (Latin pila, a ball) was used in the writings of John Arderne. 3 Hemorrhoids, which are varicosities of the hemorrhoidal veins, may be internal or external. In ternal hemorrhoids occupy the submucous space proximal to the dentate line. T h e lower port ion is covered by cuboidal epi thel ium and the upper part by columnar epithelium. T h e veins form the internal hemorrhoidal plexus and are radicles of the superior hemorrhoidal vein (Fig. 1). External hemorrhoids occupy the marginal space external to the crypt or dentate line, where the transitional epithel ium is firmly attached to the internal sphincter muscle by fibroelastic fibers of the submucosae ani, called the mucosat suspensory ligament. 22 This space occupies the distal portion of the anal canal, extending to the anal verge, where it is l imited by a ring of terminal intermuscular fibers of the conjoined longitudinal muscle which proceed medially and upward to blend with the mucosal suspensory l igament at the dentate line. Shropshear 2s prefers the term "anal intermuscular septum" to designate the terminal fibers. T h e proximal surface of this space consists of transitional or modified squamous epi thel ium and that of the distal port ion is true skin. T h e term "anoderm" aptly describes this structure. External hemorrhoids develop from branches of