Abstract
Purpose: Patients with prolapsing internal hemorrhoids were treated with Milligan-Morgan hemorrhoidectomy (MMH) technique, and the results were evaluated.
Materials and Methods: From January 2000 to January 2009, 828 consecutive hemorrhoidal patients underwent Milligan-Morgan technique. The patients records were examined, symptoms, associated with anorectal disease, operative findings, early and late postoperative complications were recorded.
Results: 70% were males and the mean age was 44 (17-76) years. Range of complaint duration was between 1 month to 5 years and according to the frequency prolapsing piles, bleeding, and anemia respectively. Prolapsing piles were located at classical (h 3.7.11) location in 74% of the patients. The majority (68%) had grade 4 hemorrhoids. 23% of our patients had associated anorectal disease (anal fissure). All procedures were performed under general anesthesia with the patient in lithotomy position. The mean operative time was 25 min. Postoperative complications occurred in 72 patients in early period. Of all patients, 4.2% complained of mild rectal pain for a postoperative period, 3.9% developed post-operative urinary retention, managed with catheterization, 1.7% developed hemorrhage. The most common early postoperative complication was anal fissure seen in 5 patients followed by anal stenosis (2 patients), and anal fistula-abscess developed in one patient. In patients treated with MMH, incontinence, and disease recurrence were not observed.
Conclusion: The Milligan-Morgan hemorrhoidectomy is still one of the most popular surgical treatments of hemorrhoids The authors conclude that the Milligan-Morgan technique is to be preferred because of its effectivity and safety.
Keywords:
Milligan-Morgan operation, hemorrhoidectomy, hemorrhoid
References
1Shanmugam V, Thaha MA, Rabindranath KS, Campbell KL, Steele RJ, Loudon MA. Rubber band ligation versus excisional haemorrhoidectomy for haemorrhoids. Cochrane Database Syst Rev 2005; 20;:CD005034.
2Jóhannsson HO, Påhlman L, Graf W. Randomized clinical trial of the effects on anal function of Milligan-Morgan versus Ferguson haemorrhoidectomy. Br J Surg 2006;93:1208–1214.
3Jayaraman S, Colquhoun PH, Malthaner RA. Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery. Dis Colon Rectum 2007;50:1297–1305.
4MacRae HM, McLeod RS. Comparison of hemorrhoidal treatment modalities. A meta-analysis. Dis Colon Rectum 1995;38:687–694.
5Guenin MO, Rosenthal R, Kern B, Peterli R, von Flüe M, Ackermann C. Ferguson hemorrhoidectomy: long-term results and patient satisfaction after Ferguson's hemorrhoidectomy. Dis Colon Rectum 2005;48:1523–1527.
6Altomare DF, Milito G, Andreoli R, Arcanà F, Tricomi N, Salafia C, Segre D, Pecorella G, Pulvirenti d'Urso A, Cracco N, Giovanardi G, Romano G; Ligasure for Hemorrhoids Study Group. Ligasure Precise vs. conventional diathermy for Milligan-Morgan hemorrhoidectomy: a prospective, randomized, multicenter trial. Dis Colon Rectum 2008;51:514–519.
7Khafagy W, El Nakeeb A, Fouda E, Omar W, Elhak NG, Farid M, Elshobaky M.Conventional haemorrhoidectomy, stapled haemorrhoidectomy, Doppler guided haemorrhoidectomy artery ligation; post operative pain and anorectal manometric assessment. Hepatogastroenterology 2009;56:1010–1015.
8Jayaraman S, Colquhoun PH, Malthaner RA. Stapled versus conventional surgery for hemorrhoids.Cochrane Database Syst Rev 2006;18:CD005393.
9Ivanov D, Babović S, Selesi D, Ivanov M, Cvijanović R.Harmonic Scalpel hemorrhoidectomy: a painless procedure? Med Pregl 2007;60:421–426.
10Amoli HA, Notash AY, Shahandashti FJ, Kenari AY, Ashraf H. A randomized,prospective, double-blind, placebocontrolled trial of the effect of topical diltiazem on post-hemorrhoidectomy pain. Colorectal Dis 2009.
11Al-Mulhim AS, Ali AM, Al-Masuod N, Alwahidi A. Post hemorrhoidectomy pain. A randomized controlled trial. Saudi Med J 2006;27:1538–1541.
12Nienhuijs S, de Hingh I.Conventional versus LigaSure hemorrhoidectomy for patients with symptomatic hemorrhoids. Cochrane Database Syst Rev 2009 21:CD006761.
13Lan P, Wu X, Zhou X, Wang J, Zhang L. The safety and efficacy of stapled hemorrhoidectomy in the treatment of hemorrhoids: a systematic review and metaanalysis of ten randomized control trials. Int J Colorectal Dis 2006;21:172–178.
14Shao WJ, Li GC, Zhang ZH, Yang BL, Sun GD, Chen YQ. Systematic review and meta- analysis of randomized controlled trials comparing stapled haemorrhoidopexy with conventional haemorrhoidectomy. Br J Surg 2008;95:147–160.
15Ozer MT, Yigit T, Uzar AI, Mentes O, Harlak A, Kilic S, Cosar A, Arslan I, Tufan T. A comparison of different hemorrhoidectomy procedures. Saudi Med J 2008;29:1264–1269.
16Madoff RD, Fleshman JW; Clinical Practice Committee, American Gastroenterological Association. American Gastroenterological Association technical review on the diagnosis and treatment of hemorrhoids. Gastroenterology 2004;126:1463– 1473.
17Pandini LC, Nahas SC, Nahas CS, Marques CF, Sobrado CW, Kiss DR. Surgical treatment of haemorrhoidal disease with CO2 laser and Milligan-Morgan cold scalpel technique. Colorectal Dis 2006;8:592-595.
18Kanellos I, Zacharakis E, Christoforidis E, Angelopoulos S, Kanellos D, Pramateftakis MG, Betsis D. Usefulness of lateral internal sphincterotomy in reducing postoperative pain after open hemorrhoidectomy. World J Surg 2005;29:464–468.
19Amorotti C, Mosca D, Trenti C, Pintaudi U. Usefulness of lateral internal sphincterotomy combined with hemorrhoidectomy by the Milligan-Morgan's technique: results of a prospective randomized trial. Chir Ital 2003;55:879–886.
20Halverson A. Hemorrhoids. Clin Colon Rectal Surg 2007;20:77–85.
21Stolfi VM, Sileri P, Micossi C, Carbonaro I, Venza M, Gentileschi P, Rossi P, Falchetti A, Gaspari A.Treatment of hemorrhoids in day surgery: stapled hemorrhoidopexy vs Milligan-Morgan hemorrhoidectomy. J Gastrointest Surg 2008;12:795–801.
