Milligan-Morgan Hemorrhoidectomy Research Articles

Analysis of factors impacting postoperative pain and quality of life in patients with mixed hemorrhoids: A retrospective study.

Hemorrhoids are among the most common and frequently encountered chronic anorectal diseases in anorectal surgery. They are venous clusters formed by congestion, expansion, and flexion of the venous plexus in the lower part of the rectum. Mixed hemorrhoids bleed easily and recurrently, and this can result in severe anemia. Hence, they may have a negative effect on the health of the patient and surgical treatment is required. Milligan-Morgan hemorrhoidectomy has been widely used since 1937 for the treatment of grade III and IV hemorrhoids. However, most patients experience different degrees of postoperative pain that may cause anxiety. To assess the factors influencing pain scores and quality of life (QoL) in patients with mixed hemorrhoids post-surgery. The clinical data of patients with mixed hemorrhoids who underwent Milligan-Morgan hemorrhoidectomy were collected retrospectively. The basic characteristics of the enrolled patients with mixed hemorrhoids were recorded, and based on the Goligher clinical grading system, the hemorrhoids were classified as grades III or IV. The endpoint of this study was the disappearance of pain in all patients. Quantitative data were presented as mean ± SD, such as age, pain score, and QoL score. Student's t-test was used to compare the groups. A total of 164 patients were enrolled. The distribution of the visual analog scale pain scores of all patients at 3, 7, 14 and 28 d after surgery showed that post-surgery pain was significantly reduced with the passage of time. Fourteen days after the operation, the pain had completely disappeared in some patients. Twenty-eight days after the surgery, none of the patients experienced any pain. Comparing the World Health Organization Quality of Life - BREF self-reporting questionnaire scores of patients between 14 and 28 d after surgery, we observed that the quality-of-life scores of the patients post-surgery had significantly improved. There were six items that were compared at 14- and 28-d post-surgery. The mean QoL score 28 d after surgery (4.79 ± 0.46) was higher than that at 14 d post-surgery (3.79 ± 0.57). The mean health condition score 28 d after surgery (4.80 ± 0.41) was also higher than that at 14 d post-surgery (4.01 ± 0.62). The mean physical health score 28 d after surgery (32.10 ± 2.96) was significantly higher than that at 14 d post-surgery (23.41 ± 2.85). The mean psychological health score 28 d after surgery (27.22 ± 1.62) was significantly higher than that at 14 d post-surgery (21.37 ± 1.70). The mean social relations score 28 d after surgery (12.21 ± 1.59) was significantly higher than that at 14 d post-surgery (6.32 ± 1.66). The mean surrounding environment score 28 d after surgery (37.13 ± 2.88) was significantly higher than that at 14 d post-surgery (28.42 ± 2.86). The differences in quality-of-life scores at day 14 and day 28 post-surgery were observed to be statistically significant (P < 0.001). Milligan-Morgan hemorrhoidectomy can significantly improve the postoperative QoL of patients. Age, sex, and the number of surgical resections were important factors influencing Milligan-Morgan hemorrhoidectomy.

Treatment of grade four hemorrhoids in a patient with acute myeloid leukemia with severe thrombocytopenia by laser hemorrhoidopexy: A case report

Here, we present the case of a 66-year-old female patient with acute myeloid leukemia and severe thrombocytopenia who came with the complaints of painful per anal mass and bleeding per rectum for 1 year. The patient is a known case of obesity, hypertension, and diabetes mellitus and has received three cycles of chemotherapy with decitabine. On examination, she was found to have fourth- degree hemorrhoids at 3, 7, and 11 oclock positions with acute edematous changes. We successfully treated this patient with laser hemorrhoidopexy, whereby laser energy was delivered to each hemorrhoidal cushion. While lasers for the successful treatment of grade 2 and 3 hemorrhoids are well documented in the literature, we successfully treated this patient with prolapsing fourth-degree hemorrhoids with just laser energy delivery. With these results, we would also like to consider laser hemorrhoidopexy as an effective treatment option for four-degree hemorrhoids for which open Milligan–Morgan hemorrhoidectomy and stapler hemorrhoidectomy are currently considered treatment options.

Laser Hemorrhoidoplasty for Treatment of the Hemorrhoids in Eastern Nepal

Background: Millions worldwide are affected by hemorrhoids (prevalence 2.9%-27.9%), causing symptoms in over 4% of individuals. These anorectal disorders result from enlarged anal hemorrhoidal cushions, often due to constipation. Internal or external, they're graded by prolapse severity, with common symptoms including painless rectal bleeding. Treatment options range from conservative to surgical, with the gold standard, Milligan-Morgan hemorrhoidectomy, associated with postoperative pain. Laser hemorrhoidoplasty, a minimally invasive diode laser approach, shows promise, offering less postoperative pain, shorter hospital stays, and fewer complications than traditional surgical methods.&#x0D; Materials and Methods: A prospective observational study of 40 adults undergoing laser hemorrhoidectomy for symptomatic Goligher’s grade II and III hemorrhoids at Nobel Medical College Teaching Hospital, Biratnagar, Nepal, from June 2022 to June 2023. Outcomes included pain scores, bleeding, operative time, postoperative complications, hospital stay length, return-to-work time, and patient satisfaction measured by QOL SF36 scoring.&#x0D; Results: Among 40 patients, 16 were male and 24 females, averaging 42.32 ± 12.26 years. Grade III hemorrhoids were found in 31 patients, Grade II in 9. Operative time averaged 17.22 ± 2.14 minutes, with one case of managed intraoperative bleeding. Postoperative symptoms included pain, skin tags, and wound infection, but no reactive bleeding, urinary, or stool/flatus incontinence. Two cases experienced recurrence. Patient satisfaction in general health evaluation scored 65.11 ± 10.35.&#x0D; Conclusion: Laser hemorrhoidoplasty is associated with less complications, quicker operative time, quick recovery and similar patient satisfaction when compared to surgical methods of hemorrhoidectomy.

MALADIE HEMORROIDAIRE TRAITEE PAR LA METHODE DE MILLIGAN MORGAN A L’HOPITAL NATIONAL DONKA

Introduction: Hemorrhoids are a common anorectal condition. Hemorrhoidectomy according to Milligan Morgan consists of the excision of varicose hemorrhoidal nodules. This technique is considered the “gold standard”. However, it is associated with significant postoperative morbidity. The aim of our study was to report our experience in the management of hemorrhoids treated according to Milligan, Morgan. Methodology: This was a retrospective, descriptive study over 3 years from January 1, 2015 to December 31, 2017. The patients treated by Milligan Morgan formed the study population. Our variables were epidemiological, therapeutic and prognostic. Results: we collected 2.76% (n=56) of patients treated by the Milligan Morgan technique of all hospitalizations (N=2,025). The average age was 45.3 years; extremes (24 and 85 years). The age group of 30 to 39 years was the most represented 37.5% (n = 21). Anal pain 100% (n=56), rectorrhagia 55.35% (n=31) and prolapse 44.64% (n=25) were the reasons found. The average duration of evolution was 4.13 years; extreme (0.16 and 31 years). The comorbidities were diabetes 12.5% (n= 7), hypertension 7.14% (n= 4) and HIV 5.35% (n= 3). More than forty four percent (n=25) were grade 3 hemorrhoids; 21.42% (n=12) grade 4 and 14.28% (n=8) grade 2 complicated by rectal bleeding. The postoperative course was simple in 80.35% (n=45). The postoperative complications encountered were urinary retention 10.71% (n=6), hemorrhage 7.14% (n=4), suppuration 7.14% (n=4) and constipation 1.78%. (n=1). Conclusion: despite the multitude of therapeutic techniques for hemorrhoids; Milligan-Morgan hemorrhoidectomy remains widely practiced due to the lower cost of the operation, and is the most effective treatment available in our practice setting.

Clinical Trial: Management of Post-Haemorrhoidectomy Wound Healing by Bergamot Flavonoid-Based Gel and Sodium Hyaluronate: An Observational, Multicentric Trial

Objective: Haemorrhoidal disease (HD) is a very diffuse anorectal condition that involves a large part of the population, both male and female of every age. Among the procedures proposed to treat HD, conventional excisional surgery remains one of the most performed. Milligan-Morgan (MM) technique is one of the most used haemorrhoidectomy techniques. In this technique, the wounds are left open and re-epithelialization requires almost 3-5 weeks, in which patients generally experience pain and intense discomfort improving over the weeks.&#x0D; Methods: The aim of this study was to evaluate the effect of topic administration of Benebeo Gel®, mainly composed by bergamot-derived flavonoids and hyaluronic acid, on post-operative wound healing after open MM haemorrhoidectomy. An observational prospective study was carried out, involving 205 patients aged between 18 and 75.&#x0D; Results and Conclusion: The results after 2 weeks of treatment seem to be promising with a very good clinical outcome and patient satisfaction within 1 month.

Comparison of Pedicle Coagulation Hemorrhoidectomy With LigaSure Versus Conventional Milligan Morgan Hemorrhoidectomy in Reducing Post-operative Pain: A Randomized Controlled Trial.

Background Hemorrhoids refer to the abnormal enlargement of the anal cushions. They are a common anorectal problem with a prevalence of 5% in the general population aged greater than 40 years. The objective of this study was to compare Milligan-Morgan open hemorrhoidectomy with pedicle ligation with LigaSure (Medtronic, Dublin, Ireland) in terms of postoperative pain on day 1 and day 7. It is important to assess the technique that is associated with lower postoperative pain because both of these techniques are still practiced in the developing world. Methods It was a randomized controlled trial conducted in the Department of Surgery, Rawalpindi, Pakistan. A total of 100 patients were selected and were allotted into the two groups by lottery method. Patients aged from 15 to 60 years who presented with symptomatic third and fourth-degree hemorrhoids were included after taking informed consent. Patients who had a previous or concomitant anorectal disease, patients who had undergone previous surgery for hemorrhoids, and those who were anesthetically unfit for surgery (American Society of Anesthesiologists (ASA) class 3 or above) were excluded from the study. Pain was assessed using the Visual Analogue scale (VAS). Data was entered and analyzed using SPSS v. 23.0 (IBM Corp., Armonk, USA). Chi-square tests were applied. P-value <0.05 was taken as statistically significant. Results Out of 100 patients, 68 (68%) were males while 32 (32%) were females. The mean age was 40.56±9.24 years. Postoperative pain at day 1 was 9.24±0.51 in the Milligan-Morgan group while that in the LigaSure group was 8.44±0.64 (p<0.0001). Postoperative pain at day 7 was 5.00±0.85 in the Milligan-Morgan group while it was 3.04±1.08 in the LigaSure group (p<0.0001). Conclusion LigaSure is a newer technique that helps to reduce complications as compared to other traditional hemorrhoidectomy procedures. Many patients avoid hemorrhoidectomy as it is associated with painful postoperative recovery. Pedicle coagulation with LigaSure was better than conventional Milligan-Morgan hemorrhoidectomy in terms of reducing the mean postoperative pain on 1st day and 7th day. Reducing the postoperative painhelps in greater patient satisfaction and lesser requirement of analgesiaamong patients of 3rd and 4th-degree hemorrhoids undergoing hemorrhoidectomy.

Milligan-Morgan hemorrhoidectomy combined with non-doppler hemorrhoidal artery ligation for the treatment of grade III/IV hemorrhoids: a single centre retrospective study

BackgroundMilligan-Morgan hemorrhoidectomy (MMH) is the most widely used surgical procedure because of its precise curative effect, but it has the disadvantages such as obvious postoperative pain and bleeding. To retrospectively evaluate the efficacy and safety of MMH combined with non-Doppler hemorrhoidal artery ligation (MMH + ND-HAL) for the treatment of grade III/IV hemorrhoids.MethodsWe conducted a retrospective analysis of 115 patients with grade III/IV hemorrhoids, 53 patients had received MMH + ND-HAL, and the remaining 62 patients received MMH. We collected and compared demographic and clinical characteristics of both groups, including intraoperative blood loss, postoperative visual analog scale (VAS) for pain, analgesic consumption, postoperative bleeding, perianal incision edema, urinary retention, anal stenosis, anal incontinence incidence, recurrence rate (prolapse or bleeding), and patient satisfaction.ResultsThe VAS pain score of the first postoperative defecation and at the postoperative 12 h, 1 day, 2 days, 3 days, and 7 days, as well as the total analgesic consumption within 7 days, for the MMH + ND-HAL group were lower than those for the MMH group (P < 0.05). The intraoperative blood loss, the incidence of postoperative bleeding, perianal incision edema, and urinary retention in the MMH + ND-HAL group was lower than that in the MMH group (P < 0.05). No anal stenosis or anal incontinence occurred in either group. At follow-up by telephone or outpatient 12 months after surgery, the recurrence rate (prolapse or bleeding) was lower in the MMH + ND-HAL group than in the MMH group (P < 0.05), and satisfaction was higher in the MMH + ND-HAL group than in the MMH group (P < 0.05).ConclusionsMMH + ND-HAL was a satisfactory surgical modality for treating III/IV hemorrhoids.

Role of antibiotics in Milligan-Morgan hemorrhoidectomy for Grade III to IV Hemorrhoids: A randomized clinical trial

This study was mainly to compare the safety and long-term clinical efficacy of using intravenous antibiotics in Milligan Morgan hemorrhoidectomy for Grade III to IV Prolapsing Hemorrhoids. This was a parallel group, 3-arm, randomized clinical trial to evaluate the efficacy of intravenous prophylactic antibiotics. A total of 150 consecutive patients undergoing Milligan Morgan hemorrhoidectomy (MMH) in a tertiary hospital for grade III/IV hemorrhoids from January 2020 to August 2022 were enrolled. Patients were randomly assigned to three groups using a computer-generated table. Group A did not receive any prophylactic antibiotic, group B received 2g I/V Cefoxitin Sodium before the induction of anesthesia, and group C received 2g I/V Cefoxitin Sodium before the induction of anesthesia and 6h after operation. There was no significant difference in measured VAS values on the 1st day,3rd day and 7th day after surgery (p> 0.05). Compared with VAS values on the 1st day postoperatively, these values got decreased on the 3rd day and 7th day after surgery (p< 0.05). In addition, there was no significant difference among the first defecation time, wound edema, bleeding, urinary retention after surgery (p> 0.05). There was no significant difference in the outcome comparison between all 3 groups' basal and the 3rd day postoperatively no matter in WBC, NUET% or CRP (p> 0.05). However, compared with basal, the WBC, NUET%,CRP(p< 0.05) of group A and group B on the 3rd day postoperatively got rised, the rate of recurrence of hemorrhoids follow-up for 1 year was 1.4%. Our results suggest that there is no efficacy on intravenous prophylactic antibiotics in Milligan Morgan hemorrhoidectomy.

Laser hemorrhoidoplasty combined with blind hemorrhoidal artery ligation compared to Milligan–Morgan hemorrhoidectomy in patients with second and third degree piles; a prospective randomized study

Background Laser hemorrhoidoplasty is a relatively new management option for symptomatic hemorrhoids. Although its advantages over the Milligan–Morgan approach were highlighted in previous trials, the combination of laser and mucopexy (hemorrhoidal artery ligation) is scarcely discussed in the literature. Herein, the author compared the outcomes of the previous combination with the traditional Milligan–Morgan procedure in cases with second and third-degree piles. Methods The 66 included patients were randomly divided into two groups; group A underwent the combined approach, while group B underwent the Milligan–Morgan procedure. Postoperative pain, satisfaction, and complications were assessed. Results Preoperative data, including patient presentation and the degree of piles, were comparable between the two groups. Nonetheless, operative time and hospitalization period showed a significant increase in group B (P = 0.004 and &lt; 0.001). Group A patients expressed significantly lower pain scores during rest and defection, as well as a better satisfaction level, compared with group B patients. The incidence of postoperative complication did not differ between the two interventions, except for urine retention, which was more frequently encountered in group B cases. An earlier return to normal daily activities was noted in group A. 1-month Wexner scores did not differ between the two groups, and no cases developed recurrence during the 1-year follow-up. Conclusion The combination of laser with hemorrhoidal artery ligation is associated with multiple advantages over surgical hemorroidectomy manifested in a better analgesic profile, better satisfaction, and an early restoration to daily activities.

Comparative Study of Short-Term Outcome between Laser Hemorrhoidoplasty and Milligan-Morgan Hemorrhoidectomy

Background: Due to the fear of postoperative pain and complications associated with open Milligan-Morgan (MM) surgery, mildly symptomatic patients often hesitate and delay undergoing surgical treatment for internal haemorrhoids. Laser Hemorrhoidoplasty (LHP) has been gaining popularity recently in the management of hemorrhoid. This study aimed to evaluate the efficacy of the LHP compared with MM surgery in the management of internal haemorrhoids. Materials and methods: This multi-center, open label, randomized controlled trial included 60 patietns with secondand third-degree internal haemorrhoids. The patients were randomized in a 1:1 ratio to receive either LHP (Group I) or conventional MM hemorrhoidectomy (Group II). Primary outcome parameter was postoperative pain assessed by Visual Anlougue Scale (VAS) at 24 hours, 7 days and 30 postoperative days. Results: Both the groups were comparable in terms of the demographic characteristics. The mean operation time was significantly lower in group I than group II (19.13±3.42 vs. 28.67±4.54 minutes, p&lt;0.001). The mean VAS score of pain at 24 hours and 7 days postoperative were significantly lower in group I than in group II (p&lt;0.001 and p&lt;0.004, respectively). At postoperative, 30 days the mean VAS scores were similar in both groups (p=0.722). The mean total days of consumed analgesic were significantly shorter in group I than in group II (7.94±5.79 vs. 11.01±2.96 days, p&lt;0.001). The mean time to return to regular activity was significantly earlier in group I than in group II (8.76±3.58 vs. 13.6±3.47, p&lt;0.001). Postoperative bleeding was less in group I than in group II (6.6% vs. 26.7%). The mean length of hospital stay, rate of complete resolution and need for medical treatment for residual symptom and repeated surgery were similar between two groups. Conclusion: LHP was associated with reduction of postoperative pain, postoperative bleeding, and administered with analgesics. So, if available LHP is preferred to open hemorrhoidectomy. IAHS Medical Journal Vol 5(2), Dec 2022; 15-19

LigaSure hemorrhoidectomy vs Milligan morgan hemorrhoidectomy: A Quasi-Experimental Study.

Objective: To explore the efficacy of two surgical procedures by comparing the mean operative time, average blood loss and postoperative pain score during conventional and LigaSure. Study Design: Quasi-experimental study. Setting: Department of Surgery, Aziz Fatimah Hospital, to compare the efficacy of two surgical procedures regarding perioperative and postoperative variables. Period: One Year (1st July 2020 -30th June 2021). Material &amp; Methods: Sixty patients with grade three and four haemorrhoids were randomized into two groups with 30 patients each. A questionnaire comprising all the variables was filled out and analyzed in SPSS 21. Results: Thirty patients were randomized into two groups, with group A comprising 21 (70%) females and, 9 (30%) males and 24 (80%) females, 6(20%) males in group B undergoing conventional hemorrhoidectomy. The study was single-blind, as the patients were unaware of the procedure they underwent. The mean age in group A was 39 years, and in group, B was 43 years. The mean operative time calculated was 38.4±2.77 and 51.7±2.60 in LigaSure and Milligan Morgan Hemorrhoidectomy, respectively, with a P-value calculated &lt;0.00001. The average blood loss in LigaSure was 31.3 ± 5.76 and 49 ± 7.11 in Milligan morgan hemorrhoidectomy. Moreover, the pain assessment score on day one and all other variables were statistically significant, with a P-value of &lt;0.00001. Conclusion: Ligasure hemorrhoidectomy is a safer surgical procedure associated with less operative time, blood loss and postoperative pain with shorter hospital stay and rapid wound healing.

Comparative study of Ligasure Haemorrhoirdectomy with conventional Milligan-Morgan Haemorrhoidectomy

AIM: Comparison of Ligasure hemorrhoidectomy with conventional Milligan Morgan hemorrhoidectomy for the treatment of grade III and IV hemorrhoids. Material and Methods: The current study was achieved between December 2020 to December 2022. A total of 64 Patients of grade III and IV hemorrhoids were randomized into two groups, Group A- Ligasure hemorrhoidectomy (32 patients) and Group B- Milligan Morgan hemorrhoidectomy (32 patients). The hemorrhoidal predicle was coagulated with Ligasure in Group A and transfixed with 1/0 Vicryl in Group B. Procedure time, the amount of lost blood, postoperative pain, and duration of hospitalization were recorded. Result: Out of 64 patients, there were 38 males and 26 females. The mean age of all patients for group A was 42 years, and for group B, was 48 years. The average procedure time in both group A was 23.6±8 min and in group B 53.5±9 min respectively. The average amount of lost blood was 12.50 ml in group A and 29.40 ml in group B. The VAS pain scores on the 0 day and 7th day in group A were 4.8, and 1.2 respectively and in group B were 7.2, and 2.6 respectively. The duration of hospitalization was 1.4 days and, 3.2 days in both groups, respectively. Conclusion: The submucosal dissection technique with Ligasure coagulation of the hemorrhoidal pedicle is safe and effective. Suturing is not required as the mucosal tissue over the pedicle is sealed off with the current. There is minimal lateral spread of either thermal or electrical energy. Because of its ease of use and less postoperative pain and complication Ligasure hemorrhoidectomy can be preformed as a day-care procedure.

Mid-term efficacy and postoperative wound management of laser hemorrhoidoplasty (LHP) vs conventional excisional hemorrhoidectomy in grade III hemorrhoidal disease: the twisting trend

PurposeHemorrhoidal disease (HD) is a common condition, and several surgical techniques have been proposed to date without being able to achieve definitive consensus on their use and indications. Laser hemorrhoidoplasty (LHP) is a minimally invasive procedure for HD treatment determining the shrinkage of the hemorrhoidal piles by diode laser limiting the postoperative discomfort and pain. The aim of the current study was to evaluate the postoperative outcomes of HD patients undergoing LHP vs conventional Milligan-Morgan hemorrhoidectomy (MM).MethodPostoperative pain, wound care management, symptoms’ resolution, patients’ quality of life, and length of return to daily activity of grade III symptomatic HD patients undergoing LHP vs MM were retrospectively evaluated. The patients were followed-up for recurrence of prolapsed hemorrhoid or symptoms.ResultFrom January 2018 to December 2019, 93 patients received conventional Milligan Morgan as control group and 81 patients received laser hemorrhoidoplasty treatment using a 1470-nm diode laser. No significant intraoperative complications occurred in both groups. Laser hemorrhoidoplasty patients experienced lower postoperative pain score (p < 0.0001) and smoother wound management. After 25 ± 8 months follow-up, the recurrence of symptoms occurred in 8.1% after Milligan-Morgan and 21.6% after laser hemorrhoidoplasty (p < 0.05) with a similar Rorvik score (7.8 ± 2.6 in LHP group vs 7.6 ± 1.9 in MM group, p = 0.12).ConclusionLHP demonstrated high efficacy in selected HD patients guaranteeing lower postoperative pain, easier wound care, higher rate of symptoms resolution, and greater patient appreciation compared to MM, even though it had a higher recurrence rate. Larger comparative studies are needed to address this issue.

HAEMORRHOIDECTOMY : ULTRASONIC SCALPEL VERSUS DIATHERMY CAUTERY

INTRODUCTION Haemorrhoids are the most common anorectal disease seen in age group between 45-50 years. Milligan Morgan haemorrhoidectomy is the gold standard operative procedure for grade 3 and grade 4 haemorrhoids.In the last decade high frequency sound wave energy ultrasonic scalpel is used to cut and coagulate tissues in Milligan-Morgan haemorrhoidectomy. OBJECTIVE Our aim is to do a comparative study between the outcomes of a Milligan Morgan haemorrhoidectomy by using ultrasonic scalpel versus diathermy cautery. MATERIALS AND METHODS This is a prospective comparative randomized study done over a period of 6months (April 2022-September 2022) at GGH Vijayawada. 60 patients of age group 45-65 years. They were randomly divided into 2 groups of 30 each. Group A – Underwent haemorrhoidectomy with diathermy cautery Group B- Underwent haemorrhoidectomy with harmonic scalpel. RESULTS Patients who underwent harmonic scalpel haemorrhoidectomy have statistically signicant P value in post operative pain , post op urinary retention and anal stenosis. CONCLUSION Harmonic scalpel is better than diathermy in having relatively less post operative pain and early resumption of daily activities and less occurrence of urinary retention and anal stenosis

A Comparative Study on Post-operative Outcomes of Stapled Haemorrhoidopexy versus Milligan–Morgan Haemorrhoidectomy in Patients above 60 Years

Abstract Background: Haemorrhoidal disease is one of the most common benign anorectal pathologies worldwide. Plethora of treatment options available for haemorrhoids. Stapled haemorrhoidopexy and Milligan–Morgan haemorrhoidectomy were commonly done surgeries. Aim: we compared the short-term post-operative outcomes of stapled haemorrhoidopexy with Milligan–Morgan haemorrhoidectomy in patients aged above 60 years. Materials and Methods: It was a prospective, observational, comparative study from August 2020 to May 2022 on 100 patients above 60 years admitted to the general surgery departments with a diagnosis of third- and fourth-degree haemorrhoids and underwent stapled haemorrhoidopexy and Milligan–Morgan haemorrhoidectomy were included in the study after applying inclusion and exclusion criteria. Results: In stapled haemorrhoidopexy, mild pain is experienced in 44 (88%) patients and moderate pain in only 6 (12%) patients compared to 38 (76%) patients in Milligan–Morgan haemorrhoidectomy experience mild pain and 12 patients (24%) had moderate pain in 1st post-operative day. Anal incontinence is present in 12 (24%) patients of Milligan–Morgan surgical candidates and 3 (6%) patients of stapled haemorrhoidectomy patients on 1st post-operative day. First post-operative day 11 patients (22%) of Milligan–Morgan surgery developed urinary retention, whereas 6 patients (12%) of stapled surgery showed urinary retention. Forty-five (90%) patients resumed to normal activities within 1 week following Milligan–Morgan haemorrhoidectomy. Forty-six (92%) patients resumed to normal activities within 1 week following stapled haemorrhoidopexy. The average operating time for stapled haemorrhoidopexy was 33.0 min and Milligan–Morgan haemorrhoidectomy was 45.6 min. Thirty-nine (78%) patients were discharged 2 days after Milligan–Morgan haemorrhoidectomy and 3 (6%) patients were discharged 2 days after stapled haemorrhiodopexy. Eleven (22%) patients were discharged 2 days after Milligan–Morgan haemorrhoidectomy and 47 (94%) patients were discharged 2 days after stapled haemorrhiodopexy. Conclusion: We found that stapled haemorrhoidopexy is a better alternative compared to Milligan–Morgan haemorrhoidectomy as it outweighs the latter in terms of short-term post-operative outcomes included in the study.

Milligan–Morgan hemorrhoidectomy vs. hemorrhoid artery ligation and recto-anal repair: a comparative study

BackgroundSeveral surgical techniques for the treatment of hemorrhoidal disease (HD) have been proposed. However, the selection of the most proper technique for each individual case scenario is still a matter of debate. The purpose of the present study was to compare the Milligan–Morgan (MM) hemorrhoidectomy and the hemorrhoidal artery ligation and rectoanal repair (HAL–RAR) technique.MethodsA retrospective analysis of the prospectively collected database of patients submitted to HD surgery in our department was conducted. Patients were divided into two groups, the MM group and the HAL–RAR group. Primary end points were recurrence rates and patients’ satisfaction rates. The Unpaired t test was used to compare numerical variables while the x2 test for categorical variables.ResultsA total of 124 patients were identified, submitted either to HAL–RAR or MM hemorrhoidectomy. Eight (8) patients were lost to follow up and were excluded from the analysis. Of the remaining 116 patients, 69 patients (54 males and 15 females–male / female ratio: 3.6) with a median age of 47 years old (range 18–69) were included in the HAL–RAR group while 47 patients (40 males and 7 females–male / female ratio: 5.7) with a median age of 52 years old (range 32–71) comprised the MM group. At a median follow up of 41 months (minimum 24 months–maximum 72 months), we recorded 20 recurrences (28.9%) in the HAL–RAR group and 9 recurrences in the MM group (19.1%) (p 0.229). The mean time from the procedure to the recurrence was 14.1 ± 9.74 months in the HAL–RAR group and 21 ± 13.34 months in the MM group. Patients with itching, pain or discomfort as the presenting symptoms of HD experienced statistically significantly lower recurrences (p 0.0354) and reported statistically significantly better satisfaction rates (6.72 ± 2.15 vs. 8.11 ± 1.99—p 0.0111) when submitted to MM. In the subgroup of patients with bleeding as the presenting symptom, patients satisfaction rates were significantly better (8.59 ± 1.88 vs. 6.45 ± 2.70—p 0.0013) in the HAL–RAR group.ConclusionsIn patients with pain, itching or discomfort as the presenting symptoms of HD, MM was associated with less recurrences and better patients satisfaction rates compared to HAL–RAR. In patients with bleeding as the main presenting symptom of HD, HAL–RAR was associated with better patients’ satisfaction rates and similar recurrence rates compared to MM.

Top 100 most-cited articles on hemorrhoids: A bibliometric analysis and visualized study.

Hemorrhoids have a significant incidence in people and are becoming a common public health problem. This study provides a bibliometric and visualized analysis of the most influential literature in the field. The aim is to reveal trends in the field of hemorrhoids and to provide a reference for researchers. The 100 most frequently cited studies in the field of hemorrhoids were collected from the Web of Science(WOS), and were analyzed in terms of the annual publication, types of literature, countries, institutions, authors, journals, and keywords. During the study, we used a combination of VosViewer, Carrot2, Microsoft Excel, and Tableau tools to better present the visual information. A total of 4,481 articles were retrieved, of which 3,592 were of the Article and Review types, among which we selected the 100 most frequently cited. A large amount of highly cited literature on hemorrhoid surgery emerged from 1990 to 2010, and the interest of researchers in hemorrhoid surgery seems to have waned after 2010. The sources of highly cited literature in the field of hemorrhoids are predominantly Western, with the United States. and the United Kingdom accounting for almost half of the publications worldwide. However, countries with higher prevalence populations do not have significant research on hemorrhoids. St. Mark's Hospital has published the largest number of influential articles in the field of hemorrhoid disease. Kamm MA and Phillips RKS are the most authoritative authors in the field. Diseases of the Colon & Rectum and the British Journal of Surgery are the most influential journals in this field. The highly cited literature covers a wide range of disciplines, with Thomson's classic "The nature of hemorrhoids" receiving the most attention among the studies focusing on hemorrhoids. Keyword and clustering analysis revealed that The most famous focus in the field of hemorrhoid research is the evolution of stapled hemorrhoidectomy (SH) and Milligan-morgan hemorrhoidectomy (MMH). This study is the first to explore developments in the field of hemorrhoids, and it helps surgeons quickly understand global trends in the field of hemorrhoids. In recent years, the development of hemorrhoids seems to have hit a bottleneck, with scholarly interest in the field of waning, especially in surgery Procedures. The theory of inferior anal cushion migration has proven to be the most influential theory in the field, but after studies based on SH and MMH, more high-quality evidence is needed to continue advancing the field of hemorrhoids. The results of this study are intended to add to the attention and interest of scholars in this area and provide a reference for further research.

ENSEAL® Hemorrhoidectomy, a Novel Technique, Versus Conventional Open Method for the Management of Grade III and IV Hemorrhoids.

Background Surgical removal of hemorrhoids is the gold-standard treatment for symptomatic grade III and IV hemorrhoid disease.There are numerous ways the hemorrhoidectomy surgical procedure is done but the most effective and least painful way is still to be elucidated. Objective To compare the outcomes of ENSEAL® (Ethicon, Inc., Raritan, USA) versus gold standard Milligan-Morgan hemorrhoidectomy in patients presenting with grade-III and IV hemorrhoids Materials and methods After ethical approval, the Randomized Controlled Trial was conducted at the Department of Surgery, Unit III, Lahore General Hospital, Lahore, Pakistan, between January 2020 and January 2022. In this study, 140 patients who met the inclusion criteria were recruited after informed consent. Patients were split randomly into two equal groups using a lottery technique. In group A, hemorrhoidectomy was carried out with ENSEAL®, whereas in group B, open hemorrhoidectomy was performed by the Milligan-Morgan method. the surgery duration and blood loss werenoted. After the operation, patients were transferred to and discharged from the post-anesthesiarecovery room. Patients were further followed up for pain scores after 24 hours. Data was analyzed by using Statistical Package for Social Sciences (SPSS) v25 (IBM Corp., Armonk, USA). Data was categorized for age, gender, body mass index (BMI), degree of hemorrhoids, and duration of hemorrhoids. A p-value <0.05 was considered significant. Results 140 patients were included in this study. Group A patients underwent ENSEAL® hemorrhoidectomy, and group B was formed from those who underwent the Milligan-Morgan procedure. In group A, there were 41 (58.5%) males and 29 (41.4%) females, while in group B, there were 43 (61.4%) males and 27 (38.5%) females. The mean age of group A patients was 49.97 ± 7.36 years and 43.2 ± 8.01 years in group B. In group A, the mean operative time was 20.87 ± 3.05 min, while 27.10 ± 3.42 minin group B, which is statistically significant with a p-value of <0.001. In group A, mean blood loss was 9.79 ± 2.87 ml, while 13.36 ± 3.73 ml in group B, which is statistically significant with a p-value of <0.001. In group A, the mean pain score was 2.7 ± 1.08, while 3.34 ± 1.16 in group B, which is statistically significant with a p-value of <0.001. Conclusion When considering the length of the procedure and blood loss, ENSEAL® hemorrhoidectomy has been determined to be an effective treatment that the patients tolerated well. Therefore, ENSEAL® hemorrhoidectomy can be a safe and efficient alternative to conventional treatment for hemorrhoids that are causing symptoms.

Laser hemorrhoidoplasty for hemorrhoidal disease: a systematic review and meta-analysis.

Laser hemorrhoidoplasty (LHP) is known as a new minimally invasive and painless procedure for symptomatic hemorrhoids. However, Milligan-Morgan (MM) may offer the best result of long-term cure rates. In this study, we aim to compare the efficacy between LHP and MM for hemorrhoidal disease treatment. Using specific keywords, we comprehensively go through the potential articles on PubMed, Europe PMC, and Google Scholar sources until April 19, 2022. All published studies on LHP and MM hemorrhoidectomy were collected. Statistical analysis was done by using Review Manager 5.4 software. Twelve studies with a total of 1756 patients with hemorrhoid grades II-IV were included for the analysis. Our pooled analysis revealed that LHP was associated with shorter operative time (p < 0.00001), shorter length of hospital stay (p = 0.0005), lower risk of urinary retention (p = 0.005) and anal stenosis (p = 0.0004), and lower VAS 24-h post-operative (p < 0.00001) when compared with MM. However, LHP and MM did not differ in terms of recurrence rate (p = 0.70). LHP was superior to MM procedure in terms of shortening the recovery time and minimizing post-operative complications for patients with hemorrhoidal disease.

A study of analgesic effect of methylene blue injection in post conventional haemorrhoidectomy

Background: Haemorrhoids are common perianal disease. Milligan-Morgan haemorrhoidectomy operation is a classical haemorrhoid resection procedure that has been widely used as gold standard.  Classical haemorrhoidectomy is associated with considerable postoperative pain. This leads to patient discomfort; prolonged hospital stays and increased cost. The causes of post haemorrhoidectomy pain are multifactorial. Methylene blue has been widely used as biological dye. It is an inhibitor of soluble guanylate cyclase. It has also been found to reduce cyclooxygenase products. The mechanism of action of methylene blue is likely to be related to the destruction of dermal nerve endings.Methods: A prospective study of 114 indoor patients was conducted to compare the effects of 1% intradermal methylene blue injection at local site and injection paracetamol (I.V.) as per requirement after Milligan-Morgan haemorrhoidectomy admitted to Surat municipal institute of medical education and research (SMIMER) hospital at Department of General Surgery. Samples were divided into two groups each of 57 patients, in case group patients were given intradermal methylene blue at local site after haemorrhoidectomy and in both groups’ injection paracetamol was given as per requirement. Both groups are assessed by visual analogue scale (VAS).Results: Present study concluded that mean post-operative score according visual analogue scale (VAS) in case group was significantly lower as compared to control group on 1st and 3rd post-operative day.Conclusions: Methylene blue injection has an analgesic effect at local site after post conventional haemorrhoidectomy without any significant side effects of methylene blue.