Background: Currently, several therapies are used for symptomatic hemorrhoidal disease with various degrees of accepted treatment modality, but information on long-term outcomes is limited. Objectives: This study aimed to compare ligation and cauterization of hemorrhoidal pedicles with Milligan-Morgan hemorrhoidectomy. Patients and methods: This prospective cohort study was conducted on 200 patients with symptomatic hemorrhoidal disease in Sulaimani Surgical Teaching Hospital from January 2014 to January 2021. Patients were divided into 2 groups of 100 patients each. Group A underwent ligation and cauterization, while group B underwent Milligan-Morgan hemorrhoidectomy. Then, postoperative pain, urinary retention, and bleeding were collected. Patients were followed up for one year and data were collected regarding incontinence, anal stenosis and recurrence. Results: The mean age of patients was 37.19±9.7 years, and most were females. The most common symptom was mucosal prolapse, followed by bleeding per rectum, then discharge, pruritis, and perianal pain/discomfort. Patients in group A experienced less pain than those in group B. Regarding the postoperative complications, surgical site infection was the most common one in both groups (34%), followed by bleeding per rectum (26%), then urinary retention (20%), incontinence (15%), and recurrence (11%). In comparison, anal stenosis was only found in 3% of group B patients. Conclusions: The ligation and cauterization technique was safer, less costly, less painful, and had lower postoperative complication rates compared to the Milligan-Morgan procedure for the treatment of hemorrhoids.

Background Different surgical strategies emerged as a pilonidal disease (PNS) became more prevalent. There is considerable debate over the best surgical management. Objective This study aimed to compare the outcomes of marsupialization (MP) vs laying open (LO) techniques in studied patients. Patients and Methods This study was conducted on 200 consecutive patients with chronic PNS who operated either the excision and MP technique (Group 1, no.=100) or excision and LO technique (Group 2, no.=100) in Hospital, Sulaimaniyah, Iraq, from January 2012 to January 2022. The patients' socio-demographics, perioperative data, complications and recurrences were collected using a well-designed, self-prepared questionnaire. Also, the patient’s data was evaluated after surgery regarding postoperative pain, satisfaction, healing and dressing time, incapacity to work and overall postoperative complications. Results Most patients were aged 20–29 years (40.5%), males (71.5%), had working hours for > 6 hours (57%), had no family history of PNS (86.0%), presented with pain (44.83%), and with hirsutism (41.5%). For postoperative pain, 39.5% of the patients had severe pain, 38% had moderate, and 22.5% had mild, with highly significant differences (p = 0.000) between both studied groups. Concerning patient postoperative satisfaction, most patients (32.5%) had good and least had excellent (6.0%) satisfaction, with highly significant differences (p = 0.000) between both studied groups. Moreover, for the association between the outcomes of both used techniques, a substantial correlation between both groups was found for incapacity for regular daily activity (p = 0.046), healing time (p = 0.000), dressing time (p = 0.000), infection, dehiscence, bleeding and recurrence (p = 0.045). Conclusion MP was the preferred technique over LO in managing postoperative patient satisfaction, pain severity, duration of healing, and dressing time, as it had fewer complications with less recurrence rate.