An evaluation of Milligan-Morgan and Ferguson procedures for haemorrhoidectomy at Liaquat University Hospital Jamshoro, Hyderabad, Pakistan

Abstract

Objective: o compare the outcome of Milligan-Morgan (MMH) and Ferguson (FH) techniques for haemorrhoidectomy with regard to postoperative pain, control of bleeding, early mobilization of patients and wound healing. Methodology: In this prospective, randomized clinical study conducted between January 2005 to December 2008, 213 patients with late 2nd degree; third or fourth degree hemorrhoids were assigned to two groups. One hundred ten patients in group A were operated by an open method and 103 patients in group B were operated by closed method. Results: Age ranged from 22-70 years with mean age of 45.5 years. Peak incidence was between 41-50 years. Out of 213 patients, 170 (79.81%) were male and 43 (20.18%) were females. The mean ± SD operating time was significantly more in group B (31.3±4.8 min) than group A (25.2±5.6). The duration of hospitalization and duration off from work was more in group A than the group B. Wound healing was quicker in group B than the group A. Post operative pain scores were significantly low in the Group A than Group B during first 24 hours and at first bowel movements. Reactionary hemorrhage occurred in 4 (3.63%) patients of group A, no patient in group B developed this complication. Retention of urine was seen in 13 (11.81%) patients in group A and 4 (3.88%) in group B. No patient in group A developed anal stenosis, while 3 (2.91%) patients in group B developed anal stenosis. Wound infection was one (0.9%) in group A and two (1.9%) in group B. Two (3.63%) patients in group A came with recurrent hemorrhoids and in group B, only one (0.97%) patient reported recurrence. Conclusions: The closed technique is more beneficial with respect to postoperative pain, control of bleeding, early mobilization of patients and wound healing.

Hemorrhoidal disease: Predilection sites, pattern of presentation, and treatment

“…The wound healed faster when seen at outpatient follow-up visit, more than in cases done by Milligan-Morgan open technique as documented in literature. [20] A balance is usually struck at operation between removing too much tissue with the risk of stenosis or removing too little and risking recurrence. This is especially true with circumferential Grade IV hemorrhoids [Figure 3].…”

Evaluation the Role of Harmonic Scalpel in Open and Closed Hemorrhidectomy, Comparative Study

“…7 Numerous studies have documented the benefits of the harmonic scalpel technique in treating hemorrhoids, including a reduction in intraoperative time, a decrease in blood loss, and improved outcomes following surgery, including reduced pain, decreased tissue oedema, a lower risk of infection, and improved wound healing. 8 The harmonic scalpel is an ultrasonically actuated device that vibrates at a rate of 55,000 per second using sound waves as its power source. It has a reputation for coagulating small and medium-sized arteries, which means that it might lessen tissue edema and swelling during surgery.…”

The efficacy of topical sucralfate in improving pain and wound healing after haemorrhoidectomy procedure: A systematic review, meta‐analysis, and meta‐regression of randomised clinical trials

“…Moreover, wound healing is slower than other techniques. Thus, persisting the pain even months to years 12‐15 …”

“…Thus, persisting the pain even months to years. [12][13][14][15] Pethidine is a synthetic opioid analgesic drug, approved for use since 1943. It has been used widely for moderate and severe acute pain such as labour and postoperative patient and post-open haemorrhoidectomy.…”