Milligan–Morgan hemorrhoidectomy combined with rubber band ligation and polidocanol foam sclerotherapy for the management of grade III/IV hemorrhoids: a retrospective study
Abstract Background Hemorrhoids are one of the most common and annoying benign diseases in the field of colorectal surgery. A Milligan–Morgan hemorrhoidectomy (MMH) is the most frequently applied surgical technique due to its clear efficacy and high success rate, but the reported postoperative compl...
Saved in:
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-05-01
|
| Series: | BMC Gastroenterology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12876-025-03963-3 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850189905970331648 |
|---|---|
| author | Qing Long Yong Wen Jun Li |
| author_facet | Qing Long Yong Wen Jun Li |
| author_sort | Qing Long |
| collection | DOAJ |
| description | Abstract Background Hemorrhoids are one of the most common and annoying benign diseases in the field of colorectal surgery. A Milligan–Morgan hemorrhoidectomy (MMH) is the most frequently applied surgical technique due to its clear efficacy and high success rate, but the reported postoperative complications remain a major problem. This study aimed to retrospectively evaluate the efficacy and safety of a MMH combined with rubber band ligation and polidocanol foam sclerotherapy (MMH + RBL + PFS) for the management of grade III/IV hemorrhoids. Methods This was a single-center retrospective study. A total of 255 patients with grade III/IV hemorrhoids who underwent MMH + RBL + PFS (n = 128) or MMH (n = 127) between May 2022 and June 2023 were included in the study. The primary outcomes included recurrence rates, hemorrhoid severity score (HSS), and patient satisfaction 12 months after surgery. Secondary outcomes included intraoperative outcomes and postoperative outcomes. Results Follow-up was conducted by telephone or outpatient visit 12 months after surgery. The recurrence rate was lower in the MMH + RBL + PFS group than in the MMH group (p < 0.05). The patient satisfaction score was higher in the MMH + RBL + PFS group than in the MMH group (p < 0.05), and there was no significant difference in the HSS between the two groups (p > 0.05). The median operation time in the two groups was similar (16 min (15–20 min) vs.16 min (15–18 min), p > 0.05). The median number of incisions in the the MMH + RBL + PFS group was 3 (2–3), while that in the MMH group was 3 (3–4) (p < 0.05). There was no significant difference in intraoperative blood loss between the two groups (p > 0.05). Visual analog scale pain scores were lower in the MMH + RBL + PFS group than in the MMH group at the first postoperative defecation at 12 h and at 1, 3, and 7 days (all p < 0.05). The wound healing time was shorter in the MMH + RBL + PFS group than in the MMH group (27.62 ± 3.74 vs. 28.73 ± 4.48 days, respectively, p < 0.05). The incidence of urinary retention was lower in the MMH + RBL + PFS group than in the MMH group (5.47% vs. 12.60, respectively, p < 0.05). Nine patients (one case in the MMH + RBL + PFS group and eight cases in the MMH group (p < 0.05)) had delayed bleeding and were successfully controlled with manual compression or surgical hemostasis. No cases had anal stenosis in the MMH + RBL + PFS group, and six cases (4.72%) had it in the MMH group, all with mild anal stenosis and successfully treated by dilatation alone (p < 0.01). No incision infection or anal incontinence occurred in either group. At the 12-month follow-up after surgery, the recurrence rate was lower in the MMH + RBL + PFS group (0.78%) than in the MMH group (7.09%) (p < 0.05). The patient satisfaction score was higher in the MMH + RBL + PFS group (91.41%) than in the MMH group (81.10%) (p < 0.05), and there was no significant difference in the HSS between the two groups (p > 0.05). Conclusions Compared with the MMH, the MMH + RBL + PFS surgical procedure is safe and effective for grade III/IV hemorrhoids, which is associated with a lower recurrence rate, a higher patient satisfaction score, a lower postoperative pain score, fewer postoperative complications, and a shorter wound healing time. |
| format | Article |
| id | doaj-art-b16d4fd7b5ab4db8ae5c615d85d17911 |
| institution | OA Journals |
| issn | 1471-230X |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Gastroenterology |
| spelling | doaj-art-b16d4fd7b5ab4db8ae5c615d85d179112025-08-20T02:15:28ZengBMCBMC Gastroenterology1471-230X2025-05-0125111010.1186/s12876-025-03963-3Milligan–Morgan hemorrhoidectomy combined with rubber band ligation and polidocanol foam sclerotherapy for the management of grade III/IV hemorrhoids: a retrospective studyQing Long0Yong Wen1Jun Li2Department of Traditional Chinese Medicine, The Affiliated Hospital, Southwest Medical UniversityDepartment of Traditional Chinese Medicine, The Affiliated Hospital, Southwest Medical UniversityDepartment of Traditional Chinese Medicine, The Affiliated Hospital, Southwest Medical UniversityAbstract Background Hemorrhoids are one of the most common and annoying benign diseases in the field of colorectal surgery. A Milligan–Morgan hemorrhoidectomy (MMH) is the most frequently applied surgical technique due to its clear efficacy and high success rate, but the reported postoperative complications remain a major problem. This study aimed to retrospectively evaluate the efficacy and safety of a MMH combined with rubber band ligation and polidocanol foam sclerotherapy (MMH + RBL + PFS) for the management of grade III/IV hemorrhoids. Methods This was a single-center retrospective study. A total of 255 patients with grade III/IV hemorrhoids who underwent MMH + RBL + PFS (n = 128) or MMH (n = 127) between May 2022 and June 2023 were included in the study. The primary outcomes included recurrence rates, hemorrhoid severity score (HSS), and patient satisfaction 12 months after surgery. Secondary outcomes included intraoperative outcomes and postoperative outcomes. Results Follow-up was conducted by telephone or outpatient visit 12 months after surgery. The recurrence rate was lower in the MMH + RBL + PFS group than in the MMH group (p < 0.05). The patient satisfaction score was higher in the MMH + RBL + PFS group than in the MMH group (p < 0.05), and there was no significant difference in the HSS between the two groups (p > 0.05). The median operation time in the two groups was similar (16 min (15–20 min) vs.16 min (15–18 min), p > 0.05). The median number of incisions in the the MMH + RBL + PFS group was 3 (2–3), while that in the MMH group was 3 (3–4) (p < 0.05). There was no significant difference in intraoperative blood loss between the two groups (p > 0.05). Visual analog scale pain scores were lower in the MMH + RBL + PFS group than in the MMH group at the first postoperative defecation at 12 h and at 1, 3, and 7 days (all p < 0.05). The wound healing time was shorter in the MMH + RBL + PFS group than in the MMH group (27.62 ± 3.74 vs. 28.73 ± 4.48 days, respectively, p < 0.05). The incidence of urinary retention was lower in the MMH + RBL + PFS group than in the MMH group (5.47% vs. 12.60, respectively, p < 0.05). Nine patients (one case in the MMH + RBL + PFS group and eight cases in the MMH group (p < 0.05)) had delayed bleeding and were successfully controlled with manual compression or surgical hemostasis. No cases had anal stenosis in the MMH + RBL + PFS group, and six cases (4.72%) had it in the MMH group, all with mild anal stenosis and successfully treated by dilatation alone (p < 0.01). No incision infection or anal incontinence occurred in either group. At the 12-month follow-up after surgery, the recurrence rate was lower in the MMH + RBL + PFS group (0.78%) than in the MMH group (7.09%) (p < 0.05). The patient satisfaction score was higher in the MMH + RBL + PFS group (91.41%) than in the MMH group (81.10%) (p < 0.05), and there was no significant difference in the HSS between the two groups (p > 0.05). Conclusions Compared with the MMH, the MMH + RBL + PFS surgical procedure is safe and effective for grade III/IV hemorrhoids, which is associated with a lower recurrence rate, a higher patient satisfaction score, a lower postoperative pain score, fewer postoperative complications, and a shorter wound healing time.https://doi.org/10.1186/s12876-025-03963-3Milligan–Morgan hemorrhoidectomy (MMH)Rubber band ligationPolidocanol foam sclerotherapyHemorrhoidsPostoperative complications |
| spellingShingle | Qing Long Yong Wen Jun Li Milligan–Morgan hemorrhoidectomy combined with rubber band ligation and polidocanol foam sclerotherapy for the management of grade III/IV hemorrhoids: a retrospective study BMC Gastroenterology Milligan–Morgan hemorrhoidectomy (MMH) Rubber band ligation Polidocanol foam sclerotherapy Hemorrhoids Postoperative complications |
| title | Milligan–Morgan hemorrhoidectomy combined with rubber band ligation and polidocanol foam sclerotherapy for the management of grade III/IV hemorrhoids: a retrospective study |
| title_full | Milligan–Morgan hemorrhoidectomy combined with rubber band ligation and polidocanol foam sclerotherapy for the management of grade III/IV hemorrhoids: a retrospective study |
| title_fullStr | Milligan–Morgan hemorrhoidectomy combined with rubber band ligation and polidocanol foam sclerotherapy for the management of grade III/IV hemorrhoids: a retrospective study |
| title_full_unstemmed | Milligan–Morgan hemorrhoidectomy combined with rubber band ligation and polidocanol foam sclerotherapy for the management of grade III/IV hemorrhoids: a retrospective study |
| title_short | Milligan–Morgan hemorrhoidectomy combined with rubber band ligation and polidocanol foam sclerotherapy for the management of grade III/IV hemorrhoids: a retrospective study |
| title_sort | milligan morgan hemorrhoidectomy combined with rubber band ligation and polidocanol foam sclerotherapy for the management of grade iii iv hemorrhoids a retrospective study |
| topic | Milligan–Morgan hemorrhoidectomy (MMH) Rubber band ligation Polidocanol foam sclerotherapy Hemorrhoids Postoperative complications |
| url | https://doi.org/10.1186/s12876-025-03963-3 |
| work_keys_str_mv | AT qinglong milliganmorganhemorrhoidectomycombinedwithrubberbandligationandpolidocanolfoamsclerotherapyforthemanagementofgradeiiiivhemorrhoidsaretrospectivestudy AT yongwen milliganmorganhemorrhoidectomycombinedwithrubberbandligationandpolidocanolfoamsclerotherapyforthemanagementofgradeiiiivhemorrhoidsaretrospectivestudy AT junli milliganmorganhemorrhoidectomycombinedwithrubberbandligationandpolidocanolfoamsclerotherapyforthemanagementofgradeiiiivhemorrhoidsaretrospectivestudy |