Abstract

Classical Milligan Morgan Hemorrhoidectomy versus its Modification: Higher Risk of Fistula and Mucosal Ectropion

Aim: Assessment of a modified procedure of hemorrhoidectomy in terms of some postoperative complications in comparison to the original Milligan-Morgan hemorrhoidectomy. Methods: Total 182 patients with primary hemorrhoids were enrolled in the study, in Diwaniya Teaching Hospital, Iraq. The patients were equally divided and managed by the standard Milligan-Morgan open hemorrhoidectomy and the intended modification of the original procedure with the primary aim of reducing some of post-operative complications by providing wound coverage using the ligated hemorrhoidal pedicle which is further fixed to the cut edge perianal skin. Four post-operative complications pain, bleeding, fistula, and mucosal ectropion were compared between both groups. Results: There were 170 males and 12 females with a ratio of 14.16:1. Pain scale was not statistically different in both groups, with majority of patients 77.5% complained from mild and moderate pain. Most patients (91.7%) have a mild or no postoperative bleeding, with no significant differences between the two procedures. The frequency of post-operative low anal fistula was significantly higher in the modified procedure (7.7%, p=0.014). The development of post-operative mucosal ectropion was interestingly and significantly high (18.7%, p<0.00005) in patient who were subjected to the modified hemorrhoidectomy as compared to the classical hemorrhoidectomy. Conclusion: Understanding of the detailed anatomy of the anorectum is a crucial step before attempting any form of hemorrhoidectomy, and any modification for the originally tested procedures should follow the principles of preservation of the vital anatomical structure and its relations. The modification in our study associated with high frequency of post-operative fistula and ectropion.

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