Brief Article
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World J Gastroenterol. Aug 14, 2013; 19(30): 5011-5015
Published online Aug 14, 2013. doi: 10.3748/wjg.v19.i30.5011
Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection for circumferential mixed hemorrhoids
Ming Lu, Guang-Ying Shi, Guo-Qiang Wang, Yan Wu, Yang Liu, Hao Wen
Ming Lu, Guo-Qiang Wang, Yan Wu, Yang Liu, Hao Wen, Department of General Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
Guang-Ying Shi, Department of Gastroenterology, Xinjiang Production and Construction Corps Hospital, Urumqi 830042, Xinjiang Uygur Autonomous Region, China
Author contributions: Lu M is the principal surgeon and wrote the manuscript; Shi GY reviewed the literature; Wang GQ, Wu Y and Liu Y observed the indexes of the patients; and Wen H designed the study, revised and finalized the manuscript to be published.
Correspondence to: Hao Wen, Chief Physician, Professor, Doctoral Tutor, Department of General Surgery, First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi 830054, Xinjiang Uygur Autonomous Region, China. wenhao@163.com
Telephone: +86-991-4366594
Received: May 20, 2013
Revised: July 1, 2013
Accepted: July 12, 2013
Published online: August 14, 2013
Processing time: 84 Days and 12.2 Hours
Abstract

AIM: To identify a more effective treatment protocol for circumferential mixed hemorrhoids.

METHODS: A total of 192 patients with circumferential mixed hemorrhoids were randomized into the treatment group, where they underwent Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection, or the control group, where traditional external dissection and internal ligation were performed. Postoperative recovery and complications were monitored.

RESULTS: The time to wound healing was 12.96 ± 2.25 d in the treatment group shorter than 19.58 ± 2.71 d in the control group. Slight pain rate was 58.3% in the treatment group higher than 22.9% in the control group; moderate pain rate was 33.3% in the treatment group lower than 56.3% in the control group severe pain rate was 8.4% in the treatment group lower than 20.8% in the control group. No edema rate was 70.8% in the treatment group higher than 43.8% in the control group; mild local edema rate was 26% in the treatment group lower than 39.6% in the control group obvious local edema was 3.03% in the treatment group lower than 16.7% in the control group. No stenosis rate was 85.4% in the treatment group higher than 63.5% in the control group; moderate stenosis rate was 14.6% in the treatment group Lower than 27.1% in the control group severe anal stenosis rate was 0% in the treatment group lower than 9.4% in the control group.

CONCLUSION: Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection is the optimal treatment for circumferential mixed hemorrhoids and can be widely applied in clinical settings.

Keywords: Milligan-Morgan hemorrhoidectomy; Mixed hemorrhoids; Anal cushion; Internal sphincter

Core tip: We treated 96 patients with circumferential mixed hemorrhoids using Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection, and compared their clinical outcomes with those undergoing traditional hemorrhoidectomy. The differences are significant in favor of the modified Milligan-Morgan technique in terms of time to wound healing, anal stenosis, wound pain, edema and other complications. This approach can be widely applied in clinical practice.