Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2025; 17(3): 103953
Published online Mar 27, 2025. doi: 10.4240/wjgs.v17.i3.103953
Comparative analysis of Ferguson hemorrhoidectomy combined with doppler-guided hemorrhoidal artery ligation and Ferguson hemorrhoidectomy in hemorrhoidal disease treatment
Ismail Cem Eray, Ugur Topal, Serdar Gumus, Kubilay Isiker, Burak Yavuz, Ishak Aydin
Ismail Cem Eray, Ugur Topal, Serdar Gumus, Kubilay Isiker, Burak Yavuz, Ishak Aydin, Department of General Surgery, Cukurova University Medical Faculty, Adana 01130, Türkiye
Author contributions: Eray IC was responsible for conception, acquisition of data, drafting the article, final approval; Topal U was responsible for conception, analysis, and interpretation of data, revising the article, final approval; Gumus S was responsible for conception, revising the article, final approval; Isiker K was responsible for conception, acquisition of data, final approval; Yavuz B was responsible for data analysis, revising the article, final approval; Aydın I was responsible for conception and design, drafting the article, final approval.
Institutional review board statement: This study was conducted with the approval of the Cukurova University Faculty of Medicine Ethics Committee, as evidenced by decision number 138/31, dated 03 November, 2023. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent statement: Informed consent was obtained from all individual participants included in the study. Each participant was provided with comprehensive information regarding the nature of the study, the procedures involved, potential risks and benefits, and their rights as research subjects, including the right to withdraw from the study at any point without any consequences.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: sharing statement: Research data is available from the authors upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ugur Topal, Assistant Professor, Department of General Surgery, Cukurova University Medical Faculty, Saricam, Adana 01130, Türkiye. dr.ugurtopal@gmail.com
Received: December 5, 2024
Revised: January 10, 2025
Accepted: January 21, 2025
Published online: March 27, 2025
Processing time: 81 Days and 8.9 Hours
Abstract
BACKGROUND

In hemorrhoidal disease, despite the existence of numerous treatment options to alleviate symptoms, surgical intervention continues to be the gold standard. The advantages and disadvantages of many methods have been shown in numerous studies However, only a few studies have compared the effectiveness of combined methods.

AIM

To compare the results of a coloproctology clinic that switched to the Doppler-guided hemorrhoidal artery ligation (DG-HAL) + Ferguson hemorrhoidectomy (FH) technique from the FH in the treatment of hemorrhoidal disease.

METHODS

In this retrospective cohort, data from a total of 45 patients who underwent DG-HAL + FH (n = 24) and FH (n = 21) for grade III hemorrhoidal disease between 2020 and 2022 were analyzed. Demographic and clinical data, surgical duration, intraoperative blood loss, hospital stay, postoperative analgesic consumption, pain scores using the Visual Analog Scale (VAS), complications, time to return to normal activities, and the recurrence rate were compared in both groups.

RESULTS

The study included 45 patients, with 75.6% (n = 34) male and 24.4% (n = 11) female. The rate of intraoperative blood loss was higher in the FH group (P < 0.05). The VAS scores and postoperative complication rates were similar in both groups. The need for postoperative analgesics was lower in the DG-HAL + FH group (2 vs 4 days, P < 0.05), while the FH group showed a shorter time to return to normal activities (9.5 vs 6.0 days, P = 0.02). The recurrence rate (16.7% vs 0%) and Clavien–Dindo Score-1 complications (20.8% vs 9.5%, P = 0.29) were higher in the DG-HAL + FH group but were insignificant.

CONCLUSION

Our study revealed that the addition of the DG-HAL to classical hemorrhoidectomy caused less intraoperative bleeding and a lower postoperative analgesia requirement.

Keywords: Hemorrhoidal disease; Doppler-guided hemorrhoidal artery ligation; Ferguson hemorrhoidectomy; Postoperative pain; Recurrence

Core Tip: In the contemporary treatment of hemorrhoidal disease, there is a broad spectrum of methods ranging from conservative treatments to stapled hemorrhoidectomy. The purpose of choosing combined therapy was to avoid undesirable complications such as pain and anal stenosis associated with conventional hemorrhoidectomies and to prevent potential tissue and sensory loss. We thought that non-invasive methods like Doppler or laser pexy might not be sufficient in some cases, while excision could be beneficial for prolapsed hemorrhoids. In this study, we compared the combined Ferguson approach [Ferguson + Doppler-guided hemorrhoidal artery ligation (DG-HAL)] with Ferguson hemorrhoidectomy only. We found that the duration of postoperative analgesic need was significantly lower in the DG-HAL + hemorrhoidectomy group, and the return to normal activity was quicker in Ferguson hemorrhoidectomy group.