Modified procedure for prolapse and hemorrhoids: Lower recurrence, higher satisfaction

Figure 1 Patients with prolapsing hemorrhoids treated with a modified procedure for prolapse and hemorrhoids. A: Preoperative hemorrhoids status; B: The hemorrhoids were exposed; C: Absorbable sutures were fixed in a modified location, the circular stapler was tightened, and the gun was fired; D: The mucosa was dissected.

Figure 2 Length of hospital stay and operating time. A: Mean length of hospital stay was significantly longer after Milligan-Morgan hemorrhoidectomy (8.05 ± 2.50 d) than after any of the other procedures (^aP < 0.0001) and was significantly longer than after the modified procedure for prolapse and hemorrhoids (7.24 ± 1.30 d) and after the procedure for prolapse and hemorrhoids (6.13 ± 1.93 d) (^bP < 0.0001); B: Mean operating time was significantly greater in Milligan-Morgan hemorrhoidectomy (19.98 ± 4.21 min) than in any of the other procedures (^cP < 0.0001) and was significantly shorter in the procedure for prolapse and hemorrhoids (13.30 ± 2.74 min) than in the modified procedure for prolapse and hemorrhoids (15.55 ± 3.27 min) (^dP < 0.0001). MMH: Milligan-Morgan hemorrhoidectomy; M-PPH: Modified procedure for prolapse and hemorrhoids; PPH: Procedure for prolapse and hemorrhoids.

Figure 3 Early postoperative complications. A: Postoperative anastomotic bleeding rate after the modified procedure for prolapse and hemorrhoids (M-PPH) was significantly lower than that after the procedure for prolapse and hemorrhoids (^aP < 0.0001); B: Sensation of rectal tenesmus rate after procedure for prolapse and hemorrhoids was significantly higher than that after the Milligan-Morgan hemorrhoidectomy (^bP = 0.005). The rate after the modified procedure for prolapse and hemorrhoids was significantly higher than that after the procedure for prolapse and hemorrhoids (^cP = 0.008) or Milligan-Morgan hemorrhoidectomy (^dP < 0.0001). MMH: Milligan-Morgan hemorrhoidectomy; M-PPH: Modified procedure for prolapse and hemorrhoids; PPH: Procedure for prolapse and hemorrhoids.

Figure 4 The rate of postoperative recurrence. The rate after the procedure for prolapse and hemorrhoids was significantly higher than that after the modified procedure for prolapse and hemorrhoids (^aP < 0.0001) or the Milligan-Morgan hemorrhoidectomy (^bP < 0.0001). MMH: Milligan-Morgan hemorrhoidectomy; M-PPH: Modified procedure for prolapse and hemorrhoids; PPH: Procedure for prolapse and hemorrhoids.

Figure 5 Further postoperative anal dysfunction. A: The incidence of postoperative anal discharge in the Milligan-Morgan hemorrhoidectomy, procedure for prolapse and hemorrhoids and modified procedure for prolapse and hemorrhoids group was 3.7%, 6.2% and 5.6%, respectively; B: The rate of postoperative anal incontinence after the modified procedure for prolapse and hemorrhoids was significantly higher than that after the Milligan-Morgan hemorrhoidectomy (^aP = 0.001); C: The postoperative anal stenosis rate after Milligan-Morgan hemorrhoidectomy was significantly higher than that after the procedure for prolapse and hemorrhoids (^bP < 0.0001) or the modified procedure for prolapse and hemorrhoids (^cP < 0.0001). MMH: Milligan-Morgan hemorrhoidectomy; M-PPH: Modified procedure for prolapse and hemorrhoids; PPH: Procedure for prolapse and hemorrhoids.