Acta Scientific Medical Sciences (ASMS)(ISSN: 2582-0931)

Research Article Volume 7 Issue 8

Combining Milligan-Morgan Technique with Left Lateral Sphincterotomy for Better Outcomes in Prolapsed Hemorrhoids

Enton Bollano1*, Krenar Lila1, Dariel Thereska1, and Ina Kola2, Blina Abdullahu3, Jyotsna MMBS4, Wern Lynn5, Naglaa Ghobriel MBBS1, FNU Deepali MMBS7, Fjolla Hyseni8, Abdallah al-madani9 Valon Vokshi10, Jacklyn Tan Wohlers11 and Arben Gjata1

1Departament of Surgery, Faculty of Medicine, University of Medicine, Tirana, University Hospital Center “Mother Theresa”, Tirana, Albania
2Department of Burns and Plastic Surgery, University Hospital Center “Mother Theresa”, Tirana, Albania
3MD, Faculty of Medicine, University of Medicine, Tirana, University Hospital Center “Mother Theresa”, Tirana, Albania
5Department of Internal Medicine,UPMC HARRISBURG USA
7MBBS, Department of Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN, USA
8MD, PhD candidate, Research scientist/Sonographer, NYU Langone Health, New York, USA
9King Hussein Medical Center Jordan AMMAN
10Valon Vokshi Department of Anesthesiology university clinical center, Kosovo
11Department of Laboratory Medicine and Pathology, Mayo Clinic Rocester MN, USA

*Corresponding Author: Enton Bollano, Departament of Surgery, Faculty of Medicine, University of Medicine, Tirana, University Hospital Center “Mother Theresa”, Tirana, Albania.

Received: July 12, 2023; Published: July 24, 2023


Introduction: The "Milligan-Morgan" technique is considered as the golden standard for the surgical treatment of hemorrhoid disease [1]. However, modification aim to improve patient’s outcome and reduce the number of postoperative complications and faster rehabilitation of patients has been and remains subject to many studies. The choice of technique depends on various factors, including the severity of hemorrhoids, the surgeons expertise, and the individual patients needs and preferences.

Aim: The study aimed to compare the outcomes of patients who underwent the Milligan-Morgan technique alone versus those who had the Milligan-Morgan technique combined with left lateral sphincterotomy. The researchers likely evaluated several factors, including postoperative pain, wound healing, complications, recurrence rates, and patient satisfaction. By comparing the two groups, the study aimed to determine whether the addition of left lateral sphincterotomy provided any additional benefits in terms of improved outcomes, reduced postoperative pain, or better overall patient satisfaction compared to the Milligan-Morgan technique alone.

Material and Methods: In this study, 152 patients diagnosed with hemorrhoidal prolapse were divided into two groups: Group A, consisting of 92 patients who underwent the "Milligan-Morgan" technique without left lateral sphincterotomy (MM), and Group B, consisting of 60 patients who underwent the "Milligan-Morgan" technique with left lateral sphincterotomy (MMS). We compared the data related to pain level and complications, including postoperative pain, wound healing, complications, recurrence rates, and patient satisfaction, during the hospitalization period and six months after surgery between the two groups.

Results: The study indicated several findings regarding the comparison of the "Milligan-Morgan" technique without left lateral sphincterotomy (Group A) and with left lateral sphincterotomy (Group B) for patients with hemorrhoidal prolapse. Here is a summary of the findings:

  1. The average pain level was 4.96 for Group A and 5.26 for Group B. These results suggest that patients in Group B (MMS) had slightly higher pain levels but showed better tolerance during the postoperative period compared to Group A (MM).
  2. Group A had a 43% wound closure rate, while Group B had a significantly higher closure rate of 9%. This indicates that wounds in Group B closed relatively faster compared to Group A.
  3. Urinary retention was compared between the two groups, resulting in 33% in Group A and 4% in Group B. The statistical significance of P = 0.0001 indicates that Group B had a significantly lower incidence of urinary retention compared to Group A.
  4. Incontinence: both groups had similar rates of incontinence at the six-month mark.

Complications: Up to six months after surgery, there were 8 patients with anal stricture, which did not reach statistical significance (P = 0.14). However, Group A had a higher number of complications, including: postoperative pain, wound healing issues, complications, and recurrence rates compared to Group B. Group B had a lower incidence of complications (14%) compared to Group A (37%).

Conclusion: The addition of left lateral sphincterotomy to open hemorrhoidectomy in patients with prolapsed hemorrhoids offers several benefits: postoperative pain reduction, faster wound healing, preserved urinary continence, reduction in postoperative complications.

 Keywords: Open Hemorrhoidectomy; Pain; Sphincterotomy; Hemorrhoids; Hemorrhoidal Prolapse


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    Citation: Enton Bollano., et al. “Combining Milligan-Morgan Technique with Left Lateral Sphincterotomy for Better Outcomes in Prolapsed Hemorrhoids”.Acta Scientific Medical Sciences 7.8 (2023): 176-181.


    Copyright: © 2023 Enton Bollano., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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