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Closed vs. open hemorrhoidectomy--is there any difference?

G Arbman1, H Krook, S Haapaniemi

  • 1Department of Surgery and Urology, Norrköping-Finspång, Vrinnevi Hospital, Norrköping, Sweden.

Diseases of the Colon and Rectum
|May 17, 2000
PubMed
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Comparing closed (Ferguson) and open (Milligan-Morgan) hemorrhoidectomy, this study found no significant differences in complications or pain. However, the closed method demonstrated faster wound healing and fewer delayed healing symptoms.

Area of Science:

  • Colorectal Surgery
  • Surgical Outcomes Research

Background:

  • Hemorrhoidectomy remains a common surgical procedure for symptomatic hemorrhoids.
  • Both open (Milligan-Morgan) and closed (Ferguson) techniques are widely employed.

Purpose of the Study:

  • To compare the Ferguson (closed) and Milligan-Morgan (open) hemorrhoidectomy techniques.
  • Evaluation focused on postoperative conditions, complications, and long-term results.

Main Methods:

  • A randomized study involving 77 patients with second or third-degree hemorrhoids.
  • Patients were randomized to either Milligan-Morgan (39) or Ferguson (38) procedure.
  • Data collected included operative details, complications, hospital stay, pain assessment, and follow-up at 3 weeks, 6 weeks, and over 1 year.

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Main Results:

  • No statistically significant differences were observed in overall complications, pain levels, or postoperative hospital stay between the two techniques.
  • Four reoperations for bleeding occurred, exclusively in the Milligan-Morgan group.
  • At 3-week follow-up, 86% of Ferguson hemorrhoidectomy patients had healed wounds versus 18% of Milligan-Morgan patients, with significantly more delayed healing symptoms in the latter group.

Conclusions:

  • Both closed and open hemorrhoidectomy techniques are effective treatments for hemorrhoids with no serious drawbacks.
  • The closed method offers no advantage in immediate postoperative pain relief but shows superior wound healing rates.
  • Concerns regarding wound dehiscence with the closed method appear to be exaggerated.