Transverse incision with longitudinal ligation procedure: Innovation, pitfalls, and clinical perspectives

The transverse incision with longitudinal ligation (TILL) procedure is a new method for treating circumferential prolapsed hemorrhoids. A study by Song et al found TILL to be better than the traditional Milligan-Morgan hemorrhoidectomy for short-term results, showing less pain, quicker healing, and lower risk of anal stenosis. TILL reduces tissue tension and controls blood supply, allowing effective removal of diseased tissue while maintaining anal function and structure. However, the study's limitations, including its retrospective, single-center design, small sample size, and short follow-up, restrict the findings' generalizability and ability to assess long-term outcomes like recurrence. Larger, multicenter trials are needed for a thorough evaluation and wider clinical adoption of TILL.