A Comparative Study of Open (Milligan-Morgan) Versus Closed (Ferguson) Hemorrhoidectomy
Introduction : Hemorrhoidectomy is an operation for third and fourth degree haemorrhoids. There are two methods by which hemorrhoidectomy can be done -open (Milligan-Morgan) in which the wound is left open and allowed to heal by secondary intension and closed (Ferguson) methods in which the wound is closed with absorbale sutures. Aim: To compare post operative pain and recovery in open (Milligan-Morgan) and closed (Ferguson) methods and evaluate optimum choice of the procedure for third or fourth degree hemorrhoids. Study Design: Prospective randomized study. Settings: Department of Surgery, Dr. Vasantrao Pawar Medical College, Hospital and Research Center. Duration: Two year (August 2010 to August 2012). Sample Size: 70 cases (35 cases in each group). Inclusion Criteria: Patients with third/four degree hemorrhoids. Exclusion Criteria: Patients with associated anal and perianal conditions like fissure in ano, inflammatory bowel diseases and rectal malignancy, portal hypertension were excluded from the study. Results: Mean hospital stay for open group was 5 days and closed group was 3 days. Post operative pain was seen in 77% in open group and 48 % in closed group. Pain was relieved earlier in closed group. 71% patients had completely healed wounds at 3 weeks in closed group in comparision to only 42% in open group. Anal stenosis was seen in 2 patients of open hemorrhoidectomy. Conclusion: Closed hemorrhoidectomy is the procedure of choice for three/four degree hemorrhoids.