Outcome of a modified Park's submucosal hemorrhoidectomy versus Milligan-Morgan for grade III-IV circumferential prolapsed hemorrhoids

Abstract

Background: This prospective randomized controlled study compared the short- and long-term efficacy and advantages of modified Park's submucosal over Milligan-Morgan hemorrhoidectomy (MMH) in the treatment of grade III and IV circumferential prolapsed hemorrhoids (CPH). Methods: A total of 186 consecutive patients with grade III or IV CPH were enrolled. The patients were randomized to MPSH (n = 93) or MMH (n = 93) treatment groups. Patient data included demographics, clinical characteristics, surgical parameters, underlying or arising complications, and CPH recurrence. The patients were closely followed up for at least 24 months. Results: The patient demographic data and clinical parameters were comparable in the two groups (P > 0.05). MPSH took significantly longer operative time (P 0.05). However, the cumulative relapse-free rate was substantially higher in the MPSH group (P < 0.05). Conclusion: MPSH and MMH are both practical and safe techniques for treating grade III and IV CPH disease. However, MPSH is safer, easier, and faster to perform and is associated with fewer recurrences within 24 months of surgery. Additional clinical studies are needed to validate these conclusions.

Keywords

• Circumferential prolapsed hemorrhoids (CPH)
• Milligan-Morgan hemorrhoidectomy (MMH)
• Modified Park's submucosal hemorrhoidectomy (MPSH)