Our Summary

The study compared two different surgical techniques for treating hemorrhoids: the Milligan-Morgan (MM) hemorrhoidectomy and the hemorrhoidal artery ligation and rectoanal repair (HAL-RAR) technique.

They studied a group of 124 patients, but 8 were removed from the study because they couldn’t be reached for follow-up. Of the 116 remaining patients, 69 had the HAL-RAR procedure and 47 had the MM procedure.

After about 3.5 years, they found that hemorrhoids came back in about 29% of the HAL-RAR group and 19% of the MM group. The return of hemorrhoids happened faster in the HAL-RAR group (about 14 months) than in the MM group (around 21 months).

Interestingly, patients who had symptoms like itching, pain, or discomfort before surgery had fewer recurrences and were more satisfied with their results if they had the MM procedure. In contrast, patients whose main symptom before surgery was bleeding were more satisfied with the HAL-RAR procedure.

In conclusion, for patients with pain, itching or discomfort as their main symptom, the MM procedure may be the better option. For patients whose main symptom is bleeding, the HAL-RAR procedure may be more satisfactory.

FAQs

  1. What were the two surgical techniques compared in the study for treating hemorrhoids?
  2. What were the recurrence rates for hemorrhoids after the HAL-RAR and MM procedures?
  3. Which procedure is better for patients whose main symptom is bleeding, and which is better for those experiencing pain, itching, or discomfort?

Doctor’s Tip

When discussing a hemorrhoidectomy with your doctor, it is important to consider your specific symptoms and needs in order to determine the most appropriate surgical technique for you. If you are experiencing pain, itching, or discomfort as your main symptom, the Milligan-Morgan (MM) procedure may be more beneficial. If your main symptom is bleeding, the hemorrhoidal artery ligation and rectoanal repair (HAL-RAR) technique may be more suitable. Be sure to discuss your symptoms and concerns with your doctor to determine the best course of action for your individual situation.

Suitable For

Patients who are typically recommended for hemorrhoidectomy are those who have not responded well to conservative treatments such as dietary changes, fiber supplements, and topical medications. Patients with severe or recurrent hemorrhoids that significantly impact their quality of life, such as frequent bleeding, pain, itching, or discomfort, may benefit from surgical intervention. It is important for patients to discuss their symptoms and treatment options with their healthcare provider to determine the most appropriate course of action for their individual case.

Timeline

Before hemorrhoidectomy:

  • Patient experiences symptoms such as itching, pain, discomfort, or bleeding due to hemorrhoids.
  • Consults with a healthcare provider who recommends surgical treatment for severe cases.
  • Patient undergoes pre-operative evaluations and preparation for surgery.

After hemorrhoidectomy:

  • Patient undergoes either the Milligan-Morgan (MM) or hemorrhoidal artery ligation and rectoanal repair (HAL-RAR) procedure.
  • Recovery period post-surgery, which may involve pain, discomfort, and bleeding.
  • Follow-up appointments with healthcare provider to monitor healing and address any complications.
  • In the long term, some patients may experience a recurrence of hemorrhoids, with differences in recurrence rates and timing depending on the surgical technique used.
  • Patients may have varying levels of satisfaction based on their pre-operative symptoms and the type of procedure they underwent.

What to Ask Your Doctor

Some questions a patient should ask their doctor about hemorrhoidectomy:

  1. What are the different surgical techniques available for treating hemorrhoids, and which one do you recommend for me?
  2. What are the potential risks and complications associated with the hemorrhoidectomy procedure?
  3. How long is the recovery period after the surgery, and what can I expect in terms of pain and discomfort during this time?
  4. Will I need to make any changes to my diet or lifestyle before or after the surgery to help with recovery?
  5. What is the likelihood of hemorrhoids coming back after the surgery, and how can I reduce the risk of recurrence?
  6. How many hemorrhoidectomy procedures have you performed, and what is your success rate with this surgery?
  7. Are there any alternative treatments or non-surgical options for managing hemorrhoids that I should consider?
  8. How soon after the surgery can I expect to see improvement in my symptoms, and when can I resume normal activities?
  9. Will I need to schedule follow-up appointments after the surgery, and what signs or symptoms should I watch for that may indicate a complication?
  10. Can you explain the differences in satisfaction rates and recurrence rates between the Milligan-Morgan (MM) and HAL-RAR techniques based on the study findings?

Reference

Authors: Symeonidis D, Spyridakis M, Zacharoulis D, Tzovaras G, Samara AA, Valaroutsos A, Diamantis A, Tepetes K. Journal: BMC Surg. 2022 Dec 6;22(1):416. doi: 10.1186/s12893-022-01861-z. PMID: 36474223