COMPARISON OF MILLIGAN MORGAN (OPEN) VERSUS FERGUSON (CLOSED) HEMORRHOIDECTOMY IN TERMS OF POST-OPERATIVE COMPLICATIONS: A RANDOMIZED CONTROLLED TRIAl

Abstract

Background: Excisional hemorrhoidectomy remains the gold standard surgical treatment for advanced hemorrhoidal disease; however, controversy persists regarding the comparative superiority of the Milligan–Morgan (open) and Ferguson (closed) techniques in terms of postoperative outcomes. Variations in postoperative pain, wound healing, and bleeding reported in international literature necessitate further regional evidence to guide surgical decision-making. Objective: To compare postoperative complications, specifically hemorrhage, wound dehiscence, and postoperative pain, between the Milligan–Morgan (open) and Ferguson (closed) hemorrhoidectomy techniques in patients with Grade III and Grade IV hemorrhoids. Methods: This single-center, parallel-group randomized controlled trial was conducted at the Department of Surgery, Khyber Teaching Hospital, Peshawar, from February 2023 to July 2023. A total of 168 patients aged 30–70 years with Grade III or Grade IV hemorrhoids were enrolled and randomly allocated in a 1:1 ratio to either Group A (Milligan–Morgan/open hemorrhoidectomy; n=84) or Group B (Ferguson/closed hemorrhoidectomy; n=84) using block randomization with allocation concealment. Postoperative pain assessment was performed by an independent blinded observer. Primary outcome measures included postoperative hemorrhage, wound dehiscence, and postoperative pain assessed using the Visual Analogue Scale (VAS). Data were analyzed using IBM SPSS Statistics version 25.0. Results: Baseline demographic and clinical characteristics were comparable between the two groups. Postoperative hemorrhage occurred in 20 patients (23.8%) in both the Milligan–Morgan and Ferguson groups, with no statistically significant difference observed (p=0.999). Wound dehiscence occurred in 20 patients (23.8%) in the open group and 17 patients (20.2%) in the closed group (p=0.576). The relative risk (RR) for wound dehiscence in the Milligan–Morgan group was 1.18 (95% CI: 0.66–2.08). The mean postoperative pain score on the first postoperative day was 4.11 ± 1.98 in the open group compared with 3.77 ± 1.53 in the closed group, with a mean difference of 0.34 (95% CI: −0.20 to 0.88; p=0.224). Conclusion: Both Milligan–Morgan (open) and Ferguson (closed) hemorrhoidectomy techniques demonstrated comparable safety profiles, with no statistically significant difference in postoperative hemorrhage, wound dehiscence, or postoperative pain. However, the Ferguson technique showed favorable clinical trends toward lower wound dehiscence rates and reduced postoperative pain, suggesting potential advantages in enhancing early postoperative recovery and patient comfort.

Keywords: Hemorrhoidectomy; Milligan–Morgan; Ferguson; postoperative complications; randomized controlled trial.