Comparison between Ligation and Cauterization of Hemorrhoidal Pedicle with Milligan-Morgan Hemorrhoidectomy

Abstract Background: Currently, several therapies are used for symptomatic hemorrhoidal disease with various degrees of accepted treatment modality, but information on long-term outcomes is limited. Objectives: This study aimed to compare ligation and cauterization of hemorrhoidal pedicles with Milligan-Morgan hemorrhoidectomy. Patients and methods: This prospective cohort study was conducted on 200 patients with symptomatic hemorrhoidal disease in Sulaimani Surgical Teaching Hospital from January 2014 to January 2021. Patients were divided into 2 groups of 100 patients each. Group A underwent ligation and cauterization, while group B underwent Milligan-Morgan hemorrhoidectomy. Then, postoperative pain, urinary retention, and bleeding were collected. Patients were followed up for one year and data were collected regarding incontinence, anal stenosis and recurrence. Results: The mean age of patients was 37.19±9.7 years, and most were females. The most common symptom was mucosal prolapse, followed by bleeding per rectum, then discharge, pruritis, and perianal pain/discomfort. Patients in group A experienced less pain than those in group B. Regarding the postoperative complications, surgical site infection was the most common one in both groups (34%), followed by bleeding per rectum (26%), then urinary retention (20%), incontinence (15%), and recurrence (11%). In comparison, anal stenosis was only found in 3% of group B patients. Conclusions: The ligation and cauterization technique was safer, less costly, less painful, and had lower postoperative complication rates compared to the Milligan-Morgan procedure for the treatment of hemorrhoids.