Milligan–Morgan hemorrhoidectomy, mucopexy, and hybrid combination for grade III hemorrhoids: a large retrospective cohort study

Abstract Background Mucopexy has emerged as a nonexcisional alternative to Milligan–Morgan (MM) hemorrhoidectomy. Objective This study compares MM, mucopexy, and hybrid MM/mucopexy procedures in patients with grade III hemorrhoidal disease (HD). Design Retrospective cohort study. Setting Tertiary referral setting. Patients Symptomatic grade III HD treated between 2016 and 2018. Interventions Four groups were defined: group 1 included patients treated with MM alone; group 2 received mucopexy on one pile combined with MM on the remaining two; group 3 underwent mucopexy on two piles with MM on the remaining one; and group 4 was treated with mucopexy alone. Main outcomes measures Recurrence rates and patient-reported outcome measures (PROMs) using a visual-analogic scale (VAS) at 2 years, postoperative pain at 7 days, early complication rates at 30 days, and PROMs at 30 days. Results A total of 686 consecutive patients with III-degree HD were included in the analysis. The most frequent approach was MM alone (group 1, n  = 309, 45%), followed by mucopexy alone (group 4, n  = 138, 20.2%), then the combined approaches (group 2, n  = 120, 17.5%; group 3, n  = 119, 17.3%). Group 4 had the lowest pain scores and the highest 30-day PROM ( p  < 0.001), whereas group 1 showed the best long-term results, with the lowest recurrence rate (4.2% versus 14.5% in group 4) and highest long-term PROM. Limitations Retrospective analysis. Conclusions Mucopexy and the hybrid procedures reduce morbidity and enhances early postoperative PROM in grade III HD. However, its higher recurrence rate suggests that a patient- and pile-specific approach may help balance efficacy with surgical invasiveness.