ISSN ONLINE: 2558-815X
ISSN PRINT: 1584-9244
ISSN-L: 1584-9244

Is left lateral sphincterotomy a necessity during the Milligan-Morgan hemorrhoidectomy?


Introduction. The Milligan-Morgan technique is considered the gold standard for the surgical treatment of hemorrhoid disease. However, the modification of the Milligan-Morgan technique to reduce the risk of postoperative complications and allow a faster recovery of the patients is still debated.
The objective of the study was to assess the results of the surgical treatment of hemorrhoidal prolapse by comparing Milligan-Morgan technique, with and without left lateral sphincterotomy.
Material and methods. 152 patients diagnosed with hemorrhoidal prolapse, divided into two groups, were included in this study: group A, 92 patients treated by Milligan-Morgan technique, without left lateral sphincterotomy (MM); group B, 60 patients with left lateral sphincterotomy (MMS). The pain level and the outcomes during hospitalization and six months after surgery of these two groups were compared. The pain level was evaluated using the visual analog scale (VAS), 0 to 10.
Results. The mean level of postoperative and during the first defecation pain was 4.96 (±0.2) in group A and 5.26 (±0.3) (p=0.0001) in group B. The wound closure 30 days after surgery was 43% in group A and 15% in group B (p=0.0001). Urinary retention was present in 33% of patients from group A and 4% from group B (p=0.0001). Incontinence evaluated after six months, according to Pescatori score, and complications were not significant. Eight patients from group A had anal stricture (p=0.14). Postoperative complications in group A vs. group B were 37% vs. 4% (p=0.0001).
Conclusions. Lateral sphincterotomy reduces the level of postoperative pain, allows a faster healing and recovery of the patient and reduces the frequency of postoperative complications.
Keywords: hemorrhoidectomy, pain, sphincterotomy.

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Bollano E, Lila K, Thereska D, Simaku A, Gjata A. Is left lateral sphincterotomy a necessity during the Milligan-Morgan hemorrhoidectomy? Arch Balk Med Union. 2023;58(4):341-346.