Outcome of a modified Park's submucosal hemorrhoidectomy versus Milligan-Morgan for grade III-IV circumferential prolapsed hemorrhoids

Background: This prospective randomized controlled study compared the short- and long-term efficacy and advantages of modified Park's submucosal over Milligan-Morgan hemorrhoidectomy (MMH) in the treatment of grade III and IV circumferential prolapsed hemorrhoids (CPH).

Methods: A total of 186 consecutive patients with grade III or IV CPH were enrolled. The patients were randomized to MPSH (n = 93) or MMH (n = 93) treatment groups. Patient data included demographics, clinical characteristics, surgical parameters, underlying or arising complications, and CPH recurrence. The patients were closely followed up for at least 24 months.

Results: The patient demographic data and clinical parameters were comparable in the two groups (P > 0.05). MPSH took significantly longer operative time (P < 0.05). Although there was no significant difference in mean postoperative pain between the two groups at days 3 and 14, pain at day 7 was significantly more frequent and severe in the MMH group (P < 0.05). There were no significant group differences in postoperative bleeding, intraoperative blood loss, or development of anal stenosis (P > 0.05). However, the cumulative relapse-free rate was substantially higher in the MPSH group (P < 0.05).

Conclusion: MPSH and MMH are both practical and safe techniques for treating grade III and IV CPH disease. However, MPSH is safer, easier, and faster to perform and is associated with fewer recurrences within 24 months of surgery. Additional clinical studies are needed to validate these conclusions.