Milligan-Morgan (Open) Versus Ferguson Haemorrhoidectomy (Closed): A Systematic Review and Meta-Analysis of Published Randomized, Controlled Trials

World J Surg. 2016 Jun;40(6):1509-19. doi: 10.1007/s00268-016-3419-z.

Abstract

Objective: The purpose of this article is to systematically analyse the randomized, controlled trials (RCTs) comparing Ferguson or closed haemorrhoidectomy (CH) versus open haemorrhoidectomy (OH) or Milligan-Morgan haemorrhoidectomy in the management of haemorrhoidal disease (HD).

Methods: RCTs on the effectiveness of CH and OH in the management of HD were analysed systematically using RevMan(®), and combined outcome was expressed as odds ratio (OR) and standardized mean difference.

Results: Eleven CRTs encompassing 1326 patients were analysed systematically. There was significant heterogeneity among included trials. Therefore, in the random effects model, CH was associated with a reduced post-operative pain (SMD, -0.36; 95 % CI, -0.64, -0.07; z = 2.45; p = 0.01), faster wound healing (OR, 0.08; 95 % CI, 0.02, 0.24; z = 4.33; p < 0.0001), lesser risk of post-operative bleeding (OR, 0.50; 95 % CI, 0.27, 0.91; z = 2.27; p < 0.02) and prolonged duration of operation (SMD, 6.10; 95 % CI, 3.21, 8.98; z = 4.13; p < 0.0001). But the variables such as pain on defecation (SMD, -0.33; 95 % CI, -0.68, 0.03; z = 1.82; p = 0.07), length of hospital stay, post-operative complications, HD recurrence and risk of surgical site infection were similar in both groups.

Conclusion: CH has clinically measurable advantages over OH in terms of reduced post-operative pain, lower risk of post-operative bleeding and faster wound healing.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Defecation
  • Hemorrhoidectomy / adverse effects*
  • Hemorrhoidectomy / methods*
  • Hemorrhoids / surgery*
  • Humans
  • Length of Stay
  • Operative Time
  • Pain, Postoperative / etiology
  • Postoperative Hemorrhage / etiology*
  • Randomized Controlled Trials as Topic
  • Recurrence
  • Surgical Wound Infection / etiology*
  • Treatment Outcome
  • Wound Healing