Is the Procedure of Ligation and Excision the Gold Standard? -Basic Ligation and Excision Techniques, and the Evidence-

Abstract

Hemorrhoid treatment strategies are chosen depending on the size and form of the hemorrhoid. Surgery is considered to be appropriate for Grade III hemorrhoids, which requires manual reduction. Hemorrhoidectomy based on the Milligan-Morgan procedure has been improved for a long time, and has been regarded as the standard procedure because of its many advantages: anal functions are conserved, complete cure can be achieved, the procedure is safe, and serious complications are rare. Delayed massive bleeding, which is a problem of this operative procedure, occurred in 2.2% of cases, 81% of which happened within 14 days after the operation. Postoperative anal stenosis and recurrence were found in 0.1% and 0.2% of cases, respectively. In addition, 46.2% of hemorrhoid patients had comorbid lesions different from hemorrhoids. We therefore consider that a different anal hemorrhoidectomy procedure is required that safely provides persistent therapeutic effects for all hemorrhoid cases.