Ponad 7000 publikacji medycznych!
Statystyki za 2021 rok:
odsłony: 8 805 378
Artykuły w Czytelni Medycznej o SARS-CoV-2/Covid-19

Poniżej zamieściliśmy fragment artykułu. Informacja nt. dostępu do pełnej treści artykułu
© Borgis - Nowa Medycyna 1/2016, s. 22-28 | DOI: 10.5604/17312485.1203778
*Małgorzata Kołodziejczak1, Przemysław Ciesielski1, 2, Paweł Dutkiewicz2
The place of Milligan-Morgan haemorrhoidectomy in the contemporary algorithm for the treatment of haemorrhoidal disease – a review of current literature
1Warsaw Proctology Centre, Saint Elizabeth’s Hospital, Mokotów Medical Centre, Warsaw
Head of Department: Małgorzata Kołodziejczak, PhD, Associate Professor
2Department of General Surgery, County Hospital in Wołomin
Head of Department: Krzysztof Górnicki, MD, PhD
Summary
Among the classic methods of hemorrhoidectomy the two most commonly used methods are open Milligan-Morgan hemorhoidectomy (MMH) and closed Ferguson hemorrhoidectomy (FH). Although the Milligan-Morgan method was described by the authors in 1937 it is still, with some modifications, a commonly used method of surgical treatment of hemorrhoids. The advantages of the method are high efficacy, ease of execution, short learning curve and minimal recurrence rate. Disadvantages are pain after surgery and a long, about six-week, healing period of the anal canal. The authors present indications for the procedure, describe the technique of the operation and the place of the MMH procedure in the algorithm of hemorrhoidal disease treatment. The authors also compare the effectiveness of the MMH and the rate of complications to those of other surgical methods such as FH by reviewing the literature of recent years. Despite the introduction of many new surgical techniques the classic open Milligan-Morgan hemorrhoidectomy stood the test of time and still has its place in the treatment of advanced and complicated hemorrhoidal disease.



Introduction
Currently the indications for the classic haemorrhoid surgery have been significantly narrowed. It is thought that the majority of patients with haemorrhoidal disease should receive effective conservative treatment and only 10-15% of patients require surgery.
The two most commonly used classic methods of haemorrhoid removal are open Milligan-Morgan haemorrhoidectomy and closed Ferguson haemorrhoidectomy. Interestingly enough, while both methods have been known for several decades, they are still in use with certain modifications. The Milligan-Morgan haemorrhoidectomy procedure was described by its authors in 1937 and has been the most commonly used surgical method in the treatment of haemorrhoids up to this day (1).
Indications
Classic haemorrhoidectomy is chosen mainly for patients with grade IV haemorrhoidal disease as well as patients with earlier grades of the disease with profuse bleeding resulting in anaemia, for whom other methods of treatment have proven ineffective (including surgical procedures conducted in outpatient settings) and patients with large marginal folds coexisting with haemorrhoids. In patients with prolapsed haemorrhoids with thrombotic lesions there are indications for urgent surgery due to the risk of necrosis that could lead to sepsis (2).
Contraindications
Relative contraindications include pregnancy, immune system disorders, coagulopathies, cirrhosis, portal hypertension (3).
An absolute contraindication is the lack of patient’s consent to the operation.
Description of the method
An open haemorrhoidectomy may be performed using conventional surgical instruments: scissors, scalpel, as well as laser or LigaSure.
A haemorrhoid should be cut around (using a scalpel, scissors or electrocoagulation) and dissected from the bed (from the external sphincter muscle), cutting through the Parks ligament. If the enlarged node is accompanied with an overgrown marginal fold, it should also be removed. While dissecting the node the mucous membrane should be spared with a view to better subsequent regeneration of the anal canal. Subsequently the vascular pedicle is transfixed with an absorbable suture (fig. 1) and the haemorrhoid is ligated to both sides and cut off. The remaining pedicle should not be too long (this causes discomfort for the patient), but it also should not be too short since during the demarcation of the pedicle bleeding from the haemorrhoidal artery may occur. The present author applies an additional suture at the top of the wound in order to approximate the margins of the wound, which also prevents the ligature from sliding off. After the excision of all three nodes and control of haemostasis the cosmetic effect is also evaluated. Excessively overgrown marginal folds may be cut off using radial incisions in relation to the anal canal. If the distances between the different wounds (bridges) are too small and an additional wound would create the risk of stenosis of the anal canal or compromised healing, an overgrown fold may be sutured into the anal canal, thus achieving a good cosmetic effect without widening the surface of the wound.
Fig. 1. Milligan-Morgan surgery: transfixing of a vascular pedicle
Advantages of the method
A major advantage of the method described is its efficacy measured by a low rate of relapse, which has been confirmed in numerous multicentre studies. Other advantages include simplicity of the procedure and a short learning curve (4).
Disadvantages of the method
The main disadvantage of this method is post-operative pain and a long healing period (up to 6 weeks), which, however, is also true for other surgical methods used for this indication.
Complications

Powyżej zamieściliśmy fragment artykułu, do którego możesz uzyskać pełny dostęp.
Mam kod dostępu
  • Aby uzyskać płatny dostęp do pełnej treści powyższego artykułu albo wszystkich artykułów (w zależności od wybranej opcji), należy wprowadzić kod.
  • Wprowadzając kod, akceptują Państwo treść Regulaminu oraz potwierdzają zapoznanie się z nim.
  • Aby kupić kod proszę skorzystać z jednej z poniższych opcji.

Opcja #1

24

Wybieram
  • dostęp do tego artykułu
  • dostęp na 7 dni

uzyskany kod musi być wprowadzony na stronie artykułu, do którego został wykupiony

Opcja #2

59

Wybieram
  • dostęp do tego i pozostałych ponad 7000 artykułów
  • dostęp na 30 dni
  • najpopularniejsza opcja

Opcja #3

119

Wybieram
  • dostęp do tego i pozostałych ponad 7000 artykułów
  • dostęp na 90 dni
  • oszczędzasz 28 zł
Piśmiennictwo
1. Milligan ETC, Morgan CN, Jones LE et al.: Surgical anatomy of the anal canal and operative treatment of haemorrhoids. Lancet 1937; 1: 1119-1124. 2. Mitra A, Yadav A, Mehta N et al.: Complicated Perianal Sepsis. Indian J Surg 2015 Dec; 77 (suppl. 3): 769-773. Epub 2013 Nov 5. 3. Lohsiriwat V: Treatment of hemorrhoids: A coloproctologist’s view. World J Gastroenterol 2015 Aug 21; 21(31): 9245-9252. doi:10.3748/wjg.v21.i31.9245. 4. Argov S, Levandovsky O, Yarhi D: Milligan-Morgan hemorrhoidectomy under local anesthesia – an old operation that stood the test of time. A single-team experience with 2,280 operations. Int J Colorectal Dis 2012 Jul; 27(7): 981-985. 5. Porrett LJ, Porrett JK, Ho YH: Documented complications of staple hemorrhoidopexy: a systematic review. Int Surg 2015 Jan; 100(1): 44-57. doi:10.9738/INTSURG-D-13-00173.1. 6. Pescatori M: Closed vs. open hemorrhoidectomy: associated sphincterotomy and postoperative bleeding. Dis Colon Rectum 2000; 43: 1174-1175. 7. Akhmedova EV: Results of an acute thrombosis of hemorrhoidal nodes treatment. Klin Khir 2015 Sep; 9: 54-55. 8. Reboa G, Gipponi M, Rattaro A et al.: Residual Prolapse in Patients with III-IV Degree Haemorrhoids Undergoing Stapled Haemorrhoidopexy with CPH34 HV: Results of an Italian Multicentric Clinical Study. Surg Res Pract 2014: 710128. doi:10.1155/2014/710128. Epub 2014 Jun 15. 9. Shaikh AR, Dalwani AG, Soomro N: An evaluation of Milligan-Morgan and Ferguson procedures for haemorrhoidectomy at Liaquat University Hospital Jamshoro, Hyderabad, Pakistan. Pak J Med Sci 2013 Jan-Mar; 29(1): 122-127. 10. Bhatti MI, Sajid MS, Baig MK: Milligan-Morgan (Open) Versus Ferguson Haemorrhoidectomy (Closed): A Systematic Review and Meta-Analysis of Published Randomized, Controlled Trials. World J Surg 2016 Jan 26. 11. Gençosmanoğlu R, Sad O, Koç D, Inceoğlu R: Hemorrhoidectomy: open or closed technique? A prospective, randomized clinical trial. Dis Colon Rectum 2002 Jan; 45(1): 70-75. 12. Majeed S, Naqvi SR, Tariq M, Ali MA: Comparison of open and closed techniques of haemorrhoidectomy in terms of post-operative complications. J Ayub Med Coll Abbottabad 2015 Oct-Dec; 27(4): 791-793. 13. Graviè JF, Lehur PA, Huten N et al.: Stapled Hemorrhoidopexy Versus Milligan-Morgan Hemorrhoidectomy A Prospective, Randomized, Multicenter Trial With 2-Year Postoperative Follow Up. Ann Surg 2005 Jul; 242(1): 29-35. 14. Towliat Kashani SM, Mehrvarz S, Mousavi Naeini SM, Erfanian R: Milligan-Morgan Hemorrhoidectomy vs Stapled Hemorrhoidopexy. Trauma Mon 2012 Jan; 16(4): 175-177. 15. Panarese A, Pironi D, Vendettuoli M et al.: Stapled and conventional Milligan-Morgan haemorrhoidectomy: different solutions for different targets. Int J Colorectal Dis 2012 Apr; 27(4): 483-487. 16. Ganio E, Altomare DF, Milito G et al.: Long-term outcome of a multicentre randomized clinical trial of stapled haemorrhoidopexy versus Milligan-Morgan haemorrhoidectomy. Br J Surg 2007 Aug; 94(8): 1033-1037. 17. Onur Gülseren M, Dinc T, Özer V et al.: Randomized Controlled Trial Comparing the Effects of Vessel Sealing Device and Milligan Morgan Technique on Postoperative Pain Perception after Hemorrhoidectomy. Dig Surg 2015; 32(4): 258-261. 18. Sakr MF: LigaSure versus Milligan-Morgan hemorrhoidectomy: a prospective randomized clinical trial. Tech Coloproctol 2010 Mar; 14(1): 13-17. 19. Schreckenbach T, El Youzouri H, Bechstein WO, Habbe N: Proctologic surgery done by residents – Complications preprogrammed? J Visc Surg 2016 Jan 25. 20. Ruiz-Tovar J, Duran M, Alias D et al.: Reduction of postoperative pain and improvement of patients’ comfort after Milligan-Morgan hemorrhoidectomy using topical application of vitamin E ointment. Int J Colorectal Dis 2015 Dec 29 [Epub ahead of print]. 21. Shiau JM, Su HP, Chen HS et al.: Use of a topical anesthetic cream (EMLA) to reduce pain after hemorrhoidectomy. Reg Anesth Pain Med 2008 Jan-Feb; 33(1): 30-35. 22. Solorio-López S, Palomares-Chacón UR, Guerrero-Tarín JE et al.: Efficacy of metronidazole versus placebo in pain control after hemorrhoidectomy. Results of a controlled clinical trial. Rev Esp Enferm Dig 2015 Nov; 107(11): 681-685. doi:10.17235/reed.2015.3926/2015. 23. Ma-Mu-Ti-Jiang A ba-bai-ke-re, Huang H-G, Re W-N et al.: How we can improve patients’ comfort after Milligan-Morgan open haemorrhoidectomy. World J Gastroenterol 2011 Mar 21; 17(11): 1448-1456. 24. Haas E, Onel E, Miller H et al.: A double-blind, randomized, active-controlled study for post-hemorrhoidectomy pain management with liposome bupivacaine, a novel local analgesic formulation. Am Surg 2012 May; 78(5): 574-581. 25. Baptista JF, Gomez RS, Paulo DN et al.: Epidural anesthesia with ropivacaine with or without clonidine and p
otrzymano: 2016-02-17
zaakceptowano do druku: 2016-03-07

Adres do korespondencji:
*Małgorzata Kołodziejczak
Warszawski Ośrodek Proktologii Szpital św. Elżbiety – Mokotowskie Centrum Medyczne
ul. Goszczyńskiego 1, 02-615 Warszawa
tel. +48 (22) 542-08-16
e-mail: drkolodziejczak@o2.pl

Nowa Medycyna 1/2016
Strona internetowa czasopisma Nowa Medycyna