International Journal of Colorectal Disease

, Volume 27, Issue 7, pp 981–985 | Cite as

Milligan–Morgan hemorrhoidectomy under local anesthesia — an old operation that stood the test of time

A single-team experience with 2,280 operations
  • Samuel ArgovEmail author
  • Olga Levandovsky
  • Danielle Yarhi
Original Article



This study was carried out to evaluate the morbidity and efficacy of Milligan–Morgan (M&M) hemorrhoidectomy in comparison to novel techniques (e.g., hemorrhoidal artery ligation [HAL], stapler hemorrhoidopexy [PPH]).


This is a retrospective review of a single-team experience with 2,280 M&M hemorrhoidectomy patients, with 1–12 years follow-up. All patients were operated upon in jack-knife position, using local anesthesia under light sedation in an ambulatory facility. This method allowed us to operate on 40 pregnant women. All operations were performed using simple, commercially available instruments.


We found negligible morbidity, no mortality and a very efficient operation on long-term follow-up. The surgical literature is littered with dreadful complications and even mortality from stapled hemorrhoidopexy (Giordano et al., Dis Colon Rectum 51:1574–1576, 2008; Brown et al., Tech Coloproctol 11:357–358, 2007; Cipriani and Pescatori, Colorectal Dis 4:367–370, 2002; Mongardini et al., G Chir 26:275–277, 2005) and the inefficiency of Doppler HAL (Faucheron and Gangner, Dis Colon Rectum 51:945–949, 2008; Scheyer et al., Am J Surg, 191:89–93, 2006).


In days of soaring medical expenditures, nobody will argue about the superiority of M&M hemorrhoidectomy as the cheapest operation available. In all aspects, M&M hemorrhoidectomy under local anesthesia beats its competitors in terms of morbidity, mortality, long-term efficiency and low cost.


Bleeding prolapsed hemorrhoids Anemia Hemorrhoidectomy Local anesthesia Pregnancy 


  1. 1.
    Corman ML (2005) Colon and rectal surgery, 5th ed. Chapter 8, p. 177Google Scholar
  2. 2.
    Giordano P, Bradley BM, Peiris L (2008) Obliteration of the rectal lumen after stapled hemorrhoidopexy: report of a case. Dis Colon Rectum 51:1574–1576PubMedCrossRefGoogle Scholar
  3. 3.
    Brown S, Baraza W, Shorthouse A (2007) Total rectal lumen obliteration after stapled hemmorrhoidopexy: a cautionary tale. Tech Coloproctol 11:357–358PubMedCrossRefGoogle Scholar
  4. 4.
    Cipriani S, Pescatori M (2002) Acute rectal obstruction after P.P.H. stapled hemorrhoidectomy. Colorectal Dis 4:367–370PubMedCrossRefGoogle Scholar
  5. 5.
    Mongardini M, Custureri FM, Schillaci F et al (2005) Rectal stenosis after stapler hemorrhoidopexy [Italian]. G Chir 26:275–277PubMedGoogle Scholar
  6. 6.
    Milligan ETC, Naunton Morgan C, Jones LE, Officer R (1937) Surgical anatomy of the anal canal, and the operative treatment of hæmorrhoids. Lancet 230:1119–1124CrossRefGoogle Scholar
  7. 7.
    Argov S, Levandovsky O (2006) Local anesthesia in anal surgery: a simple, safe procedure. Am J Surg 191:111–113PubMedCrossRefGoogle Scholar
  8. 8.
    Argov S, Levansovsky O (2001) Radical ambulatory hemorrhoidectomy under local anesthesia. Am J Surg 182:69–72PubMedCrossRefGoogle Scholar
  9. 9.
    Ganio E, Altomare F, Gabrielli F et al (2001) Prospective randomized multicentre trial comparing stapled with open haemorrhoidectomy. Br J Surg 88:669–674PubMedCrossRefGoogle Scholar
  10. 10.
    Mehingan BJ, Monson JR, Hartley JE (2000) Stapling procedure for haemorrhoids versus Milligan–Morgan haemorrhoidectomy: randomised controlled trial. Lancet 355:782–785CrossRefGoogle Scholar
  11. 11.
    Rowsell M, Bello M, Hemingway DM (2000) Circumferential mucosectomy (stapled haemorrhoidectomy) versus conventional haemorrhoidectomy: randomised controlled trial. Lancet 355:779–781PubMedCrossRefGoogle Scholar
  12. 12.
    Ho YH, Cheong WK, Tsang C et al (2000) Stapled heorrhoidectomy – cost and effectiveness. Randomized, controlled trial including incontinence score, anorectal manometry, and endoanal ultrasound assessments at up to three months. Dis Colon Rectum 43:1666–1675PubMedCrossRefGoogle Scholar
  13. 13.
    Shalaby R, Desoky A (2001) Randomized clinical trial of stapled versus Milligan–Morgan haemorrhoidectomy. Br J Surg 88:1049–1053PubMedCrossRefGoogle Scholar
  14. 14.
    Boccasanta P, Capretti PG, Venturi M et al (2001) Randomised controlled trial between stapled circumferential mucosectomy and conventional circular hemorrhoidectomy in advanced hemorrhoids with external mucosal prolapsed. Am J Surg 182:64–68PubMedCrossRefGoogle Scholar
  15. 15.
    Wilson MS, Pope V, Doran HE et al (2002) Objective comparison of stapled anopexy and open hemorrhoidectomy: a randomized controlled trial. Dis Colon Rectum 45:1437–1444PubMedCrossRefGoogle Scholar
  16. 16.
    Pavlidis T, Papaziogas B, Souparis A et al (2002) Modern stapled Longo procedure vs. conventional Milligan–Morgan hemorrhoidectomy: a randomized controlled trial. Int J Colorectal Dis 17:50–53PubMedCrossRefGoogle Scholar
  17. 17.
    Kairaluoma M, Nuorva K, Kellokumpu I (2003) Day-case stapled (circular) vs. diathermy hemorrhoidectomy: a randomized, controlled trial evaluating surgical and functional outcome. Dis Colon Rectum 46:93–99PubMedCrossRefGoogle Scholar
  18. 18.
    Etzioni DA et al (2009) Impact of the aging population on the demand for colorectal procedures. Dis Colon Rectum 52:583–590PubMedCrossRefGoogle Scholar
  19. 19.
    Cirocco CW (2008) Life threatening sepsis and mortality following stapled hemorrhoidopexy. Surgery 143:824–829PubMedCrossRefGoogle Scholar
  20. 20.
    Kornaros S, Dalamangas K, Zisi-Sermpetzoglou A (2011) Fulminant intra-abdominal sepsis after stapled-hemorrhoidectomy. Surg Infect 12:145–148CrossRefGoogle Scholar
  21. 21.
    Faucheron JL, Gangner Y (2008) Doppler-guided hemorrhoidal artery ligation for the treatment of symptomatic hemorrhoids; early and three-year follow-up results in 100 consecutive patients. Dis Colon Rectum 51:945–949PubMedCrossRefGoogle Scholar
  22. 22.
    Scheyer M et al (2006) Doppler-guided hemorrhoidal artery ligation. Am J Surg 191:89–93PubMedCrossRefGoogle Scholar
  23. 23.
    Stelzner F (1992) Hemorrhoidectomy—a simple operation? Incontinence, stenosis, fistula, infection and fatalities [German]. Chirurg 63:316–326PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Samuel Argov
    • 1
    Email author
  • Olga Levandovsky
    • 1
  • Danielle Yarhi
    • 1
  1. 1.Elisha HospitalHaifaIsrael

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