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

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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.

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Authors Contribution

Study conception: Mr MS Sajid, MBBS, MBA, MSc, FRCS, Specialist Registrar Colorectal Surgery; Mr MK Baig, MBBS, MD, FRCS, Consultant Colorectal Surgeon. Design: Mr MS Sajid, Mr MI Bhatti, MBBS, FRCS, Specialist Registrar Colorectal Surgery. Literature search: Mr MS Sajid, Mr MI Bhatti. PRISMA flow chart for study selection: Mr MS Sajid, Mr MI Bhatti, Mr MK Baig. Data acquisition: Mr MS Sajid, Mr I Bhatti. Data confirmation: Mr MK Baig. Data analysis: Mr MS Sajid, Mr MK Baig, Mr I Bhatti. Data interpretation: Mr MS Sajid, Mr MK Baig, Mr WFA Miles, Mr MI Bhatti. Proofreading of the article: Mr MK Baig. Final approval of the version to be published: Mr MS Sajid, Mr MI Bhatti, Mr MK Baig.

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Authors and Affiliations

  1. Department of General, Endoscopic & Laparoscopic Colorectal Surgery, Western Sussex Hospitals, NHS Foundation Trust, Worthing Hospital, Washington Suite, North Wing, Worthing, West Sussex, BN11 2DH, UK

    Muhammad Shafique Sajid & Mirza K. Baig

  2. Department of General & Colorectal Surgery, NHS Foundation Trust, Queen Elizabeth Hospital, King’s Lynn, Gayton Road, King’s Lynn, Norfolk, PE30 4ET, UK

    Muhammad I. Bhatti

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  1. Muhammad I. Bhatti
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Correspondence to Muhammad Shafique Sajid.

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All authors have read the manuscript and agreed for submission. We also declare no conflict of interest, no financial disclosure needs be declared and we do not have any political interest in the publication of this article. We are happy to transfer all publishing rights to CD and associated companies for this article if accepted for publication.

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Bhatti, M.I., Sajid, M.S. & Baig, M.K. Milligan–Morgan (Open) Versus Ferguson Haemorrhoidectomy (Closed): A Systematic Review and Meta-Analysis of Published Randomized, Controlled Trials. World J Surg 40, 1509–1519 (2016). https://doi.org/10.1007/s00268-016-3419-z

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  • DOI: https://doi.org/10.1007/s00268-016-3419-z

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