Comparative Outcomes of Milligan-Morgan (Open) Versus Ferguson (Closed) Hemorrhoidectomy: A Retrospective Study

Introduction The debate remains unresolved about whether an open (Milligan-Morgan) or closed (Ferguson) approach is superior for hemorrhoidectomy. Advocates from both groups state that each has its own set of advantages and disadvantages. In light of this, we intend to share our experience by comparing the two in terms of their post-operative outcomes. This study aims to compare open (Milligan-Morgan) and closed (Ferguson) hemorrhoidectomy in terms of post-operative outcomes. Materials and methods This retrospective study was carried out at the Department of Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan. A total of 137 patients who underwent hemorrhoidectomy from January 1, 2022, to May 31, 2024, were enrolled. Post-operative outcomes were noted in terms of surgical site infection (SSI), excessive bleeding, and visual analog scale (VAS) pain score. Data were analyzed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, NY, USA). Results A total of 137 patients were enrolled in the study, with 93 (67.9%) undergoing Milligan-Morgan (open) hemorrhoidectomy and 44 (32.1%) undergoing the Ferguson (closed) procedure. The mean age in the open group was 46.87 ± 10.79 years, compared to 44.59 ± 9.06 years in the closed group. Male participants comprised 59 (63.4%) in the open group and 19 (43.2%) in the closed group. SSI was observed in 32 patients (23.3%); 22 (68.8%) were from the open group, and 10 (31.3%) were from the closed group (p-value, 0.905). Hemorrhage was recorded in 34 patients (15.3%), with 21 (61.8%) in the open group and 13 (38.2%) in the closed group (p-value, 0.378). The mean post-operative VAS pain score was 3.76 ± 1.79 for the open technique versus 4.07 ± 1.37 for the closed technique, respectively (p-value, 0.321). Conclusion Though the SSI and hemorrhage rates were higher with the Milligan-Morgan technique than with the Ferguson technique, the mean post-operative VAS score was also higher with the Milligan-Morgan procedure. However, none of the differences was found to be statistically significant.