Surgical outcomes of modified Ferguson hemorrhoidectomy for grade IV hemorrhoidal disease

Aims: Grade IV internal hemorrhoidal disease represents an advanced stage of hemorrhoidal pathology, often necessitating surgical intervention. Ferguson hemorrhoidectomy, a closed excisional technique, is frequently employed for its reported advantages in postoperative recovery and complication profiles. This study aims to evaluate the effectiveness, postoperative outcomes, and complication rates of modified Ferguson hemorrhoidectomy in patients with grade IV internal hemorrhoidal disease. Methods: In this retrospective analysis, 229 patients with grade IV internal hemorrhoidal disease who underwent modified Ferguson hemorrhoidectomy between March 2021 and December 2024 were included. Demographic data, postoperative complications, postoperative pain, recurrence rates, and time to return to daily activities were recorded. Postoperative follow-up was conducted up to a mean duration of 16.8 months. Results: Among 229 patients (mean age 43.7±10.7 years; 58% male), 81% underwent three-quadrant hemorrhoidectomy. Postoperative complications included urinary retention (3.9%), urinary tract infection (0.9%), minor bleeding (1.3%), mild anal stenosis (0.9%), and minor perianal infection (5.2%). The median postoperative VAS pain scores were 4 (range: 2–7) on day 1 and 2 (range: 1–5) on day 7. No significant differences were observed in preoperative and postoperative Cleveland Clinic Incontinence Scores (p>0.05). Median time to return to normal daily activities was 12 days (range 5–19). Conclusion: Modified Ferguson hemorrhoidectomy provides an effective and safe surgical option for grade IV internal hemorrhoidal disease, with low complication and recurrence rates and a favorable recovery profile. These results support its use as a reliable treatment approach in advanced hemorrhoidal disease.