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BACKGROUND: Grade III-IV hemorrhoids require surgical treatment. The Milligan Morgan hemorrhoidectomy (MM) – still considered the gold standard – is now flanked by less invasive surgical methods such as Procedure for Prolapse and Hemorroids (PPH) and Transanal Hemorroidal Dearterialization (THD). The authors wanted to compare in a prospective, randomized trial the MM hemorrhoidectomy and the THD in the treatment of grade III-IV hemorrhoids.
MATERIALS AND METHODS: Between January 2010 and March 2013 they were recruited 87 patients with grade III-IV hemorrhoids. All patients did not previously undergo surgical treatment. From the time of recruitment, for a period of six months the patients evaluated the extent of the symptoms of which were suffering expressing in simple and subjective questionare how hemorrhoidal disease accounted on their social life and wellness. After six months of the 52 patients with grade III hemorrhoids 27 were randomly treated with THD and 25 with Milligan Morgan; of 37 grade IV 18 they were treated with THD and 19 with MM. It was evaluated in particular the post-operative pain recovery, the reaching the feeling of wellness (evaluated with a modified VAS scale), the presence of bleeding and soiling. The patients then underwent follow-up to at three months, one year and three years.