Abstract:

Objective

To systematically evaluate the efficacy and safety of Ferguson Hemorrhoidectomy （Closed） versus Milligan-Morgan Hemorrhoidectomy （Open） for the treatment of mixed hemorrhoids and to provide an evidence-based basis for surgical protocols.

Methods

CNKI， Wanfang，WIP， CBM and PubMed databases were searched to collect randomized controlled trials （RCTs） of closed hemorrhoidectomy （the study group） versus open hemorrhoidectomy （the control group）， and the years of searching were from January 2000 to May 2024.The quality of the literature was assessed using the bias assessment tool recommended by Cochrane Systematic Reviews after screening and extracting the literature information； Meta-analysis， sensitivity analysis， publication bias analysis and regression analysis were done using STATA 17.0 software.

Results

A total of 30 RCTs with 3 505 patients were included.Meta-analysis showed that compared with open hemorrhoidectomy， closed hemorrhoidectomy had a higher cure rate ［RR=1.16，95% CI （1.08～1.25）， P＜0.01］， shorter wound healing time ［SMD= -1.90， 95%CI （ -2.32～ -1.48）， P＜0.01］，shorter operative time ［SMD= -2.68， 95%CI （ -4.70～ -0.65）， P=0.01］， less intermediate bleeding ［SMD=-6.94， 95%CI（ -10.96～ -2.91）， P＜0.01］， and lower VAS scores on the first postoperative bowel movement［SMD= -0.85， 95%CI （ -1.42～ -0.29）， P＜0.01］， lower probability of postoperative bleeding ［RR=0.65，95%CI （0.51～0.82）， P＜0.01］， shorter hospital stay ［SMD= -0.92， 95%CI （ -1.63～ -0.22）， P=0.01］ and less frequent postoperative bowel difficulties ［RR=0.24， 95%CI （0.07～0.81）， P=0.02］， but the probability of postoperative trabecular dehiscence was higher ［RR=7.66， 95%CI （2.56～22.97）， P＜0.01］.The differences in the rates of trabecular infection， postoperative pain， edema， urinary retention， anal fissure， anal cleanliness，anal stenosis， 24-hour postoperative VAS scores， return to work time， and recurrence rates between the two surgical procedures were not statistically significant （all P＞0.05）.The results of sensitivity analysis showed that the robustness of the results of this study was good.The risk of publication bias analysis showed the possibility of publication bias.

Conclusion

The overall efficacy of closed hemorrhoidectomy is better than open hemorrhoidectomy.Closed hemorrhoidectomy has a higher cure rate， shorter wound healing time， and does not increase the rate of wound infection or anal stenosis， making it a safe and effective procedure.

Key words: Hemorrhoids, Mixed hemorrhoids, Ferguson Hemorrhoidectomy, Milligan-morgan hemorrhoidectomy, Meta analysis