Low excision and high suspension hemorrhoidectomy versus conventional Milligan-Morgan hemorrhoidectomy for mixed hemorrhoids: a 12-month prospective randomized controlled trial.

BACKGROUND

Mixed hemorrhoids represent a highly prevalent benign anorectal disorder. Milligan-Morgan hemorrhoidectomy (MM) is the gold-standard treatment but carries substantial risks of severe postoperative pain, delayed recovery, and anal dysfunction due to extensive tissue resection. Low excision and high suspension hemorrhoidectomy (LEHS) is a refined, function-preserving technique, yet high-quality long-term comparative evidence remains limited. This study aimed to assess the efficacy, safety, and anal functional outcomes of LEHS versus MM for grade III-IV mixed hemorrhoids over 12 months.

METHODS

This single-center, prospective, randomized, non-inferiority trial enrolled 120 eligible patients between January 2024 and June 2024, randomized 1:1 to LEHS or MM groups with allocation concealment and blinded outcome assessment. Primary outcomes were 12-week clinical effective rate and 12-month hemorrhoid recurrence rate; secondary outcomes included perioperative indicators, pain scores, recovery metrics, complications, anorectal manometry, and patient satisfaction. Statistical analysis was performed via SPSS 26.0 with a -10% non-inferiority margin (P < 0.05).

RESULTS

Baseline characteristics were well balanced between groups (all P > 0.05). The 12-week effective rate (96.4% vs. 92.9%) and 12-month recurrence rate (1.8% vs. 5.4%) confirmed LEHS non-inferiority (both P > 0.05). LEHS yielded longer operative time, less blood loss, lower VAS pain scores, faster recovery, fewer complications (14.8% vs. 33.3%, P = 0.027), and more favorable anorectal physiology (all P < 0.001), with higher patient satisfaction.

CONCLUSIONS

LEHS is non-inferior to MM in clinical efficacy and long-term recurrence control for grade III-IV mixed hemorrhoids, with superior safety, faster recovery, and better-preserved anal function without excessive hypertonia. It is a reliable, minimally invasive surgical alternative worthy of clinical promotion.

TRIAL REGISTRATION: ClinicalTrials.gov, NCT07495046 (Registered: March 2026, retrospectively registered).