A Prospective Comparative Randomized Study of Post-Operative Outcomes in Patients with Second and Third Degree Internal HemorrhoidsManaged with Suture HemorroidopexyVersus Open Milligan-Morganhemorroidectomy

Background: Hemorrhoidal disease is a common benign anorectal condition frequently requiring surgical intervention in patients with second- and third-degree internal hemorrhoids. Although open Milligan–Morgan hemorrhoidectomy remains the conventional standard, it is associated with significant postoperative pain and delayed recovery. Suture Hemorrhoidopexy has emerged as a minimally invasive alternative aimed at reducing postoperative morbidity. The objective is to compare postoperative pain, recovery parameters, complications, and recurrence between suture Hemorrhoidopexy and open Milligan–Morgan Hemorrhoidectomy in patients with second- and third-degree internal hemorrhoids. Material and Methods: This prospective, comparative, randomized study was conducted at a tertiary care center in Ahmedabad from June 2022 to June 2025, following Institutional Ethics Committee approval. A total of 46 patients were randomized into two groups: suture Hemorrhoidopexy (n = 23) and open Milligan–Morgan Hemorrhoidectomy (n = 23). Postoperative pain was assessed using the Visual Analogue Scale (VAS). Other outcome measures included hospital stay duration, time to return to normal activities, postoperative complications, recurrence, and patient satisfaction. Proper tests were used for the statistical analysis, and p < 0.05 was considered significant. Results: Patients undergoing suture Hemorrhoidopexy experienced significantly lower postoperative pain at 24 hours (3.1 ± 0.9 vs 6.4 ± 1.1) and 72 hours (1.8 ± 0.7 vs 4.3 ± 1.0) compared to the Milligan–Morgan group (p < 0.001). The average length of stay (1.9 ± 0.6 vs 3.6 ± 1.1 days) and the duration of time to normal activity (6.2 ± 1.8 vs 13.4 ± 3.6 days) were also significantly less in the suture Hemorrhoidopexy group. Postoperative complications were fewer, and patient satisfaction was higher with suture Hemorrhoidopexy, while recurrence rates were comparable between the two procedures. Conclusion: Suture hemorrhoidopexy is a safe and effective alternative to open Milligan-Morgan hemorrhoidectomy of the second- and third-degree internal hemorrhoid, which will result in less pain after surgery, quicker wound healing, and lower initial complication rates compared to open Milligan-Morgan hemorrhoidectomy with similar recurrence rates.

Keywords: Internal haemorrhoids, Second-degree haemorrhoids, Third-degree haemorrhoids, Suture hemorrhoidopexy, Milligan–Morgan hemorrhoidectomy, Post-operative outcomes, Randomized comparative study, Post-operative pain, Surgical management of haemorrhoids, Complications and recovery.