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Randomized trial comparing in-situ radiofrequency ablation and Milligan-Morgan hemorrhoidectomy in prolapsing hemorrhoids.

The Milligan-Morgan (MM) operation is the most widely practiced procedure for prolapsed hemorrhoids. But it is also associated with a fair amount of postoperative pain, a long period of convalescence, and complications like bleeding and anal stenosis. The aim of this study was to evaluate the efficacy of in-situ radiofrequency ablation (RA) of hemorrhoids. During a 6-month period, 40 patients with grade 3 hemorrhoids were prospectively randomized for RA (21 patients) or MM hemorrhoidectomy (19 patients). Patients were evaluated for operative time, postoperative pain, time to return to work and occurrence of early and late complications. Duration of surgery was significantly higher in the MM group (p<0.0001). Postoperative hospitalization was longer in the MM group (p<0.001). The post defecation pain and pain at rest were much less in the RA group (p<0.001). Wound healing period (16.3 vs. 37.5 days) and time to return to work (7.3 vs. 18.3 days) were other significant findings. Early complications occurred more frequently in the MM group, but late complications like external skin tags [4 patients vs. 2 patients] and one asymptomatic recurrence was noted in the RA group. In-situ RA of prolapsing hemorrhoids is a quick and bloodless procedure. It is associated with significantly less postoperative pain, shorter hospital stay and early return to normal activity. It can be considered as an alternative to conventional hemorrhoidectomy.