# Modified Ferguson hemorrhoidectomy for grade II–IV hemorrhoids offers low recurrence and complication rates: a retrospective cohort study

## TL;DR

Modified Ferguson hemorrhoidectomy (MFH) is safer and more effective than traditional surgery for severe hemorrhoids, with fewer complications and faster recovery.

## Contribution

The study demonstrates that MFH significantly reduces recurrence and improves outcomes compared to conventional Milligan-Morgan hemorrhoidectomy.

## Key findings

- MFH had a significantly lower recurrence rate (1.2%) compared to MMH (5.0%) after 24 months.
- Healing time was shorter with MFH (26.3 days) than MMH (30.9 days).
- MFH showed higher patient satisfaction and fewer postoperative complications like edema.

## Abstract

This study aimed to evaluate the efficacy and safety of modified Ferguson hemorrhoidectomy (MFH) compared with conventional Milligan-Morgan hemorrhoidectomy (MMH) for grade II–IV hemorrhoids.

A retrospective cohort of patients undergoing MFH or MMH between September 2020 and August 2021 was reviewed. The primary outcomes were healing time and recurrence after at least 24 months of follow-up. Secondary outcomes included Hemorrhoidal Disease Symptom Score (HDSS), postoperative complications, patient satisfaction, and quality-of-life assessment.

A total of 515 patients were enrolled (MFH, n = 254; MMH, n = 261) with a median follow-up of 29 months. The recurrence rate was significantly lower in the MFH group compared with MMH (1.2% vs. 5.0%, p = 0.013), with Kaplan–Meier analysis confirming superior recurrence-free survival (98.8% vs. 95.0% at 36 months). Healing time was shorter with MFH (26.3 ± 4.3 vs. 30.9 ± 3.5 days, p < 0.001). MFH reduced the risk of postoperative edema (2.4% vs. 9.6%, p = 0.01; OR 0.23, 95% CI 0.09–0.56) but showed a higher incidence of urinary retention (3.9% vs. 1.1%, p = 0.04). No anal stenosis or fecal incontinence was observed in either group. Patient satisfaction was higher in MFH (9.7 ± 0.7 vs. 9.4 ± 1.2, p = 0.002), and improvements in HDSS and SHSHD scores were sustained during long-term follow-up. Multivariate regression confirmed MFH as an independent protective factor against recurrence (adjusted OR 0.26, 95% CI 0.08–0.91, p = 0.035).

Modified Ferguson hemorrhoidectomy is a safe and effective technique for grade II-IV hemorrhoids, offering lower recurrence, shorter healing, fewer complications, and higher satisfaction compared with Milligan-Morgan hemorrhoidectomy.