Optimizing circumferential prolapsed hemorrhoid surgery: Transverse incision with longitudinal ligation procedure delivers superior radicality compared to Milligan-Morgan technique

doi:10.3748/wjg.v31.i39.110288

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Oct 21, 2025; 31(39): 110288
Published online Oct 21, 2025. doi: 10.3748/wjg.v31.i39.110288

Optimizing circumferential prolapsed hemorrhoid surgery: Transverse incision with longitudinal ligation procedure delivers superior radicality compared to Milligan-Morgan technique

Xin-Bo Song, Yan-Zhi Wang, Yan-Mei Wang, Hong Sun, Jia-Nan Li, Huang-Fu Ma, Xin Li, Ting-Ting Sui, Rui-Han Liu, Li-Xia Lai

Xin-Bo Song, Yan-Zhi Wang, Yan-Mei Wang, Jia-Nan Li, Huang-Fu Ma, Xin Li, Ting-Ting Sui, Rui-Han Liu, Li-Xia Lai, Department of Proctology, China-Japan Friendship Hospital, Beijing 100029, China

Hong Sun, Department of Proctology in Traditional Chinese Medicine, Xinjiang Production and Construction Corps Hospital, Urumqi 830002, Xinjiang Uygur Autonomous Region, China

Co-first authors: Xin-Bo Song and Yan-Zhi Wang.

Author contributions: Lai LX designed the study; Song XB, Wang YZ, Wang YM, Sun H, Li JN, Ma HF, Sui TT, Li X, and Liu RH conducted the study and collected the data; Wang YZ analyzed the manuscript; Song XB wrote the manuscript; Song XB and Wang YZ contributed equally to this manuscript as co-first authors. All authors approved the final manuscript.

Supported by Scientific Research Fund of China-Japan Friendship Hospital, No. 2019-1-QN-53.

Institutional review board statement: This study was approved by the Ethics Committee of China-Japan Friendship Hospital, No. 2020-83-K49.

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Li-Xia Lai, MD, Department of Proctology, China-Japan Friendship Hospital, No. 2 Sakura East Street, Chaoyang District, Beijing 100029, China. laixia86@163.com

Received: June 13, 2025
Revised: July 20, 2025
Accepted: September 15, 2025
Published online: October 21, 2025
Processing time: 130 Days and 1.1 Hours

Abstract

BACKGROUND

Circumferential prolapsed hemorrhoids (CPHs) necessitate surgical intervention. While Milligan-Morgan hemorrhoidectomy (MMH) remains widely used, it compromises functional preservation and associates with significant postoperative pain, edema, and delayed healing in severe CPH cases. To address these limitations, our research team innovatively proposed the transverse incision with longitudinal ligation procedure (TILL). This novel technique utilizes targeted transverse incisions and longitudinal pedicle ligation to optimize complete resection while preserving anal anatomy and function.

AIM

To optimize CPH resection and anal function preservation through comparative efficacy-safety evaluation of TILL vs MMH.

METHODS

A total of 180 patients were retrospectively reviewed in China. The patients were divided into two groups of 90 based on the surgical methods. The treatment group underwent the TILL procedure, while the control group underwent MMH. The main observation index was the evaluation of clinical efficacy after wound healing. Secondary outcomes included the recurrence rate and wound healing time. Safety measurements were also evaluated.

RESULTS

The TILL group showed a significant difference compared to the MMH group (P = 0.022), indicating better overall treatment effects. The time for wound healing in the TILL group was shorter than that in the MMH group (P = 0.001). Compared to those who underwent MMH, those who underwent TILL experienced significantly reduced postoperative pain, with lower average scores for anal edema and anal stenosis (both P < 0.05).

CONCLUSION

TILL demonstrates superior efficacy to MMH for advanced CPH, reducing recovery times and postoperative pain, edema, and stenosis while preserving anal function.

Keywords: Circumferential prolapsed hemorrhoid; Milligan-Morgan hemorrhoidectomy; Transverse incision with longitudinal ligation procedure; Efficacy; Anal function

Core Tip: This study compared transverse incision with longitudinal ligation procedure (TILL) and Milligan-Morgan hemorrhoidectomy (MMH) in 180 grade III/IV circumferential prolapsed hemorrhoid patients. Results showed TILL had superior clinical efficacy (P = 0.022), faster wound healing (P = 0.001), and less postoperative pain, anal edema, and stenosis (all P < 0.05) vs MMH. TILL provided more thorough hemorrhoid removal, shorter recovery, and better anal function preservation. The findings suggest TILL is safer and more effective than traditional MMH for advanced circumferential prolapsed hemorrhoid, reducing complications like pain and stenosis while improving surgical outcomes. TILL represents a significant advancement in hemorrhoidectomy technique.