Hua HW, Wu J. Transverse incision with longitudinal ligation procedure: Innovation, pitfalls, and clinical perspectives. World J Gastroenterol 2025; 31(48): 114738 [DOI: 10.3748/wjg.v31.i48.114738]
Corresponding Author of This Article
Jiong Wu, MD, Chief Physician, Professor, Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No. 110 Ganhe Road, Hongkou District, Shanghai 200437, China. tcmoctober9@163.com
Research Domain of This Article
Surgery
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Dec 28, 2025; 31(48): 114738 Published online Dec 28, 2025. doi: 10.3748/wjg.v31.i48.114738
Transverse incision with longitudinal ligation procedure: Innovation, pitfalls, and clinical perspectives
Hong-Wei Hua, Jiong Wu
Hong-Wei Hua, Jiong Wu, Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
Author contributions: Hua HW wrote the original draft; Wu J contributed to conceptualization, writing, reviewing and editing; Hua HW and Wu J participated in drafting the manuscript; all authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: Jiong Wu, MD, Chief Physician, Professor, Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No. 110 Ganhe Road, Hongkou District, Shanghai 200437, China. tcmoctober9@163.com
Received: September 27, 2025 Revised: November 3, 2025 Accepted: November 13, 2025 Published online: December 28, 2025 Processing time: 91 Days and 12.6 Hours
Abstract
The transverse incision with longitudinal ligation (TILL) procedure is a new method for treating circumferential prolapsed hemorrhoids. A study by Song et al found TILL to be better than the traditional Milligan-Morgan hemorrhoidectomy for short-term results, showing less pain, quicker healing, and lower risk of anal stenosis. TILL reduces tissue tension and controls blood supply, allowing effective removal of diseased tissue while maintaining anal function and structure. However, the study's limitations, including its retrospective, single-center design, small sample size, and short follow-up, restrict the findings' generalizability and ability to assess long-term outcomes like recurrence. Larger, multicenter trials are needed for a thorough evaluation and wider clinical adoption of TILL.
Core Tip: This commentary underscores the transverse incision with longitudinal ligation (TILL) procedure as an innovative approach for addressing circumferential prolapsed hemorrhoids. The primary innovation of TILL resides in its "tension modulation", achieved through a specific incision and ligation design that adeptly balances the radical excision of hemorrhoids with the preservation of anal structure and function. This method offers distinct advantages over the Milligan-Morgan hemorrhoidectomy, particularly in minimizing postoperative pain, edema, and the risk of stenosis. Consequently, TILL emerges as a promising complementary technique within the spectrum of contemporary hemorrhoid treatments, although further validation is necessary.
