352 Systematic Review and Meta Analysis: Transanal Hemorrhoidal Dearterialization (THD) versus Milligan-Morgan Hemorrhoidectomy (MMH) in Grade III/IV Hemorrhoids

Abstract In cases of hemorrhoidal disease, when conservative measures fall short in providing relief or in advanced stages of the disease, surgical intervention becomes necessary. This article presents a systematic review and meta- analysis comparing THD and MMH for the treatment of grade III/IV haemorrhoids. The study included relevant articles that reported outcomes of THD and MMH in patients with grade III/IV haemorrhoids. Data on demographic characteristics, follow-up duration, operation time, grade of haemorrhoids, and post-operative complications were extracted and analysed. The included studies revealed varying sample sizes and patient ages, with THD and Milligan-Morgan Haemorrhoidectomy performed on individuals aged 48 to 58.8 years. Both surgical techniques demonstrated comparable efficacy in addressing post-operative complications like pain, bleeding, incontinence, and itching. Minor variations in bleeding rates were noted, possibly linked to differences in operation time. Follow-up durations ranged from 12 months to 7.0 years, revealing promising outcomes for THD and Milligan-Morgan Haemorrhoidectomy in pain relief and recurrence prevention. The available evidence showed low recurrence rates and high patient satisfaction with both approaches. THD offers advantages such as reduced post-operative pain and faster recovery, while Milligan-Morgan Haemorrhoidectomy remains a reliable surgical method. Consideration of patient characteristics, surgeon expertise, and individual preferences should guide the choice between the two techniques. Further research with standardized methodologies, larger sample sizes, and extended follow-up periods is essential for more robust conclusions and comparative effectiveness data. The systematic review and meta-analysis presented here contribute valuable insights for clinicians in making informed treatment decisions.