What question did this study set out to answer?

This study aims to evaluate the efficacy, safety, and anal function outcomes of low excision and high suspension hemorrhoidectomy compared to the conventional Milligan-Morgan method.

July 5, 2026Open Access

Low excision and high suspension hemorrhoidectomy versus conventional Milligan-Morgan hemorrhoidectomy for mixed hemorrhoids: a 12-month prospective randomized controlled trial

Key Points

This study aims to evaluate the efficacy, safety, and anal function outcomes of low excision and high suspension hemorrhoidectomy compared to the conventional Milligan-Morgan method.
Enrolled 120 eligible patients randomized 1:1 to LEHS or MM groups between January 2024 and June 2024.
Primary outcomes assessed were 12-week clinical effectiveness and 12-month recurrence rate; secondary outcomes included pain scores and complications.
Statistical analysis performed using SPSS 26.0 with a -10% non-inferiority margin.
12-week effective rate showed LEHS at 96.4% vs. MM at 92.9%, both P > 0.05 for non-inferiority.
12-month recurrence rate was 1.8% for LEHS vs. 5.4% for MM, confirming non-inferiority (P > 0.05).
LEHS resulted in fewer complications (14.8% vs. 33.3%, P = 0.027) and better patient satisfaction with lower pain scores.

Abstract

BACKGROUND: Mixed hemorrhoids represent a highly prevalent benign anorectal disorder. Milligan-Morgan hemorrhoidectomy (MM) is the gold-standard treatment but carries substantial risks of severe postoperative pain, delayed recovery, and anal dysfunction due to extensive tissue resection. Low excision and high suspension hemorrhoidectomy (LEHS) is a refined, function-preserving technique, yet high-quality long-term comparative evidence remains limited. This study aimed to assess the efficacy, safety, and anal functional outcomes of LEHS versus MM for grade III-IV mixed hemorrhoids over 12 months. METHODS: This single-center, prospective, randomized, non-inferiority trial enrolled 120 eligible patients between January 2024 and June 2024, randomized 1:1 to LEHS or MM groups with allocation concealment and blinded outcome assessment. Primary outcomes were 12-week clinical effective rate and 12-month hemorrhoid recurrence rate; secondary outcomes included perioperative indicators, pain scores, recovery metrics, complications, anorectal manometry, and patient satisfaction. Statistical analysis was performed via SPSS 26.0 with a -10% non-inferiority margin (P 0.05). The 12-week effective rate (96.4% vs. 92.9%) and 12-month recurrence rate (1.8% vs. 5.4%) confirmed LEHS non-inferiority (both P > 0.05). LEHS yielded longer operative time, less blood loss, lower VAS pain scores, faster recovery, fewer complications (14.8% vs. 33.3%, P = 0.027), and more favorable anorectal physiology (all P < 0.001), with higher patient satisfaction. CONCLUSIONS: LEHS is non-inferior to MM in clinical efficacy and long-term recurrence control for grade III-IV mixed hemorrhoids, with superior safety, faster recovery, and better-preserved anal function without excessive hypertonia. It is a reliable, minimally invasive surgical alternative worthy of clinical promotion. TRIAL REGISTRATION: ClinicalTrials.gov, NCT07495046 (Registered: March 2026, retrospectively registered).

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