Open Haemorrhoidectomy (Milligan–Morgan Technique)
Haemorrhoids are a very common benign condition of the anorectal region.
Symptoms:
• Pruritus
• Mucous discharge from the anus
• Most commonly, the appearance of blood on toilet paper during defaecation, or bleeding during bowel movements
Haemorrhoids typically present as small swellings or nodules at the anal verge, or as painful perianal lumps. Constipation is a frequent antecedent factor.
Diagnosis is established through simple digital rectal examination.
However, other anorectal conditions must be excluded, requiring mandatory colonoscopic evaluation of the large bowel.
Management
Patients diagnosed with haemorrhoids should initially undergo conservative treatment:
• Dietary optimisation
• Avoidance of constipation with regulation of bowel habits
In the event of failure of conservative measures, surgical treatment is indicated.
Timely intervention prevents progression of haemorrhoidal disease, the development of fissures or fistulae, and importantly, anaemia from recurrent bleeding.
The traditional operative technique is open haemorrhoidectomy (Milligan–Morgan).
One to three haemorrhoidal cushions are excised, and occasionally secondary nodules.
The procedure may be performed under regional anaesthesia (spinal or epidural), although general anaesthesia is preferred.
Postoperative course
Mild postoperative pain may occur and is managed with analgesics.
For 15–20 days, meticulous local hygiene is required, including regular warm sitz baths.
