title: Milligan-Morgan hemorrhoidectomy under local anesthesia - an old operation that stood the test of time. A single-team experience with 2,280 operations.
abstract: OBJECTIVE
  This study was carried out to evaluate the morbidity and efficacy of Milligan-Morgan (M&M) hemorrhoidectomy in comparison to novel techniques (e.g., hemorrhoidal artery ligation [HAL], stapler hemorrhoidopexy [PPH]).
  
  
  METHODS
  This is a retrospective review of a single-team experience with 2,280 M&M hemorrhoidectomy patients, with 1-12 years follow-up. All patients were operated upon in jack-knife position, using local anesthesia under light sedation in an ambulatory facility. This method allowed us to operate on 40 pregnant women. All operations were performed using simple, commercially available instruments.
  
  
  RESULTS
  We found negligible morbidity, no mortality and a very efficient operation on long-term follow-up. The surgical literature is littered with dreadful complications and even mortality from stapled hemorrhoidopexy (Giordano et al., Dis Colon Rectum 51:1574-1576, 2008; Brown et al., Tech Coloproctol 11:357-358, 2007; Cipriani and Pescatori, Colorectal Dis 4:367-370, 2002; Mongardini et al., G Chir 26:275-277, 2005) and the inefficiency of Doppler HAL (Faucheron and Gangner, Dis Colon Rectum 51:945-949, 2008; Scheyer et al., Am J Surg, 191:89-93, 2006).
  
  
  CONCLUSIONS
  In days of soaring medical expenditures, nobody will argue about the superiority of M&M hemorrhoidectomy as the cheapest operation available. In all aspects, M&M hemorrhoidectomy under local anesthesia beats its competitors in terms of morbidity, mortality, long-term efficiency and low cost.
authors.affiliation: Elisha Hospital, PO Box 8744, Haifa 31087, Israel. margie@tx.technion.ac.il
authors.forename: Samuel
authors.initials: S
authors.lastname: Argov
authors.forename: Olga
authors.initials: O
authors.lastname: Levandovsky
authors.forename: Danielle
authors.initials: D
authors.lastname: Yarhi
mesh_terms: D001003:Anal Canal / Q000601:surgery; D000772:Anesthesia, Local; D004210:Dissection; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D056888:Patient Positioning; D013537:Sutures