title: Milligan-Morgan (Open) Versus Ferguson Haemorrhoidectomy (Closed): A Systematic Review and Meta-Analysis of Published Randomized, Controlled Trials.
abstract: OBJECTIVE
  The purpose of this article is to systematically analyse the randomized, controlled trials (RCTs) comparing Ferguson or closed haemorrhoidectomy (CH) versus open haemorrhoidectomy (OH) or Milligan-Morgan haemorrhoidectomy in the management of haemorrhoidal disease (HD).
  
  
  METHODS
  RCTs on the effectiveness of CH and OH in the management of HD were analysed systematically using RevMan(®), and combined outcome was expressed as odds ratio (OR) and standardized mean difference.
  
  
  RESULTS
  Eleven CRTs encompassing 1326 patients were analysed systematically. There was significant heterogeneity among included trials. Therefore, in the random effects model, CH was associated with a reduced post-operative pain (SMD, -0.36; 95 % CI, -0.64, -0.07; z = 2.45; p = 0.01), faster wound healing (OR, 0.08; 95 % CI, 0.02, 0.24; z = 4.33; p < 0.0001), lesser risk of post-operative bleeding (OR, 0.50; 95 % CI, 0.27, 0.91; z = 2.27; p < 0.02) and prolonged duration of operation (SMD, 6.10; 95 % CI, 3.21, 8.98; z = 4.13; p < 0.0001). But the variables such as pain on defecation (SMD, -0.33; 95 % CI, -0.68, 0.03; z = 1.82; p = 0.07), length of hospital stay, post-operative complications, HD recurrence and risk of surgical site infection were similar in both groups.
  
  
  CONCLUSIONS
  CH has clinically measurable advantages over OH in terms of reduced post-operative pain, lower risk of post-operative bleeding and faster wound healing.
authors.affiliation: Department of General & Colorectal Surgery, NHS Foundation Trust, Queen Elizabeth Hospital, King's Lynn, Gayton Road, King's Lynn, Norfolk, PE30 4ET, UK.
authors.forename: Muhammad I
authors.initials: MI
authors.lastname: Bhatti
authors.affiliation: Department of General, Endoscopic & Laparoscopic Colorectal Surgery, Western Sussex Hospitals, NHS Foundation Trust, Worthing Hospital, Washington Suite, North Wing, Worthing, West Sussex, BN11 2DH, UK. surgeon1wrh@hotmail.com.
authors.forename: Muhammad Shafique
authors.initials: MS
authors.lastname: Sajid
authors.affiliation: Department of General, Endoscopic & Laparoscopic Colorectal Surgery, Western Sussex Hospitals, NHS Foundation Trust, Worthing Hospital, Washington Suite, North Wing, Worthing, West Sussex, BN11 2DH, UK.
authors.forename: Mirza K
authors.initials: MK
authors.lastname: Baig
mesh_terms: D003672:Defecation; D061865:Hemorrhoidectomy / Q000009:adverse effects* / Q000379:methods*; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D061646:Operative Time; D010149:Postoperative Pain / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000209:etiology*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D013530:Surgical Wound Infection / Q000209:etiology*; D016896:Treatment Outcome; D014945:Wound Healing
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