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Background <p>Mucopexy has emerged as a nonexcisional alternative to Milligan–Morgan (MM) hemorrhoidectomy.</p> Objective <p>This study compares MM, mucopexy, and hybrid MM/mucopexy procedures in patients with grade III hemorrhoidal disease (HD).</p> Design <p>Retrospective cohort study.</p> Setting <p>Tertiary referral setting.</p> Patients <p>Symptomatic grade III HD treated between 2016 and 2018.</p> Interventions <p>Four groups were defined: group 1 included patients treated with MM alone; group 2 received mucopexy on one pile combined with MM on the remaining two; group 3 underwent mucopexy on two piles with MM on the remaining one; and group 4 was treated with mucopexy alone.</p> Main outcomes measures <p>Recurrence rates and patient-reported outcome measures (PROMs) using a visual-analogic scale (VAS) at 2 years, postoperative pain at 7 days, early complication rates at 30&#xa0;days, and PROMs at 30&#xa0;days.</p> Results <p>A total of 686 consecutive patients with III-degree HD were included in the analysis. The most frequent approach was MM alone (group 1, <i>n</i> = 309, 45%), followed by mucopexy alone (group 4, <i>n</i> = 138, 20.2%), then the combined approaches (group 2, <i>n</i> = 120, 17.5%; group 3, <i>n</i> = 119, 17.3%). Group 4 had the lowest pain scores and the highest 30-day PROM (<i>p</i> &lt; 0.001), whereas group 1 showed the best long-term results, with the lowest recurrence rate (4.2% versus 14.5% in group 4) and highest long-term PROM.</p> Limitations <p>Retrospective analysis.</p> Conclusions <p>Mucopexy and the hybrid procedures reduce morbidity and enhances early postoperative PROM in grade III HD. However, its higher recurrence rate suggests that a patient- and pile-specific approach may help balance efficacy with surgical invasiveness.</p>

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Milligan–Morgan hemorrhoidectomy, mucopexy, and hybrid combination for grade III hemorrhoids: a large retrospective cohort study

  • 期刊论文

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  • 发表日期：

    2026年4月24日

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  • Gaetano Gallo,
  • Veronica De Simone,
  • Gianpiero Gravante,
  • Salvatore Sorrenti,
  • Simone Tierno,
  • Federico Tomassini,
  • Antonio Crucitti,
  • Pierpaolo Sileri,
  • Marco La Torre

摘要

Background

Mucopexy has emerged as a nonexcisional alternative to Milligan–Morgan (MM) hemorrhoidectomy.

Objective

This study compares MM, mucopexy, and hybrid MM/mucopexy procedures in patients with grade III hemorrhoidal disease (HD).

Design

Retrospective cohort study.

Setting

Tertiary referral setting.

Patients

Symptomatic grade III HD treated between 2016 and 2018.

Interventions

Four groups were defined: group 1 included patients treated with MM alone; group 2 received mucopexy on one pile combined with MM on the remaining two; group 3 underwent mucopexy on two piles with MM on the remaining one; and group 4 was treated with mucopexy alone.

Main outcomes measures

Recurrence rates and patient-reported outcome measures (PROMs) using a visual-analogic scale (VAS) at 2 years, postoperative pain at 7 days, early complication rates at 30 days, and PROMs at 30 days.

Results

A total of 686 consecutive patients with III-degree HD were included in the analysis. The most frequent approach was MM alone (group 1, n = 309, 45%), followed by mucopexy alone (group 4, n = 138, 20.2%), then the combined approaches (group 2, n = 120, 17.5%; group 3, n = 119, 17.3%). Group 4 had the lowest pain scores and the highest 30-day PROM (p < 0.001), whereas group 1 showed the best long-term results, with the lowest recurrence rate (4.2% versus 14.5% in group 4) and highest long-term PROM.

Limitations

Retrospective analysis.

Conclusions

Mucopexy and the hybrid procedures reduce morbidity and enhances early postoperative PROM in grade III HD. However, its higher recurrence rate suggests that a patient- and pile-specific approach may help balance efficacy with surgical invasiveness.