Grade IV hemoroidal hastalıkta modifiye Ferguson hemoroidektomi yönteminin cerrahi sonuçları

Year 2025, Volume: 7 Issue: 5, 652 - 656, 15.09.2025

Ahmet Cihangir Emral , Gökay Çetinkaya , Merter Gülen , Bahadır Ege

https://doi.org/10.38053/acmj.1736977

Abstract

Amaç: Grade IV internal hemoroidal hastalık, genellikle cerrahi müdahale gerektiren ileri evre bir hemoroidal patolojiyi temsil eder. Kapalı eksizyonel bir teknik olan Ferguson hemoroidektomi, postoperatif iyileşme süreci ve komplikasyon profili açısından sunduğu avantajlar nedeniyle sık tercih edilmektedir. Bu çalışmanın amacı, grade IV internal hemoroidal hastalığı olan hastalarda modifiye Ferguson hemoroidektomi yönteminin etkinliğini, postoperatif sonuçlarını ve komplikasyon oranlarını değerlendirmektir.
Yöntemler: Bu retrospektif analizde, Mart 2021 ile Aralık 2024 tarihleri arasında modifiye Ferguson hemoroidektomi uygulanan grade IV internal hemoroidal hastalığa sahip 229 hasta incelendi. Demografik veriler, postoperatif komplikasyonlar, postoperatif ağrı düzeyi, nüks oranları ve günlük yaşama dönüş süresi kaydedildi. Postoperatif takip süresi ortalama 16,8 ay olarak gerçekleşti.
Bulgular: Yaş ortalaması 43,7 ± 10,7 yıl olan 229 hastanın %58’i erkekti ve %81’ine üç kadran hemoroidektomi uygulandı. Postoperatif komplikasyonlar arasında üriner retansiyon (%3,9), üriner sistem enfeksiyonu (%0,9), hafif kanama (%1,3), hafif anal stenoz (%0,9) ve minör perianal enfeksiyon (%5,2) yer aldı. Postoperatif ortanca VAS ağrı skorları 1. günde 4 (dağılım: 2–7), 7. günde ise 2 (dağılım: 1–5) idi. Preoperatif ve postoperatif Cleveland Clinic İnkontinans Skorları arasında anlamlı fark saptanmadı (p > 0,05). Hastaların normal günlük yaşantıya dönüş süresi ortanca 12 gündü (dağılım: 5–19 gün).
Sonuç: Modifiye Ferguson hemoroidektomi, grade IV internal hemoroidal hastalıkta düşük komplikasyon ve nüks oranları ile etkin ve güvenli bir cerrahi seçenek sunmakta, aynı zamanda hızlı bir iyileşme profili göstermektedir. Elde edilen veriler, bu tekniğin ileri hemoroidal hastalıklarda güvenilir bir tedavi seçeneği olduğunu desteklemektedir.

Keywords

Ferguson hemoroidektomi , Hemoroidal hastalık , Postoperatif komplikasyonlar , Proktoloji , Kanama

Surgical outcomes of modified Ferguson hemorrhoidectomy for grade IV hemorrhoidal disease

Abstract

Aims: Grade IV internal hemorrhoidal disease represents an advanced stage of hemorrhoidal pathology, often necessitating surgical intervention. Ferguson hemorrhoidectomy, a closed excisional technique, is frequently employed for its reported advantages in postoperative recovery and complication profiles. This study aims to evaluate the effectiveness, postoperative outcomes, and complication rates of modified Ferguson hemorrhoidectomy in patients with grade IV internal hemorrhoidal disease.
Methods: In this retrospective analysis, 229 patients with grade IV internal hemorrhoidal disease who underwent modified Ferguson hemorrhoidectomy between March 2021 and December 2024 were included. Demographic data, postoperative complications, postoperative pain, recurrence rates, and time to return to daily activities were recorded. Postoperative follow-up was conducted up to a mean duration of 16.8 months.
Results: Among 229 patients (mean age 43.7±10.7 years; 58% male), 81% underwent three-quadrant hemorrhoidectomy. Postoperative complications included urinary retention (3.9%), urinary tract infection (0.9%), minor bleeding (1.3%), mild anal stenosis (0.9%), and minor perianal infection (5.2%). The median postoperative VAS pain scores were 4 (range: 2–7) on day 1 and 2 (range: 1–5) on day 7. No significant differences were observed in preoperative and postoperative Cleveland Clinic Incontinence Scores (p>0.05). Median time to return to normal daily activities was 12 days (range 5–19).
Conclusion: Modified Ferguson hemorrhoidectomy provides an effective and safe surgical option for grade IV internal hemorrhoidal disease, with low complication and recurrence rates and a favorable recovery profile. These results support its use as a reliable treatment approach in advanced hemorrhoidal disease.

Keywords

Ferguson hemorrhoidectomy , hemorrhoidal disease , postoperative complications , proctology , bleeding

Ethical Statement

This study received ethical approval from the Ethics Committee of Atilim University Faculty of Medicine, Medicana International Ankara Hospital (approval number: 32, dated 09.11.2023).

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