TY  - JOUR
T1  - Surgical outcomes of modified Ferguson hemorrhoidectomy for grade IV hemorrhoidal disease
TT  - Grade IV hemoroidal hastalıkta modifiye Ferguson hemoroidektomi yönteminin cerrahi sonuçları
AU  - Emral, Ahmet Cihangir
AU  - Çetinkaya, Gökay
AU  - Gülen, Merter
AU  - Ege, Bahadır
PY  - 2025
DA  - September
Y2  - 2025
DO  - 10.38053/acmj.1736977
JF  - Anatolian Current Medical Journal
JO  - Anatolian Curr Med J / ACMJ / acmj
PB  - MediHealth Academy Yayıncılık
WT  - DergiPark
SN  - 2718-0115
SP  - 652
EP  - 656
VL  - 7
IS  - 5
LA  - en
AB  - 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.
KW  - Ferguson hemorrhoidectomy
KW  - hemorrhoidal disease
KW  - postoperative complications
KW  - proctology
KW  - bleeding
N2  - 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.
CR  - Lohsiriwat V, Jitmungngan R. Strategies to reduce post-hemorrhoidectomy pain: a systematic review. Medicina (Kaunas). 2022; 58(3): 418. doi:10.3390/medicina58030418
CR  - Gallo G, Sacco R, Sammarco G. Epidemiology of hemorrhoidal disease. In: Ratto C, Parello A, Litta F. (eds) Hemorrhoids. Coloproctology, vol 2. Springer, Cham. 2018. doi:10.1007/978-3-319-53357-5_1
CR  - Gallo G, Martellucci J, Sturiale A, et al. Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of hemorrhoidal disease. Tech Coloproctol. 2020 Feb;24(2):145-164. doi:10. 1007/s10151-020-02149-1
CR  - Simillis C, Thoukididou SN, Slesser AA, Rasheed S, Tan E, Tekkis PP. Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids. Br J Surg. 2015;102(13):1603-1618. doi:10.1002/bjs.9913
CR  - Gülen M, Emral AC, Ege B. Hemoroid lastik band ligasyonu komplikasyonlarının yönetimi: masif rektal kanama. Namik Kemal Med J. 2024;12(1):40-44. doi:10.4274/nkmj.galenos.2023.36036
CR  - Sobrado Júnior CW, Obregon CA, E Sousa Júnior AHDS, Sobrado LF, Nahas SC, Cecconello I. A new classification for hemorrhoidal disease: the creation of the "BPRST" staging and its application in clinical practice. Ann Coloproctol. 2020;36(4):249-255. doi:10.3393/ac.2020.02.06
CR  - Klang E, Sobeh T, Amitai MM, Apter S, Barash Y, Tau N. Post hemorrhoidectomy complications: CT imaging findings. Clin Imaging. 2020;60(2):216-221. doi:10.1016/j.clinimag.2019.12.015
CR  - Bhatti MI, Sajid MS, Baig MK. Milligan-Morgan (open) versus Ferguson haemorrhoidectomy (closed): a systematic review and meta-analysis of published randomized, controlled trials. World J Surg. 2016;40(6):1509-1519. doi:10.1007/s00268-016-3419-z
CR  - Jeong HY, Song SG, Lee JK. Predictors of postoperative urinary retention after semiclosed hemorrhoidectomy. Ann Coloproctol. 2022;38(1):53-59. doi:10.3393/ac.2021.00304.0043
CR  - Tammela T. Postoperative urinary retention--why the patient cannot void. Scand J Urol Nephrol Suppl. 1995;175:75-77.
CR  - Bleday R, Pena JP, Rothenberger DA, Goldberg SM, Buls JG. Symptomatic hemorrhoids: current incidence and complications of operative therapy. Dis Colon Rectum. 1992;35(5):477-481. doi:10.1007/BF02049406
CR  - Kaidar-Person O, Person B, Wexner SD. Hemorrhoidal disease: a comprehensive review. J Am Coll Surg. 2007;204(1):102-117. doi:10.1016/j.jamcollsurg.2006.08.022
CR  - Milone M, Maietta P, Leongito M, Pesce G, Salvatore G, Milone F. Ferguson hemorrhoidectomy: is still the gold standard treatment? Updates Surg. 2012;64(3):191-194. doi:10.1007/s13304-012-0155-2
CR  - Lee KC, Liu CC, Hu WH, Lu CC, Lin SE, Chen HH. Risk of delayed bleeding after hemorrhoidectomy. Int J Colorectal Dis. 2019;34(2):247-253. doi:10.1007/s00384-018-3176-6
CR  - Guenin MO, Rosenthal R, Kern B, Peterli R, von Flüe M, Ackermann C. Ferguson hemorrhoidectomy: long-term results and patient satisfaction after Ferguson's hemorrhoidectomy. Dis Colon Rectum. 2005;48(8):1523-1527. doi:10.1007/s10350-005-0084-y
CR  - Eu KW, Teoh TA, Seow-Choen F, Goh HS. Anal stricture following haemorrhoidectomy: early diagnosis and treatment. Aust N Z J Surg. 1995;65(2):101-103. doi:10.1111/j.1445-2197.1995.tb07270.x
CR  - Lohsiriwat V, Jitmungngan R. Strategies to reduce post-hemorrhoidectomy pain: a systematic review. Medicina (Kaunas). 2022; 58(3):418. doi:10.3390/medicina58030418
CR  - Khanna R, Khanna S, Bhadani S, Singh S, Khanna AK. Comparison of ligasure hemorrhoidectomy with conventional Ferguson's hemorrhoidectomy. Indian J Surg. 2010;72(4):294-297. doi:10.1007/s 12262-010-0192-3
UR  - https://doi.org/10.38053/acmj.1736977
L1  - https://dergipark.org.tr/tr/download/article-file/5032447
ER  -