Milligan-Morgan hemorrhoidectomy under local anesthesia - an old operation that stood the test of time. A single-team experience with 2,280 operations.

PURPOSE: 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.

[Alertness is its own reward: adult type Hirschprung's disease--clinical description of first two cases in Israel].

Hirschprung disease is well known. The basic pathogenesis is lack of parasympathetic ganglia in the large bowel wall, part of it, or all of it. The absence of these ganglia paralyzes the involved segment leading to obstruction. Almost all babies are diagnosed and operated upon in their first year. Few rare cases manage to grow and reach maturity without diagnosis. These patients are characterized by severe constipation and grade III-IV hemorrhoids. This is adult type Hirschprung's disease. Two first cases in Israel were diagnosed, patients were operated upon, and recovered. Adult type Hirschprung's disease is reviewed and various surgical options are discussed.