General Surgery

Haemorrhoidectomy (Milligan-Morgan)

OPERATION: Haemorrhoidectomy (Milligan-Morgan)
ANAESTHETIC: General / spinal anaesthesia. Local infiltration with adrenaline-containing solution to aid haemostasis.
POSITION: Lithotomy

INDICATION:
Symptomatic grade III / IV haemorrhoids. Failed conservative and office-based management.

PROCEDURE:
WHO Checklist performed. Anal examination and proctoscopy performed. Haemorrhoids at primary positions identified (right anterior, right posterior, left lateral). [Additional components noted].

Haemorrhoidal complexes marked ensuring adequate mucocutaneous and mucosal bridges between excision sites to prevent anal stenosis. Fine diathermy point used to mark planned incisions.

First haemorrhoid: artery forceps applied to the external skin component and to the prolapsing mucosa. V-shaped incision through perianal skin at the base of the external component. Dissection deepened in the submucosal plane, staying external to the internal sphincter — internal sphincter fibres clearly identified and preserved throughout. Haemorrhoidal plexus dissected off internal sphincter up into the anal canal to the pedicle. Transfixion suture placed through the mucosal pedicle. Haemorrhoid excised. Haemostasis with diathermy.

Second and third haemorrhoids excised in identical fashion. Adequate bridges of anoderm and mucosa confirmed between all three excision sites.

Wounds left open. Haemostasis confirmed.

FINDINGS:
Grade [III / IV] haemorrhoids at [positions]. Adequate mucocutaneous bridges maintained.

EBL: Minimal. COMPLICATIONS: None.

POST-OPERATIVE INSTRUCTIONS:
Regular analgesia including topical. High fibre diet and adequate hydration. Sitz baths. Laxative to avoid constipation. Outpatient review at 4–6 weeks.