Modified Ferguson hemorrhoidectomy for grade II–IV hemorrhoids offers low recurrence and complication rates: a retrospective cohort study

Purpose This study aimed to evaluate the efficacy and safety of modified Ferguson hemorrhoidectomy (MFH) compared with conventional Milligan-Morgan hemorrhoidectomy (MMH) for grade II–IV hemorrhoids. Methods A retrospective cohort of patients undergoing MFH or MMH between September 2020 and August 2021 was reviewed. The primary outcomes were healing time and recurrence after at least 24 months of follow-up. Secondary outcomes included Hemorrhoidal Disease Symptom Score (HDSS), postoperative complications, patient satisfaction, and quality-of-life assessment. Results A total of 515 patients were enrolled (MFH, n = 254; MMH, n = 261) with a median follow-up of 29 months. The recurrence rate was significantly lower in the MFH group compared with MMH (1.2% vs. 5.0%, p = 0.013), with Kaplan–Meier analysis confirming superior recurrence-free survival (98.8% vs. 95.0% at 36 months). Healing time was shorter with MFH (26.3 ± 4.3 vs. 30.9 ± 3.5 days, p < 0.001). MFH reduced the risk of postoperative edema (2.4% vs. 9.6%, p = 0.01; OR 0.23, 95% CI 0.09–0.56) but showed a higher incidence of urinary retention (3.9% vs. 1.1%, p = 0.04). No anal stenosis or fecal incontinence was observed in either group. Patient satisfaction was higher in MFH (9.7 ± 0.7 vs. 9.4 ± 1.2, p = 0.002), and improvements in HDSS and SHSHD scores were sustained during long-term follow-up. Multivariate regression confirmed MFH as an independent protective factor against recurrence (adjusted OR 0.26, 95% CI 0.08–0.91, p = 0.035). Conclusion Modified Ferguson hemorrhoidectomy is a safe and effective technique for grade II-IV hemorrhoids, offering lower recurrence, shorter healing, fewer complications, and higher satisfaction compared with Milligan-Morgan hemorrhoidectomy.