Milligan Morgan Conventional Hemorrhoidectomy and Integrative Approach Through Ayurveda in the Management of Grade Four Multiple Hemorrhoids

Abstract

Introduction: Hemorrhoids are common anorectal conditions, and in advanced cases often require surgical intervention. Hemorrhoidectomy, though effective, can lead to complications such as pain, bleeding and anal stricture. Integrating Ayurvedic modalities with modern management may help optimize the outcome. Case Presentation: A 55-year-old male presented with fourth-degree internal hemorrhoids, with associated pain and prolapse for 15 days, and a history of intermittent rectal bleeding for 10 years. Examination revealed prolapsed, inflamed interno-external hemorrhoids at 3, 7, and 11 o’clock positions. Preoperative management included Inj. Taximax 1.5g twice a day for 3 days and Jalaukavacharana (leech therapy) to reduce inflammation. Hemorrhoidal artery ligation (HAL) with mucopexy was initially performed but failed; subsequently, Milligan-Morgan hemorrhoidectomy was carried out. Postoperatively, mild anal stricture was observed as a complication of surgery which was managed with Ayurvedic interventions. Results: Gradual wound healing with satisfactory post-operative recovery was observed along with improvement in anal stenosis. At six-months follow-up, the patient had complete recovery without recurrence of hemorrhoids or any complications. Conclusion: An integrative approach combining modern surgical methods with Ayurvedic therapies contributed to improved post-operative recovery and wound healing in grade IV hemorrhoids patient.