Closed Hemorrhoidectomy Advantages Over Open Technique
Closed hemorrhoidectomy (Ferguson technique) provides significantly faster wound healing and less postoperative pain compared to open hemorrhoidectomy (Milligan-Morgan technique), making it the superior choice for most patients requiring surgical hemorrhoidectomy. 1, 2
Wound Healing
The most compelling advantage of closed hemorrhoidectomy is dramatically faster wound healing:
- 75-90% of patients achieve complete wound healing by 3-4 weeks with closed technique, compared to only 18-40% with open technique 2, 3
- Average healing time is 14 days for closed versus 22 days for open hemorrhoidectomy 4
- All patients in closed groups showed complete healing at 2 weeks in one study, compared to only half of open hemorrhoidectomy patients 5
The closed technique involves excising hemorrhoidal components and closing wounds primarily with sutures, allowing healing by primary intention rather than the secondary healing required when wounds are left open 1
Postoperative Pain
Closed hemorrhoidectomy results in significantly less pain during the critical early postoperative period:
- Pain scores at recovery from anesthesia are significantly lower with closed technique (p<0.05) 2
- Only 15% of closed hemorrhoidectomy patients required additional narcotic analgesics compared to 45% in the open group (p<0.01) 2
- Pain at first bowel movement is significantly reduced with closed technique (p<0.01) 2, 3
- Pain during bowel movements in the first postoperative week is statistically lower with closed technique 3
However, one study found that closed hemorrhoidectomy was associated with more moderate-to-severe pain in some patients, though this finding is contradicted by multiple other trials 5
Comparable Long-Term Outcomes
Both techniques show equivalent results for complications and recurrence after one year:
- Recurrence rates of 2-10% are similar between both techniques 6, 1
- Early complications (bleeding, infection, urinary retention) show no statistically significant differences between groups 4
- Late complications including stenosis, fissure, and incontinence occur at similar rates 3, 4
Technical Considerations
The closed technique requires slightly longer operative time:
- Average 30 minutes for closed versus 24 minutes for open technique, though this difference is not statistically significant 3
- Both techniques can be performed safely as day-case procedures under local anesthesia with sedation 3
- The American Gastroenterological Association confirms that conventional excisional hemorrhoidectomy can be performed with either open or closed techniques with comparable efficacy 1
Clinical Bottom Line
Choose closed hemorrhoidectomy (Ferguson technique) as the preferred approach because it delivers faster return to normal activities through accelerated wound healing and reduced early postoperative pain, while maintaining equivalent long-term efficacy and complication rates compared to open technique 2, 3, 7. The slightly longer operative time is a negligible trade-off for the substantial patient-centered benefits.