Objective: Hemorrhoidectomy remains the gold-standard treatment for advanced hemorrhoidal disease, but long-term outcomes vary depending on the surgical technique and assessment method. This study aims to show the long-term results achieved using a combination of transperineal ultrasound (TPUS) and endoscopy in patients who underwent Milligan-Morgan hemorrhoidectomy (MM).

Methods: A consecutive series of MM patients treated between February 2020 and December 2023 were contacted and underwent a clinical proctological evaluation, a Doppler TPUS, and an endoscopic check of the anal canal. All investigations were performed using the ESAOTE MyLab XPRO80. TPUS anatomy, including Doppler views, was assessed on the axial, sagittal, and coronal planes. Outcome measures consisted of the description of Doppler TPUS modifications following MM, and their relationship with clinical and endoscopic findings. 

Results: Twenty-three patients were available for the analysis at 26 months of follow-up (range 14-48). Fifteen patients had a Doppler vascular pattern (65.2%), eight patients a scattered pattern (34.8%). No correlation was present between residual symptoms and the Doppler vascular pattern (p = 0.089). The vascular pattern was associated with endoscopic signs of recurrences (p = 0.003), and its absence was able to predict the lack of internal recurrences in all patients (100%).

Conclusions: Doppler TPUS could help in the long-term assessment of patients presenting residual symptoms after MM. If confirmed in larger future cohort studies, the 100% negative predictive value of the vascular pattern could be used to exclude internal recurrences during postoperative follow-up.