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Evidence cited from prior work indicates TILL can outperform traditional Milligan-Morgan hemorrhoidectomy for short-term outcomes, including reduced pain, faster healing, and lower risk of anal stenosis. Mechanistically, TILL decreases tissue tension and regulates blood supply to remove diseased tissue while preserving anal structure and function. Limitations of available studies restrict long-term generalizability, prompting calls for larger multicenter trials to confirm recurrence and broader clinical adoption.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/transverse-incision-with-longitudinal-ligation-procedure-innovation-pitfalls-and-clinical-perspectives/406425/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/transverse-incision-with-longitudinal-ligation-procedure-innovation-pitfalls-and-clinical-perspectives/406425.png","ImageObject",300,407,{"name":92,"@type":93},"Cart","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-01","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",13,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What problem does the transverse incision with longitudinal ligation (TILL) procedure target?","Question",{"text":113,"@type":114},"TILL targets circumferential prolapsed hemorrhoids, including severe grade III and IV cases that often require surgical treatment.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How does TILL work differently from traditional Milligan-Morgan hemorrhoidectomy?",{"text":118,"@type":114},"TILL modulates anal tension and tightness using a specific incision and ligation design, aiming to remove hemorrhoids while preserving anal structure and function, with improved blood supply control.",{"name":120,"@type":111,"acceptedAnswer":121},"What limitations in existing evidence restrict conclusions about long-term outcomes?",{"text":122,"@type":114},"Reported studies include retrospective, single-center designs, small samples, and short follow-up periods, limiting assessment of long-term outcomes such as recurrence.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},406425,1790975955,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":105,"preview_page_count":4},18829141979164,"https://eur-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","| W | J | G | World Journal of\u003Cbr>Gastroenterology |\n| --- | --- | --- | --- |\n\nSubmit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Gastroenterol 2025 December 28; 31(48): 114738  \nDOI: 10.3748/wjg.v31.i48.114738 ISSN 1007-9327 (print) ISSN 2219-2840 (online)  \nLETTER TO THE EDITOR  \nTransverse incision with longitudinal ligation procedure: Innovation, pitfalls, and clinical perspectives  \nHong-Wei Hua, Jiong Wu  \nSpecialty type: Gastroenterology and hepatology  \nProvenance and peer review:  \nInvited article; Externally peer reviewed.  \nPeer-review model: Single blind  \nPeer-review report’s classification Scientific Quality: Grade B, Grade B  \nNovelty: Grade C, Grade C  \nCreativity or Innovation: Grade C, Grade C  \nScientific Significance: Grade B, Grade B  \nP-Reviewer: Kayılıoğlu I, MD, Associate Professor, Türkiye; Xiang F, MD, Professor, China  \nReceived: September 27, 2025  \nRevised: November 3, 2025  \nAccepted: November 13, 2025  \nPublished online: December 28, 2025  \nProcessing time: 91 Days and 13.3 Hours  \nHong-Wei Hua, Jiong Wu, Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China  \nCorresponding author: Jiong Wu, MD, Chief Physician, Professor, Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No. 110 Ganhe Road, Hongkou District, Shanghai 200437, [China.](China. tcmoctober9@163.com)[ tcmoctober9@163.com](China. tcmoctober9@163.com)  \nAbstract  \nThe transverse incision with longitudinal ligation (TILL) procedure is a new method for treating circumferential prolapsed hemorrhoids. A study by Song et al found TILL to be better than the traditional Milligan-Morgan hemorrhoidectomy for short-term results, showing less pain, quicker healing, and lower risk of anal stenosis. TILL reduces tissue tension and controls blood supply, allowing effective removal of diseased tissue while maintaining anal function and structure. However, the study's limitations, including its retrospective, single-center design, small sample size, and short follow-up, restrict the findings' generalizability and ability to assess long-term outcomes like recurrence. Larger, multicenter trials are needed for a thorough evaluation and wider clinical adoption of TILL.  \nKey Words: Transverse incision with longitudinal ligation procedure; Milligan-Morgan hemorrhoidectomy; Circumferential prolapsed hemorrhoids; Methodology; Proctology; Clinical perspectives  \n©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.  \n WJG  [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 28, 2025  Volume 31  Issue 48   \nHua HW et al. TILL in clinical practice  \nCore Tip: This commentary underscores the transverse incision with longitudinal ligation (TILL) procedure as an innovative approach for addressing circumferential prolapsed hemorrhoids. The primary innovation of TILL resides in its \"tension modulation\", achieved through a specific incision and ligation design that adeptly balances the radical excision of hemorrhoids with the preservation of anal structure and function. This method offers distinct advantages over the Milligan-Morgan hemorrhoidectomy, particularly in minimizing postoperative pain, edema, and the risk of stenosis. Consequently, TILL emerges as a promising complementary technique within the spectrum of contemporary hemorrhoid treatments, although further validation is necessary.  \nCitation: Hua HW, Wu J. Transverse incision with longitudinal ligation procedure: Innovation, pitfalls, and clinical perspectives. World J Gastroenterol 2025; 31(48): 114738  \nURL: [https://www.wjgnet.com/1007-9327/full/v31/i48/114738.htm](https://www.wjgnet.com/1007-9327/full/v31/i48/114738.htm)  \nDOI: [https://dx.doi.org/10.3748/wjg.v31.i48.114738](https://dx.doi.org/1","cbCailyBVIiYEacf","https://ap.wps.com/l/cbCailyBVIiYEacf","pdf",363403,"English","# Letter to the editor\n## Transverse incision with longitudinal ligation procedure: Innovation, pitfalls, and clinical perspectives\n## Abstract\n## Key words\n## Core Tip\n## Citation","[{\"question\":\"What problem does the transverse incision with longitudinal ligation (TILL) procedure target?\",\"answer\":\"TILL targets circumferential prolapsed hemorrhoids, including severe grade III and IV cases that often require surgical treatment.\"},{\"question\":\"How does TILL work differently from traditional Milligan-Morgan hemorrhoidectomy?\",\"answer\":\"TILL modulates anal tension and tightness using a specific incision and ligation design, aiming to remove hemorrhoids while preserving anal structure and function, with improved blood supply control.\"},{\"question\":\"What limitations in existing evidence restrict conclusions about long-term outcomes?\",\"answer\":\"Reported studies include retrospective, single-center designs, small samples, and short follow-up periods, limiting assessment of long-term outcomes such as recurrence.\"}]","Transverse incision with longitudinal ligation procedure - Innovation, pitfalls, and clinical perspectives | PDF",1790565596]