Short-term and patient-reported outcomes of laser hemorrhoidoplasty plus excisional hemorrhoidectomy for the treatment of grade IV hemorrhoid

Laser hemorrhoidoplasty (LHP) is mainly used for symptomatic grade I-III hemorrhoid. Only a few studies have reported the application of lasers for grade IV hemorrhoids. The study aimed to compare LHP plus excisional hemorrhoidectomy (EH) and LigaSure hemorrhoidectomy in terms of short-term and patient-reported outcomes for the treatment of grade IV hemorrhoids. Patients with grade IV hemorrhoid undergoing LHP plus EH between June 2022 and May 2024 were retrospectively included and historically compared with patients undergoing LigaSure hemorrhoidectomy between January 2019 to May 2022 at a regional hospital. The primary outcome was the surgical results and 30-day complications. The secondary outcome was the postoperative results including pain score by using visual analogue scale (VAS) score and patient-reported outcomes by using the Hemorrhoidal Disease Symptom Score and Short Health Scale_HD. A total of 92 patients who underwent LHP plus EH and 140 who underwent LigaSure hemorrhoidectomy were included. Patients who underwent LHP plus EH had a lower frequency of urinary retention than those who underwent LigaSure hemorrhoidectomy. LHP plus EH resulted in lower scores for the VAS (maximal) and VAS (mean) on the operation day and postoperative day 1 and required less acetaminophen administration on postoperative day 1. Regarding patient-reported outcomes, pain, bleeding, and prolapse improved after postoperative week 6. LHP plus EH is a safe and feasible alternative method for grade IV hemorrhoids in selected patients with satisfactory short-term postoperative and patient-reported outcomes. Further prospective with large numbers of patients are needed to verify the topic.