A Novel Combined Surgical Technique for Mixed Hemorrhoidal Disease Using Carbon Dioxide Laser and Botulinum Toxin: Analysis of the First 100 Cases

Abstract Traditional surgical approaches for mixed hemorrhoidal disease are often associated with significant postoperative pain and prolonged recovery periods. The present study describes the findings in the first 100 patients undergoing a novel minimally invasive hybrid technique combining staged internal ligations, mucosal transection, and external resection using carbon dioxide (CO2) laser, followed by layered anatomical closure and intersphincteric injection of type-A botulinum toxin. A prospective study of 100 patients undergoing a hybrid procedure. Collected variables included demographic, surgical, and clinical data: age, sex, number of cutaneous papillae, operative time, time to first defecation, postoperative pain scores, return-to-work interval, and complication rates. The mean patient age was 46.1 years. Median operative time was 60.5 minutes. Pain during first defecation had a median score of 5, decreasing to 1 by day 7. Median time of return to work was on postoperative day 15. The overall complication rate was 10%. The number of cutaneous papillae had a positive correlation with pain during defecation (ρ = 0.501; p < 0.001), pain on day 1 (ρ = 0.228; p = 0.023), and operative time (ρ = 0.848; p < 0.001). Persistent pain on day 7 was also associated with complications (ρ = 0.391; p = 0.0001). The combined technique using staged ligation and CO2 laser appears to be a safe, effective, and innovative approach to mixed hemorrhoidal disease, with the potential to reduce postoperative pain, accelerate functional recovery, and minimize complications.