Real-world outcomes of hemorrhoidectomy with and without advanced energy devices: A propensity score-matched analysis from a tertiary center

Hemorrhoidal disease is a common anorectal condition, and surgical hemorrhoidectomy remains the definitive treatment for advanced cases. In recent years, various energy-based surgical devices have been introduced into hemorrhoidectomy practice; however, their impact on surgical outcomes remains unclear. We aim to evaluate the role of energy devices in contemporary hemorrhoid surgery by comparing outcomes between energy device-assisted and conventional hemorrhoidectomy. We conducted a retrospective study using electronic medical records to identify patients who underwent hemorrhoidectomy at our institution between January 1 and December 31, 2022. Patients were matched 1:1 between the energy device and non-energy device groups using propensity score matching. The primary outcome was the incidence of postoperative complications. Secondary outcomes included the duration of postoperative analgesic use and the total dose of opioid analgesics administered. After matching, no significant baseline differences were observed between the two groups. The energy device group had significantly higher rates of infection (13.8% vs. 5.3%, p = 0.002), postoperative bleeding (5.3% vs. 1.8%, p = 0.042), and emergency department visits (23.1% vs. 12.4%, p = 0.003) compared to the non-energy device group. There were no significant differences in overall complication rates or postoperative pain scores between the groups. Although overall complication rates did not differ significantly between groups, energy device-assisted hemorrhoidectomy was associated with higher rates of postoperative bleeding and infection, likely reflecting lateral thermal injury and the intrinsic properties of energy-based instruments. Further research is warranted to investigate additional contributing factors.