Clinical outcomes of arterial detection ligation technique for grade II/III versus grade IV hemorrhoidal disease

Doppler-guided dearterialization with mucopexy is well established for grade II/III hemorrhoidal disease (HD), whereas evidence supporting its use in grade IV disease remains limited. The arterial detection ligation (ADL) system provides deeper Doppler penetration and improved arterial mapping, potentially enhancing outcomes in advanced disease. This study compared clinical outcomes of ADL-mucopexy between patients with grade II/III and grade IV HD. Patients who underwent ADL-mucopexy between July 2022 and March 2024 were retrospectively analyzed. Patients were classified into grade II/III and grade IV groups according to the Goligher classification. Primary outcomes included postoperative pain and recurrence, while secondary outcomes comprised operative time, tenesmus, bowel function parameters, and patient satisfaction. Seventy-eight patients were included (grade II/III: n = 54; grade IV: n = 24). Patients with grade IV disease had significantly longer baseline toilet sitting times and symptom duration. Operative time and hospital stay were also longer in the grade IV group, while the number of mucopexies and external excisions was similar. Postoperatively, grade IV patients required more opioid analgesia, experienced longer times to first flatus and defecation, and reported higher 24-hour visual analog scale pain scores. Tenesmus at 1 week was more common in grade IV patients. Despite these early differences, 1-month satisfaction scores were comparable between groups (8.8 vs 8.5). Recurrence was observed in 1 patient in each group during follow-up. ADL-mucopexy demonstrated comparable short-term clinical outcomes and patient satisfaction across different HD grades. Although patients with grade IV disease experienced greater early postoperative discomfort, recurrence rates and overall satisfaction were similar. ADL-mucopexy may be considered a potential minimally invasive surgical option in carefully selected patients with grade IV HD.