Monopolar Cautery Ablation as a Minimally Invasive Treatment Option for Grade II–III Hemorrhoidal Disease

AIM: Hemorrhoidal disease (HD) is a common condition worldwide that significantly impairs quality of life. This study aims to compare the effectiveness of excisional hemorrhoidectomy (EH) and monopolar cautery ablation (MPCA). METHODS: This retrospective study included 61 patients who underwent surgery for symptomatic grade II–III hemorrhoidal disease between January 2022 and December 2023. Patients were divided into two groups according to the surgical technique: the EH group and the MPCA group. All patients were followed for at least one year. The groups were compared in terms of operative time, postoperative pain scores (at the 12th hour, postoperative days 1, 7, and 14), duration of analgesic use, patient satisfaction, time to return to daily activities, postoperative complications, and recurrence rates. RESULTS: Thirty-two patients underwent EH, and 29 underwent MPCA. Baseline characteristics, including age, sex, and hemorrhoidal stage, were comparable between the groups. Operative time and postoperative analgesic requirements were significantly lower in the MPCA group (both p < 0.001). The time to return to daily activities was significantly shorter in the MPCA group, while patient satisfaction was significantly higher (both p < 0.001). No significant differences were observed between the groups regarding hospital stay or postoperative bleeding and edema (p = 0.086, p = 1.000 and p = 0.600, respectively). No recurrences were detected in the EH group, whereas three recurrences were observed in the MPCA group (p = 0.102). CONCLUSIONS: Monopolar cautery ablation appears to be a suitable minimally invasive option for selected patients with grade II–III hemorrhoidal disease, offering advantages in terms of operative time, postoperative pain, and recovery. However, a higher short-term recurrence rate compared to excisional hemorrhoidectomy was observed. These findings should be interpreted cautiously due to the retrospective design and relatively short follow-up period. Further prospective studies with longer follow-up are required to confirm long-term efficacy and safety.