Efficacy of Polidocanol Sclerotherapy Compared with open Hemorrhoidectomy in Grade III Internal Hemorrhoids: A Prospective Non-Randomized Comparative Study

Background: Grade III internal hemorrhoids frequently fail conservative therapy. Open hemorrhoidectomy is definitive but painful, whereas polidocanol sclerotherapy is a minimally invasive alternative. Aims/Objectives: To compare the efficacy, safety and postoperative outcomes of 3% polidocanol sclerotherapy with open hemorrhoidectomy in Grade III internal hemorrhoids. Methodology: In this prospective non-randomized comparative study, 100 consecutive patients were allocated non-randomly and equally to sclerotherapy (Group A) or open hemorrhoidectomy (Group B) and followed for six months. Operative time, pain (VAS), bleeding, infection, incontinence, stenosis, recurrence, recovery and the Hemorrhoid Severity Score (HSS) were assessed. Results: Operative time was shorter with sclerotherapy (18.62±2.82 vs 46.26±7.92 min; t=23.25, p<0.001). Day-3 pain was lower (2.94±0.82 vs 6.24±1.02; t=17.83, p<0.001). Day-7 bleeding occurred in 4 (8.0%) versus 14 (28.0%) patients (χ²=5.49, p=0.019). Incontinence [0 (0.0%) vs 7 (14.0%); p=0.012] and recurrence [2 (4.0%) vs 11 (22.0%); χ²=5.66, p=0.017; risk difference −18.0%, 95% CI −30.7% to −5.3%] were fewer after sclerotherapy, which also gave faster recovery (3.18±0.87 vs 10.70±1.82 days; t=26.33, p<0.001). Conclusions: 3% polidocanol sclerotherapy is a safe, effective and minimally invasive alternative to open hemorrhoidectomy for Grade III hemorrhoids, offering less pain and faster recovery.