Background: Grade III hemorrhoidal disease (HD) with large-volume or circumferential prolapse is poorly managed with less invasive treatments. This study evaluates LigaSure™ (Covidien plc, Dublin, Ireland; now acquired by Medtronic plc, Galway, Ireland) hemorrhoidectomy outcomes in this subset. Methods: This was a prospective single-center cohort study conducted in Najaf Province, Iraq, which enrolled 316 adults with Grade III HD and at least one "special" feature (large solitary prolapse ≥3 cm or ≥1 quadrant, circumferential prolapse ≥3 quadrants, perianal fibrosis/edema, or prior failed rubber band ligation (RBL)/dearterialization (DEART)/stapled hemorrhoidopexy (SH)), from February 2023 to October 2024, with a follow-up to October 2025. Primary endpoints included operative time and 30-day complications (visual analog scale ≥7 pain, urinary retention, bleeding, infection, stenosis, incontinence). Secondary outcomes included length of stay (LOS), recovery time, and one-year recurrence. Results: Median age of participants was 30 years (range 18-55). Of the total participants, 62.7% were male, and 48.1% had prior failed therapy. Mean operative time was 28.0 ± 6.0 minutes. Severe pain was recorded in 6.9% (95% CI 4.4-10.3), urinary retention in 17.1% (95% CI 13.1-21.7); the rate of postoperative urinary retention was higher with spinal (19.6%, n=240) versus general anesthesia (9.2%, n=76). The risk difference was 12.5% (95% CI 3.2-21.8). No bleeding, infection, stenosis, or incontinence was seen. Median LOS was one day (IQR 1, 1), and median recovery duration was seven days (IQR 6, 9). The one-year follow-up rate was achieved in 91.5% (289/316) of the patients. There were no patients with reoperation, and 11.8% had minor bleeding (95% CI 8.3-16.1). Outcomes were similar regardless of prior treatment failure. Conclusion: Standardized LigaSure hemorrhoidectomy for complex Grade III HD demonstrated rapid operative times, low severe pain, acceptable urinary retention (higher with spinal anesthesia), and zero one-year reoperations, supporting early excisional surgery in this anatomical subset.
Samer Al Hakkak (Mon,) studied this question.