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

Patients with grade IV hemorrhoidal disease had significantly longer baseline toilet sitting times and symptom duration compared to grade II/III patients.

• 78 total patients were included: grade II/III group n=54, grade IV group n=24
• Patients were classified according to the Goligher classification
• Study period was July 2022 to March 2024
• These baseline differences were statistically significant between groups

Operative time and hospital stay were longer in the grade IV group compared to the grade II/III group.

• 78 patients underwent ADL-mucopexy and were retrospectively analyzed
• The number of mucopexies and external excisions performed was similar between the two groups
• The ADL system provides deeper Doppler penetration and improved arterial mapping compared to standard Doppler-guided systems
• These differences in operative time and hospital stay were noted despite similar procedural counts

Grade IV patients required more opioid analgesia and reported higher 24-hour visual analog scale pain scores postoperatively.

• Grade IV patients experienced longer times to first flatus and defecation compared to grade II/III patients
• 24-hour VAS pain scores were higher in the grade IV group
• Tenesmus at 1 week was more common in grade IV patients
• These differences reflected greater early postoperative discomfort in the grade IV group

One-month patient satisfaction scores were comparable between grade II/III and grade IV groups despite early postoperative differences.

• Satisfaction scores at 1 month were 8.8 (grade II/III) versus 8.5 (grade IV)
• Primary outcomes included postoperative pain and recurrence; secondary outcomes comprised operative time, tenesmus, bowel function parameters, and patient satisfaction
• Despite greater early postoperative discomfort in grade IV patients, satisfaction scores converged by 1 month

Recurrence rates were low and similar between groups, with only one recurrence observed in each group during follow-up.

• Recurrence was observed in 1 patient in the grade II/III group and 1 patient in the grade IV group
• Recurrence was a primary outcome measure of the study
• Doppler-guided dearterialization with mucopexy is described as well established for grade II/III HD, whereas evidence for grade IV disease was previously limited
• The comparable recurrence rates support ADL-mucopexy as a viable option across HD grades