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, but with a higher short-term recurrence rate compared to excisional hemorrhoidectomy.
Key Findings
Results
Operative time was significantly lower in the monopolar cautery ablation (MPCA) group compared to the excisional hemorrhoidectomy (EH) group.
The difference in operative time between groups was statistically significant (p < 0.001).
The study included 32 patients in the EH group and 29 patients in the MPCA group.
All patients had symptomatic grade II-III hemorrhoidal disease and were followed for at least one year.
Baseline characteristics including age, sex, and hemorrhoidal stage were comparable between the groups.
Results
Postoperative analgesic requirements were significantly lower in the MPCA group than in the EH group.
The difference in analgesic requirements was statistically significant (p < 0.001).
Duration of analgesic use was one of the primary outcomes measured.
Postoperative pain scores were assessed at the 12th hour and on postoperative days 1, 7, and 14.
Results
Time to return to daily activities was significantly shorter in the MPCA group compared to the EH group.
The difference in time to return to daily activities was statistically significant (p < 0.001).
This outcome was assessed alongside patient satisfaction as a measure of recovery.
Results
Patient satisfaction was significantly higher in the MPCA group than in the EH group.
The difference in patient satisfaction was statistically significant (p < 0.001).
Patient satisfaction was one of the primary comparative outcomes between the two surgical techniques.
Results
No significant differences were observed between the groups in hospital stay, postoperative bleeding, or postoperative edema.
Hospital stay difference was not statistically significant (p = 0.086).
Postoperative bleeding showed no significant difference between groups (p = 1.000).
Postoperative edema showed no significant difference between groups (p = 0.600).
Results
Three recurrences were observed in the MPCA group while no recurrences were detected in the EH group, though this difference did not reach statistical significance.
The difference in recurrence rates between the two groups was not statistically significant (p = 0.102).
Zero recurrences were observed in the EH group (n = 32) during the follow-up period.
Three recurrences were observed in the MPCA group (n = 29) during at least one year of follow-up.
The authors note these findings should be interpreted cautiously due to the retrospective design and relatively short follow-up period.
Methods
This was a retrospective study of 61 patients who underwent surgery for symptomatic grade II-III hemorrhoidal disease between January 2022 and December 2023.
All patients were followed for at least one year.
Patients were divided into two groups according to surgical technique: EH group (n = 32) and MPCA group (n = 29).
Outcomes compared included operative time, postoperative pain scores, duration of analgesic use, patient satisfaction, time to return to daily activities, postoperative complications, and recurrence rates.
The authors call for further prospective studies with longer follow-up to confirm long-term efficacy and safety.
What This Means
This research compared two surgical treatments for hemorrhoids (grade II-III, meaning moderate to moderately severe cases): the traditional surgical removal method (excisional hemorrhoidectomy) and a newer technique using electrical energy to shrink hemorrhoidal tissue (monopolar cautery ablation). The study followed 61 patients for at least one year after their procedures. Patients who received the newer ablation technique experienced shorter operation times, needed less pain medication afterward, returned to normal daily activities sooner, and reported higher overall satisfaction with their treatment compared to those who had traditional surgery.
However, the ablation technique showed a potential downside: three patients in that group experienced a return of their hemorrhoid symptoms within the follow-up period, while no recurrences were seen in the traditional surgery group. Importantly, this difference in recurrence rates was not statistically significant given the small sample size, meaning the study could not definitively confirm that one technique is better or worse for preventing recurrence. There were no meaningful differences between the two groups in terms of how long patients stayed in the hospital or how often they experienced bleeding or swelling after surgery.
This research suggests that monopolar cautery ablation may be a useful, less invasive option for patients with moderate hemorrhoid disease, particularly for those who prioritize faster recovery and less postoperative pain. However, because this was a relatively small retrospective study with only one year of follow-up, the authors caution that longer and larger prospective studies are needed before firm conclusions can be drawn about which technique is best for preventing hemorrhoids from coming back over the long term.