LigaSure™ Hemorrhoidectomy for Complex Grade III Hemorrhoidal Disease: A Prospective, Single-Center, Cohort Study

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.

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.

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.

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.