Less Pain, Better Outcomes: Laser-Assisted vs. Conventional Approaches in Mixed Hemorrhoid Surgery

Purpose Hemorrhoidal disease (HD) prevalently affects adults, causing bleeding and prolapse. Traditional surgical treatments, such as Milligan–Morgan hemorrhoidectomy (MMH), caused considerable postoperative pain and complications. The bleeding, prolapse, reduction, skin tags, and thrombosis (BPRST) classification provides a comprehensive HD severity assessment by investigating five factors: bleeding, prolapse, reduction, skin tags, and thrombosis. Laser hemorrhoidoplasty (LHP) provides a minimally invasive option for internal hemorrhoids, but it is less effective for mixed hemorrhoids (MH), where internal and external hemorrhoids coexist. This study introduces a combined LHP approach with external hemorrhoidectomy (LHP + EHD), comparing its efficacy to MMH and hypothesizing reduced pain and complications. Methods This study included 98 patients with MH who underwent either LHP + EHD or MMH, with the BPRST classification used preoperatively. The pain was assessed 1 week postoperatively with a visual analog scale (VAS), and complications, including bleeding, acute urinary retention (AUR), and local infection, were recorded. Statistical tests included chi-square, t-tests, and linear and logistic regression models. Results The LHP + EHD group demonstrated significantly lower VAS pain scores than the MMH group ( P  < 0.05), with similar AUR and bleeding rates across both groups. However, the LHP + EHD group exhibited a slightly higher incidence of local infection ( P  < 0.05). Multivariable analysis determined LHP + EHD as significantly reducing pain. Conclusion The LHP + EHD approach exhibits potential as a viable alternative to MMH, providing lower postoperative pain and acceptable complication rates. While promising, further studies are warranted to confirm the long-term outcomes.