Outcome of a novel nonexcisional technique using aluminum potassium sulfate and tannic acid(ALTA) sclerotherapy with ligation on patients with circumferential mixed hemorrhoids

Background: We propose a novel nonexcisional technique for circumferential mixed hemorrhoids. This procedure, namely AL,involves combining Aluminum potassium sulfate and tannic acid (ALTA) therapy with ligation. This study aimed to compare the efficacy and safety of this novel procedure over Milligan-Morgan hemorrhoidectomy (MM) in patients with circumferential mixed hemorrhoids. Methods: This multicenter retrospective study conducted at three hospitals in China included 514 patients with circumferential mixed hemorrhoids who 224underwent AL and 290 underwent MM. Primary endpoints were symptom resolution and recurrence rate. Secondary endpoints were intraoperative outcomes, postoperative pain, complications, anal function and cosmetic outcome. Results: The complete symptom resolution rate in both groups showed no statistically significant difference. Recurrence rates in the AL and MM groups were 2.2% and 12.4%, respectively ( R < 0.001 ). Mean operative time was significantly shorter in AL group ( P < 0.001 ). Anal cosmetic outcome in AL group was superior to the MM group ( R < 0.001 ). Subgroup analysis showed higher complete symptom resolution rate with grade Ⅳ hemorrhoidal patients in the AL group ( R < 0.001 ). No anal dysfunction occurred in both groups. Conclusions: AL is safe and noninferior to MM in the treatment of grade Ⅲ circumferential mixed hemorrhoids, and it is more effective in the treatment of grade Ⅳ. It shows promising results as a minimally invasive technique compared with MM, with lower recurrence rate, shorter operative time and favorable cosmetic outcome.