Refined Energy Device–Free Submucosal Hemorrhoidectomy: Eliminating Postoperative Urinary Retention and Minimizing Tissue Injury

Background: Hemorrhoidectomy remains an essential treatment for advanced hemorrhoidal disease, but postoperative pain and urinary retention continue to burden patients. Purpose: To evaluate a refined, energy device–sparing submucosal hemorrhoidectomy emphasizing limited anoderm resection, internal sphincter preservation, and submucosal dissection for hemorrhoidal plexus excision and reconstruction. Method: Retrospective descriptive study of 110 consecutive symptomatic hemorrhoidal disease cases performed by colorectal surgeons who adhered to the refinements between October 2022 and May 2024 in Lin Kou Chang Gung Memorial Hospital, Taiwan. Results: No cases of postoperative urinary retention were observed. Postoperative pain was effectively managed with oral analgesics; 7 patients (6.4%) required short-term opioids, and 1 required prolonged opioid use. The mean hospital stay was 1 day. Emergency visits occurred in 5 patients (4.5%): 4 (3.6%) for postoperative hemorrhage and 1 (0.9%) for abscess formation; all were managed non-surgically. Anal fissures developed in 2 patients (1.8%) during follow-up. Conclusion: This refined technique achieved a 0% urinary retention rate, minimized postoperative discomfort, and enabled short hospital stays. The procedure preserves anoderm integrity, limits tissue injury, and promotes rapid recovery using basic surgical instruments without energy devices.