Combined laser hemorrhoidoplasty and mucopexy for grade 4 piles: Is it the way forward?

Abstract

Objective: To evaluate the efficacy, safety, and outcomes of combined laser hemorrhoidoplasty and mucopexy in the management of grade IV hemorrhoidal disease. Study Design: Prospective Observational Cohort study. Setting: Aziz Fatimah Medical and Dental College, Faisalabad, Pakistan. Period: January 1, 2023, to January 1, 2026. Methods: A total of 193 patients with grade IV hemorrhoids underwent combined laser hemorrhoidoplasty (LHP) using a 1470-nm diode laser system and mucopexy with absorbable 2-0 polyglactin sutures. Non-probability consecutive sampling was employed. Operative parameters, symptom resolution, complications, and patient outcomes were systematically recorded and analyzed. Follow-up assessments were conducted at 2 weeks, 6 weeks, 3 months, and 6 months postoperatively to evaluate complete symptom resolution, partial improvement, and postoperative complications including hemorrhage, fistula formation, fecal soiling, and pain. Results: The mean operative time was 19 ± 3.8 minutes (range: 16–35 minutes). Complete resolution of symptoms was achieved in 85.5% of patients (n=165), while 14.5% (n=28) experienced partial improvement. Among patients with complete resolution, 32.1% (n=53) encountered postoperative complications: secondary hemorrhage (n=10, 5.2%), fistula-in-ano (n=3, 1.6%), transient fecal soiling (n=17, 8.8%), and pain/discomfort (n=23, 11.9%). All patients with partial resolution had residual mucosal prolapse despite alleviation of other symptoms. The mean age was 45.2 ± 8.6 years, mean BMI was 27.5 ± 3.4 kg/m², and mean symptom duration was 18.3 ± 6.7 months. Conclusion: Combined laser hemorrhoidoplasty and mucopexy demonstrates high efficacy for grade IV hemorrhoidal disease with short operative time and acceptable complication rates. However, residual mucosal prolapse in 14.5% of patients suggests that patient selection and surgical technique refinement remain critical for optimal outcomes.