Clinical efficacy and recurrence analysis of endoscopic rubber band ligation combined with external hemorrhoidectomy for mixed hemorrhoids

OBJECTIVE: To evaluate the efficacy and safety of endoscopic rubber band ligation combined with external hemorrhoidectomy (ERBL+EH) for mixed hemorrhoids compared with Milligan-Morgan hemorrhoidectomy (MMH), and to identify risk factors for postoperative recurrence. METHODS: or t-tests, and Cox regression was applied to identify independent risk factors for recurrence. RESULTS: Baseline characteristics were comparable between groups (P > 0.05). ERBL+EH demonstrated significantly better perioperative outcomes, including reduced blood loss, shorter operation and wound healing times, faster pain relief, fewer incisions, and lower postoperative pain scores (all P < 0.05). Complication rates were lower in the ERBL+EH group, particularly anal stenosis, prolapse, incontinence, urinary retention, and incision edema, though postoperative bleeding rates were similar between groups. At 1 year, recurrence was significantly reduced with ERBL+EH (9.7% vs. 31.0%, P < 0.001), with longer time to recurrence (10 vs. 6 months, P = 0.025). Treatment costs were higher in the ERBL+EH group, but length of hospital stay was similar. Clinical efficacy showed a higher rate of marked improvement in the ERBL+EH group (P < 0.001). Multivariate Cox regression identified ERBL+EH as a protective factor against recurrence (HR = 0.218, P = 0.006), while stage IV disease, diabetes, spicy diet, and anal prolapse were independent risk factors. CONCLUSION: ERBL+EH is superior to MMH in perioperative outcomes, complication control, and recurrence reduction, offering a safe and effective treatment for mixed hemorrhoids, albeit at higher cost. Appropriate patient selection and optimized postoperative management may further enhance long-term outcomes.