Li SH, Wu XS, Zhao L, Liu XF, Lan WR, Sun WN, Zhao N, Liu YD. Comparative study of one-step and four-step injection combined with external stripping and internal ligation for mixed hemorrhoids. World J Gastrointest Surg 2026; 18(5): 119999 [DOI: 10.4240/wjgs.v18.i5.119999]
Corresponding Author of This Article
Yue-Dong Liu, Chief Physician, The Third Department of Anorectal, The Third Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, No. 35 Shiwei Road, Heping District, Shenyang 110005, Liaoning Province, China. 19550305937@163.com
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Gastroenterology & Hepatology
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research-article
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Li SH, Wu XS, Zhao L, Liu XF, Lan WR, Sun WN, Zhao N, Liu YD. Comparative study of one-step and four-step injection combined with external stripping and internal ligation for mixed hemorrhoids. World J Gastrointest Surg 2026; 18(5): 119999 [DOI: 10.4240/wjgs.v18.i5.119999]
World J Gastrointest Surg. May 27, 2026; 18(5): 119999 Published online May 27, 2026. doi: 10.4240/wjgs.v18.i5.119999
Comparative study of one-step and four-step injection combined with external stripping and internal ligation for mixed hemorrhoids
Shu-Han Li, Xian-Shu Wu, Lun Zhao, Xue-Feng Liu, Wei-Ru Lan, Wan-Ni Sun, Na Zhao, Yue-Dong Liu
Shu-Han Li, Third Clinical College, Liaoning University of Traditional Chinese Medicine, Shenyang 110847, Liaoning Province, China
Xian-Shu Wu, Wei-Ru Lan, Yue-Dong Liu, The Third Department of Anorectal, The Third Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 110005, Liaoning Province, China
Lun Zhao, Wan-Ni Sun, The Second Department of Hemorrhoids and Fistula, The Third Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 110003, Liaoning Province, China
Xue-Feng Liu, The Second Clinical Department, Liaoning University of Traditional Chinese Medicine, Shenyang 110847, Liaoning Province, China
Na Zhao, Innovation Engineering Technology Center of Traditional Chinese Medicine, Liaoning University of Traditional Chinese Medicine, Shenyang 110847, Liaoning Province, China
Co-first authors: Shu-Han Li and Xian-Shu Wu.
Co-corresponding authors: Na Zhao and Yue-Dong Liu.
Author contributions: Li SH and Wu XS contribute equally to this study as co-first authors; Zhao N and Liu YD contribute equally to this study as co-corresponding authors; Li SH participated in research design and data collection; Wu XS participated in data analysis; Zhao L participated in data analysis and thesis writing; Liu XF responsible for research and design and fund application; Lan WR responsible for data analysis, review and editing; Sun WN be responsible for thesis writing, communication and coordination; Zhao N responsible for ethical review, copyright and licensing; Liu YD responsible for research design, data analysis, thesis writing and follow-up; all authors have read and accepted the final manuscript.
Institutional review board statement: The research was reviewed and approved by the Clinical Trial Ethics Committee of the Third Affiliated Hospital of Liaoning University of Traditional Chinese Medicine (Approval No. LLPJ-ZY-GC-2025-037-01).
Informed consent statement: All research participants or their legal guardians provided written informed consent prior to study registration.
Conflict-of-interest statement: No conflict of interest is associated with this work.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: No other data available.
Corresponding author: Yue-Dong Liu, Chief Physician, The Third Department of Anorectal, The Third Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, No. 35 Shiwei Road, Heping District, Shenyang 110005, Liaoning Province, China. 19550305937@163.com
Received: February 12, 2026 Revised: March 17, 2026 Accepted: March 30, 2026 Published online: May 27, 2026 Processing time: 104 Days and 22.7 Hours
Abstract
BACKGROUND
Mixed hemorrhoids are a common anorectal condition with a high incidence, significantly impacting patients’ quality of life due to bleeding, pain, and prolapse. While external stripping and internal ligation is a definitive surgical treatment, postoperative complications such as pain, edema, and prolonged recovery remain clinical challenges. Although combining this surgery with Xiaozhiling sclerotherapy is common, the optimal injection technique—the comprehensive four-step method vs the simplified one-step method—lacks systematic comparison. Therefore, this study aims to compare the clinical efficacy and safety of these two combined approaches.
AIM
To determine the safety and efficacy of four-step vs one-step sclerotherapy in Milligan-Morgan hemorrhoidectomy.
METHODS
Eighty patients with mixed hemorrhoids between August 2021 and April 2025 were randomly divided into control (n = 40) and observation (n = 40) groups. All patients underwent Milligan-Morgan hemorrhoidectomy, during which the observation group received a four-step Xiaozhiling injection, whereas the control group received a one-step injection. The two groups were compared regarding operative time, postoperative pain [assessed by Visual Analogue Scale (VAS) on days 1 and 5], recovery parameters (hemorrhoid sloughing time and hospital stay), complication rates, and six-month recurrence.
RESULTS
No statistically significant difference was observed in operative time between the two groups (P > 0.05). The observation group exhibited significantly lower VAS scores on postoperative days 1 and 5 compared to the control group (P < 0.05). While the time to hemorrhoid sloughing was comparable between groups (P > 0.05), the total hospital stay was significantly shorter in the observation group (P < 0.05). The incidence of postoperative complications did not differ significantly between the two groups (P > 0.05), although a trend towards fewer complications was noted in the observation group. No recurrences were observed in either group during the six-month follow-up period.
CONCLUSION
The four-step Xiaozhiling injection method offers superior short-term outcomes over the one-step method by reducing pain and hospital stay, without prolonging operative time, though long-term efficacy requires further study.
Core Tip: This retrospective study compared one-step vs four-step Xiaozhiling injection combined with external stripping and internal ligation for mixed hemorrhoids. The four-step method significantly reduced postoperative pain on days 1 and 5 and shortened hospital stays compared to the one-step method, with comparable surgical time and no recurrence at 6 months. These findings suggest the four-step injection technique offers superior postoperative recovery and represents a clinically valuable optimization for mixed hemorrhoid surgery.
