Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Gastrointest Surg. May 27, 2026; 18(5): 119999
Published online May 27, 2026. doi: 10.4240/wjgs.v18.i5.119999
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, 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.
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
Revised: March 17, 2026
Accepted: March 30, 2026
Published online: May 27, 2026
Processing time: 104 Days and 22.7 Hours
Core Tip
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.