iarjsIARJSIARJS2789-6102https://doi.org/10.47310/iarjs.2025.v05i02.004Combined LigaSure Hemorrhoidectomy with Lateral Internal Sphincterotomy: A Five-Year Clinical Evaluation in 176 Iraqi PatientsBackground: Excisional hemorrhoidectomy remains the definitive treatment for grade III-IV hemorrhoids but is frequently complicated by postoperative pain, delayed healing and anal stenosis. Objective: To evaluate postoperative outcomes of LigaSure hemorrhoidectomy combined with LIS in adults with grade III-IV hemorrhoids. Methods: Prospective cohort of 176 consecutive patients operated at a tertiary center in Baghdad (January 2020-June 2025). Primary outcomes were pain trajectory (VAS, day 1-week 3) and anal stenosis ≤3 months. Secondary outcomes included operative time, blood loss, need for hemostatic sutures, early complications (≤14 days), wound-healing status (3 and 6 weeks), recurrence ≤6 months, patient satisfaction and time to return to normal activity. Results: Mean age 42 ± 11 years; males 110 (62.5%); grade III 102 (57.9%), grade IV 74 (42.1%). Mean operative time 24 ± 6 minutes; mean blood loss 18 ± 5 mL; hemostatic sutures required in 6 (3.4%); no intraoperative complications. Pain decreased significantly from day 1 to week 3 (VAS 4.2 ± 1.1 → 0.5 ± 0.2; p<0.001). Early complications occurred in 23 (13.0%): anal edema 8 (4.5%), urinary retention 6 (3.4%), secondary bleeding 4 (2.3%), wound infection 3 (1.7%), transient flatus incontinence 2 (1.1%); all were conservatively managed. Complete wound healing: 162 (92.0%) at 3 weeks and 173 (98.3%) at 6 weeks (p<0.001). Anal stenosis 3 (1.7%, p<0.05). Six-month recurrence 2 (1.1%) with no chronic pain or recurrent prolapse. Patient-reported outcomes were favorable: excellent 151 (85.8%), good 20 (11.4%), fair 5 (2.8%); mean return to normal activity 8 ± 2 days (p<0.001 vs historical open techniques). Conclusion: LigaSure hemorrhoidectomy with adjunct LIS achieved low pain scores, rapid healing, minimal blood loss, very low stenosis (1.7%) and low short-term recurrence (1.1%), with high satisfaction and early functional recovery. The combined technique appears safe and effective for grade III-IV disease in routine practice.