→Methods Between 2020 and 2023, 1,023 patients underwent SH, with an average of 3.3 external hemorrhoids being excised per patient. The fluid mixture contained 40 mg of TA per 100 mL (0.4 mg/mL), with 5 mL (2 mg of TA) injected at the SH site and 2–3 mL (1.2 mg of TA) at each excisional hemorrhoidectomy site. The TA group (n=554; propensity score matching [PSM]-adjusted, n=375) received TA injections, whereas the non-TA group (n=469; after PSM, n=375) received conventional epinephrine injections. PSM was adjusted for age, sex, concurrent surgeries, botulinum toxin injection, and excisional hemorrhoidectomy frequency. Logistic regression models were used to analyze SHsS and reoperation rates.