Laser hemorrhoidoplasty in focus: A modern alternative to conventional surgical techniques for symptomatic hemorrhoids

Abstract

Hemorrhoidal disease is a prevalent anorectal condition causing significant morbidity, affecting approximately 4% of the general population with incidence increasing with age and sedentary lifestyle. While conventional excisional hemorrhoidectomy techniques such as Milligan-Morgan and Ferguson remain standard for long-term efficacy, they are often associated with substantial postoperative pain and prolonged recovery. This narrative review evaluates the comparative clinical outcomes of laser hemorrhoidoplasty (LHP) versus conventional surgical interventions in the treatment of grade II and III symptomatic hemorrhoids. A comprehensive analysis of comparative studies, randomized controlled trials, and meta-analyses published between 2020 and 2025 was conducted, with primary outcomes including postoperative pain, recovery time, operative duration, complication rates, and recurrence. Key findings from studies by Maloku et al and Hassan et al. were analyzed to contextualize real-world LHP use. Across multiple high-quality studies, LHP was consistently associated with significantly lower postoperative pain scores, reduced analgesic requirements, and faster return to daily activities. Maloku et al demonstrated a shorter mean operative time (15.9 minutes) and reduced pain compared to open techniques (26.8 minutes; P < 0.01). Hassan et al confirmed these benefits in a cohort of 40 patients treated under local anesthesia. Operative time was generally comparable or shorter, and vessel ligation was suggested as an adjunct to improve outcomes in select cases. Complication rates were low and similar between groups, with LHP demonstrating minimal risk for major complications such as anal stenosis or incontinence. However, recurrence rates were higher with LHP in some studies, particularly in grade III disease. LHP offers a minimally invasive, low-morbidity alternative to excisional hemorrhoidectomy for appropriately selected patients. Despite superior short-term recovery profiles, potential for higher recurrence underscores the importance of patient selection and long-term follow-up. The role of local anesthesia and adjunctive vessel ligation merits further prospective evaluation.

Keywords: Laser hemorrhoidoplasty; Hemorrhoidectomy; Minimally invasive surgery; Hemorrhoids; Postoperative pain; Recurrence; Diode laser

Core Tip: Laser hemorrhoidoplasty (LHP) is emerging as a minimally invasive alternative to conventional excisional hemorrhoidectomy for grade II-III hemorrhoids. This review synthesizes evidence from recent comparative trials and meta-analyses, highlighting LHP’s advantages in terms of reduced postoperative pain, faster recovery, and preservation of anorectal anatomy. However, despite its favorable short-term profile, concerns about recurrence—especially in grade III cases—underscore the need for careful patient selection and long-term follow-up. These findings support LHP as a viable option in selected patients, bridging the gap between efficacy and minimally invasive care.