Is laser surgery better than traditional hemorrhoidectomy for treating hemorrhoids?

Name: Is laser surgery better than traditional hemorrhoidectomy for treating hemorrhoids?
Published: 2026-10-05

In adults undergoing surgery for symptomatic grade III-IV hemorrhoids, does laser hemorrhoidectomy, compared with conventional excisional hemorrhoidectomy, reduce postoperative pain, speed recovery, and lower complication or recurrence rates?

Compiled 2026-10-05 · checked 2026-10-05 · next 2026-11-05 · automated review, how it works

Bottom line

It's unclear which is better — laser surgery often hurts less at first, but it may not fix the hemorrhoids as permanently as traditional surgery.

Four well-done randomized trials, plus several meta-analyses, agree that laser surgery causes less pain and bleeding in the days after the operation. But when they followed people for a year or more, several of the same studies found hemorrhoids were more likely to come back after laser surgery than after traditional surgery. No single study has shown laser to be the clear winner on everything that matters.

How certain

High

4 well-conducted randomised trials address this question directly.

What it shows

Unclear

The studies point in different directions.

studies found: 33studies found
randomised trials: 12randomised trials
people studied: 14,546people studied
reviews of trials: 11reviews of trials
years covered: 1991–2026years covered
finished, never published: 5finished, never published

What the research shows

Postoperative pain score
Most studies, including several meta-analyses and randomized trials, found less pain in the days and weeks after laser surgery compared to traditional surgery.[1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16]
Improvement shown
Time to return to work/normal activity
Some studies found people returned to normal activity faster after laser surgery, but one large meta-analysis found laser grouped with the slower-recovery techniques, and another older trial found no difference at all.[1,2,3,4,5]
Possible improvement
Wound healing time
Results conflict directly. Some studies found faster healing with laser, others found healing took longer or the wound was more inflamed at 10 days.[1,2,3,4,5,6]
Insufficient evidence
Postoperative bleeding rate
Most studies found less bleeding after laser surgery than after traditional surgery, though one trial found adding an extra laser step (artery ligation) made no difference to bleeding.[1,2,3,4,5,6,7,8]
Improvement shown

What it may help with

In most studies that measured it, people reported less pain in the first days to weeks after laser surgery compared with traditional surgery.[1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16]
Laser surgery was linked to less bleeding during and after the operation in several studies.[1,2,3,4,5,6,7]
Several studies found the operation itself was faster with laser, and some found people returned to work or normal activity sooner.[1,2,3,4,5,6]

Important limitations

Many of the studies are small — several randomized trials had fewer than 100 people total, which makes it hard to detect real differences or rare complications.[1,2,3,4,5,6,7,8,9]
Several of the larger reviews mixed randomized trials with non-randomized studies, which weakens how much their findings can be trusted.[1,2,3,4]
Follow-up for recurrence was often short — under a year in some reviews — even though hemorrhoids are known to sometimes come back slowly over several years.[1,2]
The few studies with 5-year follow-up are single-center and small, so it's unclear if their findings apply broadly.[1,2]
One review notes several outcomes were statistically underpowered, meaning the studies may be too small to reliably rule out a true difference either way.[1]

What the studies found

Found a benefit10 · 30%
Found no clear effect4 · 12%
Mixed or unclear19 · 58%

What kind of studies

Randomised trial12 · 36%
Meta-analysis8 · 24%
Retrospective4 · 12%
Systematic review3 · 9%
Narrative review2 · 6%
Prospective cohort2 · 6%
Guideline1 · 3%
Case series1 · 3%

The studies that decided it

Pompeu et al. 2026
Laser Hemorrhoidoplasty versus Excisional Hemorrhoidectomy: The Recovery-Durability Tradeoff in Hemorrhoid Surgery-A Systematic Review of Randomized Trials
Faster recovery, but long-term results unclear.Systematic reviewLow quality
1,099 people2026
Laser surgery caused less pain, faster recovery, and fewer complications short-term, but long-term durability remains uncertain due to limited follow-up
Who was studied
patients with hemorrhoids undergoing surgery
What they received
laser hemorrhoidoplasty
Compared with
conventional excisional hemorrhoidectomy
Main outcome
postoperative pain and recovery outcomes versus long-term durability
Quality
The abstract itself describes the evidence as low to very low certainty with underpowered outcomes and limited follow-up.
Limitations
Several outcomes remained underpowered per trial sequential analysis, and limited follow-up restricts interpretation of long-term outcomes; evidence rated low to very low certainty.
Taken word for word from the abstract
- n Fifteen RCTs involving 1099 patients were included.
- population patients
- intervention Laser hemorrhoidoplasty
- comparator conventional hemorrhoidectomy
- primaryOutcome evaluates the tradeoff between short-term recovery and long-term durability
- result Laser hemorrhoidoplasty offers improved short-term recovery but with uncertain long-term durability.
- result Given the low to very low certainty of the evidence and limited follow-up, these findings support a preference-sensitive approach rather than replacing excisional hemorrhoidectomy.
Am Surg · PMID 42503488 · Read it on PubMed ↗
Makunaite et al. 2026
Five-Year Follow-up of the Double-Blinded Randomized Controlled Trial Comparing Laser Hemorrhoidoplasty With Sutured Mucopexy and Excisional Hemorrhoidectomy
Similar recurrence, easier recovery with laser.Randomised trialLow quality
102 people5 years
no statistically significant difference in 5-year recurrence between the three surgeries, though hemorrhoidectomy had the lowest numeric recurrence and laser had a shorter, less painful recovery
Who was studied
adults with symptomatic second- or third-degree hemorrhoids who had surgery and were followed for 5 years
What they received
laser hemorrhoidoplasty
Compared with
excisional hemorrhoidectomy and sutured mucopexy
Main outcome
recurrence of hemorrhoid symptoms at 5 years
Quality
it was a small, single-center trial and its main finding—recurrence differences—did not reach statistical significance.
Limitations
This is a single-center study with a relatively small sample size.
Taken word for word from the abstract
- n A total of 102 patients were evaluated at 5 years (34 per group).
- primaryOutcome Recurrence of symptoms was the primary outcome
- intervention laser hemorrhoidoplasty
- comparator excisional hemorrhoidectomy, and sutured mucopexy
- population Patients with symptomatic second- or third-degree hemorrhoids
- result Kaplan-Meier estimates of 5-year symptom recurrence were 24% for excisional hemorrhoidectomy, 29% for laser hemorrhoidoplasty, and 44% for sutured mucopexy; these differences did not reach statistical significance (log-rank p = 0.076).
- result laser hemorrhoidoplasty produced only slightly worse results with a significantly shorter and less painful postoperative course
- limitations This is a single-center study with a relatively small sample size.
- followUp patients randomly assigned to laser hemorrhoidoplasty, excisional hemorrhoidectomy, and sutured mucopexy were followed up at 5 years after surgery
Dis Colon Rectum · PMID 42478482 · Read it on PubMed ↗
Li et al. 2024
A systematic review comparing the efficacy of 980 nm vs. 1470 nm wavelengths in laser hemorrhoidoplasty
Less pain, but mixed recurrence results.Meta-analysisModerate quality
2,492 people2024
Laser hemorrhoidoplasty was faster and caused less pain and fewer complications than open hemorrhoidectomy, with similar recurrence for 980 nm but higher recurrence for 1470 nm laser compared to hemorrhoidectomy
Who was studied
patients with hemorrhoids undergoing surgery
What they received
laser hemorrhoidoplasty (using 980 nm or 1470 nm wavelengths)
Compared with
open hemorrhoidectomy
Main outcome
operation time, postoperative pain, complications, and recurrence rate
Quality
This pooled review combined mostly non-randomized studies and could not directly compare the two laser types, limiting certainty.
Limitations
No direct studies compared the two wavelengths; many included studies were non-randomized.
Taken word for word from the abstract
- n a total of 2492 patients were included in this systematic review and meta-analysis
- population the management of hemorrhoidal disease
- intervention Laser Hemorrhoidoplasty (LHP) is a minimally invasive surgical option for the management of hemorrhoidal disease
- comparator significantly shorter compared to open hemorrhoidectomy
- primaryOutcome The duration of LHP with both wavelengths was significantly shorter compared to open hemorrhoidectomy, postoperative pain and the rate of postoperative complications were significantly lower following LHP.
- result LHP with 1470-nm wavelength resulted in significantly higher recurrence rate compared to hemorrhoidectomy.
Int J Colorectal Dis · PMID 39048788 · Read it on PubMed ↗
Gambardella et al. 2023
Mid-term efficacy and postoperative wound management of laser hemorrhoidoplasty (LHP) vs conventional excisional hemorrhoidectomy in grade III hemorrhoidal disease: the twisting trend
Less pain, but more recurrence.RetrospectiveLow quality
174 people25 ± 8 months
lower postoperative pain and smoother wound management with laser treatment, but higher recurrence of symptoms (21.6% vs 8.1%) compared to Milligan-Morgan
Who was studied
patients with grade III symptomatic hemorrhoidal disease
What they received
laser hemorrhoidoplasty using a 1470-nm diode laser
Compared with
conventional Milligan-Morgan hemorrhoidectomy
Main outcome
postoperative pain, wound care, symptom resolution, and recurrence of hemorrhoid symptoms
Quality
This was a retrospective, non-randomized comparison, so differences could be due to patient selection rather than the treatment itself.
Limitations
Retrospective design; not randomized; authors call for larger comparative studies.
Taken word for word from the abstract
- n 93 patients received conventional Milligan Morgan as control group and 81 patients received laser hemorrhoidoplasty treatment
- population grade III symptomatic HD patients
- intervention laser hemorrhoidoplasty treatment using a 1470-nm diode laser
- comparator conventional Milligan Morgan
- primaryOutcome Postoperative pain, wound care management, symptoms' resolution, patients' quality of life, and length of return to daily activity
- result Laser hemorrhoidoplasty patients experienced lower postoperative pain score (p < 0.0001) and smoother wound management.
- result the recurrence of symptoms occurred in 8.1% after Milligan-Morgan and 21.6% after laser hemorrhoidoplasty (p < 0.05)
- followUp After 25 ± 8 months follow-up
Langenbecks Arch Surg · PMID 37020091 · Read it on PubMed ↗
Wee et al. 2023
Laser hemorrhoidoplasty versus conventional hemorrhoidectomy for grade II/III hemorrhoids: a systematic review and meta-analysis
Less pain short-term, similar results longer-term.Meta-analysisModerate quality
661 people12 months
Laser surgery caused less pain, less bleeding, and quicker return to work than traditional surgery, but bleeding, prolapse, and recurrence rates were similar at 12 months
Who was studied
people with grade II or III hemorrhoids
What they received
laser hemorrhoidoplasty
Compared with
conventional (traditional) hemorrhoidectomy surgery
Main outcome
pain medicine use after surgery, complications like bleeding, and how soon patients returned to work or daily activities
Quality
It pooled results from nine studies including both randomized and nonrandomized designs, and the authors themselves say the findings need confirmation in larger, well-designed trials.
Limitations
Combined randomized and nonrandomized studies; authors state results should be verified in future well-designed trials with larger samples.
Taken word for word from the abstract
- n Nine studies totaling 661 patients (LH, 336 and CH, 325) were included.
- population patients with grade II/III hemorrhoids
- intervention laser hemorrhoidoplasty (LH)
- comparator conventional hemorrhoidectomy (CH)
- primaryOutcome The primary outcomes included postoperative use of analgesia, postoperative morbidity (bleeding, urinary retention, pain, thrombosis), and time of return to work/daily activities.
- result Postoperative pain was lower in the LH group, with lower postoperative day 1 (mean difference [MD], -2.09; 95% confidence interval [CI], -3.44 to -0.75; P=0.002) and postoperative day 7 (MD, -3.94; 95% CI, -6.36 to -1.52; P=0.001) visual analogue scores and use of analgesia (risk ratio [RR], 0.59; 95% CI, 0.42-0.81; P=0.001).
- result The risk of postoperative bleeding was also lower in the LH group (RR, 0.18; 95% CI, 0.12- 0.28; P<0.001), with a quicker return to work or daily activities (P=0.002).
- result The 12-month risks of bleeding (P>0.999) and prolapse (P=0.240), and the likelihood of complete resolution at 12 months, were similar (P=0.240).
Ann Coloproctol · PMID 36593573 · Read it on PubMed ↗
Tan et al. 2022
Systematic review and meta-analysis of postoperative pain and symptoms control following laser haemorrhoidoplasty versus Milligan-Morgan haemorrhoidectomy for symptomatic haemorrhoids: a new standard
Less pain, similar long-term results.Meta-analysisModerate quality
1,824 people8.58 ± 9.55 months
Laser surgery caused less pain in the first day, week, and month after surgery, with recurrence rates similar between groups
Who was studied
people with symptomatic hemorrhoids
What they received
laser haemorrhoidoplasty
Compared with
conventional Milligan-Morgan open haemorrhoidectomy
Main outcome
pain after surgery
Quality
It combines multiple studies including randomized trials, but mixes different study types and has only moderate-length follow-up for recurrence.
Limitations
Includes both randomized and non-randomized comparative cohort studies; follow-up for recurrence was relatively short (about 8.6 months on average).
Taken word for word from the abstract
- population Haemorrhoidal disease (HD) plagues one in every ten people
- intervention laser haemorrhoidoplasty (LHP)
- comparator conventional (Milligan-Morgan) open haemorrhoidectomy (CoH)
- primaryOutcome with postoperative pain as the primary outcome
- result LHP resulted in reduced postoperative pain for the first day (mean difference of 2.07 visual analogue scale units), week, and month.
- result Crucially, recurrence was equivocal (HR: 0.72, CI: 0.21-2.40) at a mean follow-up duration of 8.58 ± 9.55 months.
- n A total of 12 studies (6 RCTs and 6 CCSs), with a total of 1824 patients, were analysed.
Int J Colorectal Dis · PMID 35906356 · Read it on PubMed ↗
Aibuedefe et al. 2021
An update on surgical treatment of hemorrhoidal disease: a systematic review and meta-analysis
No clear benefit over traditional surgery.Meta-analysisModerate quality
3,137 people2021
Laser showed less pain than open/closed hemorrhoidectomy but with a very wide, uncertain range, and was grouped with open hemorrhoidectomy as having slower return to work compared to other techniques
Who was studied
adults with severe (grade 3 or 4) hemorrhoids needing surgery
What they received
laser surgery for hemorrhoids
Compared with
traditional open and closed hemorrhoidectomy
Main outcome
pain, recurrence, complications, and return to work after surgery
Quality
It pools many randomized trials but the comparisons involving laser have very wide confidence intervals, meaning the results are imprecise and uncertain.
Limitations
Wide confidence intervals crossing no-effect for several outcomes, and the abstract does not detail risk of bias of individual trials
Taken word for word from the abstract
- n A total of 26 studies with 3137 participants and 14 surgical treatments for grade 3/4 hemorrhoids were included.
- population surgical treatments for grade 3/4 hemorrhoids
- intervention Pain was less in patients with techniques such as laser (OR 0.34, CI 0.01-6.51)
- comparator compared to open and closed hemorrhoidectomies
- primaryOutcome The aim of this study is to compare clinical outcomes of various surgical treatments.
- result Pain was less in patients with techniques such as laser (OR 0.34, CI 0.01-6.51), infrared photocoagulation (OR 0.38, CI 0.02-5.61), and stapling (OR 0.48, CI 0.19-1.25), compared to open and closed hemorrhoidectomies.
- result With Doppler-guided (OR 0.26, CI 0.05-1.51) and stapled (OR 0.36, CI 0.15-0.84) techniques, patients return to work earlier when compared to open hemorrhoidectomy and laser.
Int J Colorectal Dis · PMID 34101003 · Read it on PubMed ↗
Poskus et al. 2020
Results of the double-blind randomized controlled trial comparing laser hemorrhoidoplasty with sutured mucopexy and excisional hemorrhoidectomy
Laser less effective but less painful than surgeryRandomised trialModerate quality
121 people1 year
Recurrence requiring treatment rate was 0% after EH, 10% after LHP, and 22% after MP, p = 0.004. LHP and MP were less painful than EH, p < 0.001. SF-36 scores were better after EH.
Who was studied
Symptomatic 2nd- or 3rd-degree hemorrhoids patients
What they received
laser hemorrhoidoplasty (LHP)
Compared with
excisional hemorrhoidectomy (EH)
Main outcome
Recurrence of symptoms requiring treatment, intensity, and duration of pain after the operation, patients' quality of life, fecal incontinence, and patients' evaluation of treatment
Quality
It was a well-designed double-blind randomized trial but done at only one hospital with a modest number of patients.
Limitations
Single-center study.
Taken word for word from the abstract
- n A total of 121 patients.
- population Symptomatic 2nd- or 3rd-degree hemorrhoids patients
- intervention LHP was performed using a 1470 nm diode laser.
- comparator Standard EH was performed up to the level of the hemorrhoidal pedicle.
- primaryOutcome Recurrence of symptoms requiring treatment, intensity, and duration of pain after the operation, patients' quality of life, fecal incontinence, and patients' evaluation of treatment.
- result Recurrence requiring treatment rate was 0% after EH, 10% after LHP, and 22% after MP, p = 0.004. LHP and MP were less painful than EH, p < 0.001.
- result SF-36 scores were better after EH.
Int J Colorectal Dis · PMID 31912268 · Read it on PubMed ↗

What actually helps, on this site

Treatments Dr. Kamrava performs for this:

Excisional Hemorrhoidectomy

More about the condition:

Hemorrhoids

All 33 studiesEvery study that answered the question, with its design, size and result.

The other 25 studiesEverything else the search returned, including anything retracted.

Zamlout et al. 2026
Laser hemorrhoidoplasty versus LigaSure hemorrhoidectomy for grade II-IV hemorrhoidal disease: a systematic review and meta-analysis
Less pain, faster recovery, more recurrence.Meta-analysisVery low qualityRelated question
461 people2026
LHP had less pain and faster recovery, but LigH had lower recurrence rates
Who was studied
adults with grade II-IV hemorrhoids
What they received
laser hemorrhoidoplasty (LHP)
Compared with
LigaSure hemorrhoidectomy (LigH)
Main outcome
postoperative pain, time to return to routine activities, and recurrence
Quality
The authors rated the evidence as very low certainty, based on only five studies with small patient numbers.
Limitations
Certainty of evidence is very low and the authors call for further high-quality randomized trials.
Taken word for word from the abstract
- n Data from 461 patients (213 LHP, 248 LigH) across five studies were analyzed.
- population We included all eligible studies involving adults with grade II-IV hemorrhoids.
- intervention laser hemorrhoidoplasty (LHP)
- comparator LigaSure hemorrhoidectomy (LigH)
- primaryOutcome Primary outcomes included postoperative pain, time to return to routine activities, and recurrence.
- result Patients in the LHP group reported significantly lower pain scores on postoperative day 1 (MD: - 1.61 points; p = 0.025), earlier return to routine activities (MD: -5.75 days; p = 0.0002), shorter operative time (MD: -6.5 min; p = 0.002), and shorter hospital stay (MD: -0.3 days; p < 0.0001) compared to the LigH group. Conversely, LigH demonstrated a significantly lower risk of recurrence (RD: 0.12; 95% CI: [0.05, 0.19]).
- quality The certainty of evidence is very low.
BMC Surg · PMID 42374341 · Read it on PubMed ↗
Heynderickx et al. 2026
Outcomes of laser hemorrhoidoplasty in grade II-IV hemorrhoidal disease: a four-year, single center experience
Low pain, but no comparison done.RetrospectiveLow qualityRelated question
132 peopleone month
low pain scores, high satisfaction, 9.1% complications, 9.8% recurrence, with grade IV disease linked to higher recurrence
Who was studied
patients with grade II-IV hemorrhoids
What they received
laser hemorrhoidoplasty
Compared with
none (single-arm retrospective cohort)
Main outcome
postoperative pain, complications, satisfaction, and recurrence rates
Quality
This was a retrospective single-center study with no comparison group, so it cannot show whether laser is better or worse than traditional surgery.
Limitations
Retrospective design, no comparator group, single center; authors call for prospective studies with a comparison group and longer follow-up.
Taken word for word from the abstract
- n This retrospective study included 132 patients (72 % male, mean age 52.8 years)
- population 132 patients (72 % male, mean age 52.8 years) with grade II-IV hemorrhoidal disease
- intervention underwent Laser Hemorrhoidoplasty in our center between January 2021 and June 2025
- comparator Further prospective studies with larger sample sizes, comparison group and longer follow-up are needed
- primaryOutcome Postoperative pain, complications, patient satisfaction, and recurrence rates were analyzed.
- result Postoperative pain scores were low, with a median Visual Analogue Scale (VAS) score of zero at discharge, after one week and after one month.
- result Postoperative complications occurred in twelve patients (9.1 %)
- result Overall recurrence occurred in thirteen patients (9.8 %)
- result Higher hemorrhoidal grade was significantly associated with recurrence
Rev Esp Enferm Dig · PMID 42313087 · Read it on PubMed ↗
Wang et al. 2026
Conventional<em> </em><em>vs.</em> Laser Haemorrhoidectomy for Symptomatic Haemorrhoids: A Meta-Analysis
Less bleeding and pain with laser.Meta-analysisModerate quality
size not given2026
Laser surgery caused less blood loss during surgery, less bleeding afterward, and less pain than conventional hemorrhoidectomy
Who was studied
people with symptomatic hemorrhoids
What they received
diode laser hemorrhoidoplasty (DLH)
Compared with
conventional hemorrhoidectomy (Milligan-Morgan or Ferguson techniques)
Main outcome
blood loss, bleeding after surgery, pain, complications, recovery time, and recurrence
Quality
It combines 13 studies which strengthens the evidence, but the abstract doesn't report study sizes, quality of included trials, or detailed heterogeneity, so some uncertainty remains.
Limitations
Abstract does not report number of patients included, quality of individual studies, or follow-up duration.
Taken word for word from the abstract
- intervention Diode laser haemorrhoidoplasty (DLH)
- comparator conventional haemorrhoidectomy (CH) techniques, namely Milligan-Morgan haemorrhoidectomy (MMH) and Ferguson haemorrhoidectomy (FH)
- population symptomatic haemorrhoids
- primaryOutcome Primary outcomes included intraoperative blood loss, postoperative bleeding, pain (measured by VAS), complications (e.g., urinary retention and anal stenosis), recovery time, and recurrence rate.
- result DLH offered significant benefits over MMH and FH, including reduced intraoperative blood loss (MD = -20.19 mL, 95% CI: -28.32 -12.07; p <0.001), lower postoperative bleeding (OR = 0.32, 95% CI: 0.11 - 0.93; p = 0.04), and less postoperative pain, both immediately and one week later.
J Coll Physicians Surg Pak · PMID 41689325 · Read it on PubMed ↗
Schwandner 2025
[Hemorrhoidal disease and stage-dependent treatment (including anal prolapse)]
No comparison reported between methods.Narrative reviewVery low qualityRelated question
size not given2025
The abstract does not report a comparative result between laser and conventional surgery, only that minimally invasive techniques are increasingly competing with conventional hemorrhoidectomy
Who was studied
people with hemorrhoids of different severity stages, including acute anal prolapse
What they received
minimally invasive techniques such as laser hemorrhoidoplasty, hemorrhoidal artery ligation, and radiofrequency ablation
Compared with
conventional hemorrhoidectomy surgery
Main outcome
symptom control and long-term recurrence prevention
Quality
This is a general narrative review describing treatment options by disease stage without presenting study data or comparative outcomes.
Limitations
No data, outcomes, or comparative results are presented; it is a general overview of treatment strategies rather than a study of laser versus conventional surgery.
Taken word for word from the abstract
- population The treatment of hemorrhoidal disease is carried out depending on the symptoms and stage of the disease.
- intervention minimally invasive techniques (e.g. hemorrhoidal artery ligation, laser hemorrhoidoplasty, radiofrequency ablation)
- comparator "conventional" hemorrhoidectomy procedures are increasingly in competition with minimally invasive techniques
- primaryOutcome The ultimate goal of all treatment strategies for hemorrhoidal disease is symptom control and long-term absence of recurrence.
- result "conventional" hemorrhoidectomy procedures are increasingly in competition with minimally invasive techniques (e.g. hemorrhoidal artery ligation, laser hemorrhoidoplasty, radiofrequency ablation).
Chirurgie (Heidelb) · PMID 40586790 · Read it on PubMed ↗
Alessa et al. 2025
The Outcome of Laser Ablation Hemorrhoidoplasty versus Conventional Hemorrhoidectomy
Less pain and bleeding with laser.RetrospectiveLow quality
100 people2025
Laser treatment caused less pain and less bleeding after surgery than conventional surgery
Who was studied
patients with hemorrhoids (piles)
What they received
laser hemorrhoidoplasty
Compared with
conventional surgical hemorrhoidectomy
Main outcome
postoperative pain and bleeding
Quality
This was a retrospective, non-randomized comparison with unequal hemorrhoid severity between groups, which can bias the results.
Limitations
Retrospective data collection; groups differed in hemorrhoid degree distribution (laser group had more second-degree, conventional group had more severe degree 3/4 cases), which may confound outcome comparisons.
Taken word for word from the abstract
- population 50 patients who underwent laser hemorrhoidoplasty and another 50 patients who underwent conventional hemorrhoidectomy
- intervention laser hemorrhoidoplasty
- comparator conventional surgical hemorrhoidectomy
- primaryOutcome Clinical outcomes revealed that laser hemorrhoidoplasty was associated with less postoperative pain and bleeding.
- result Notably, all laser patients reported mild pain (1-3), while the conventional group exhibited a broader spectrum, including severe pain (7-9) in 96% of cases.
- result bleeding outcomes were more favorable in the laser group, with 100% experiencing minor bleeding compared to the conventional group, which showed a higher incidence of both minor and moderate bleeding
- n about 50 patients who underwent laser hemorrhoidoplasty and another 50 patients who underwent conventional hemorrhoidectomy
Ann Afr Med · PMID 40576418 · Read it on PubMed ↗
Zakaria et al. 2025
Laser hemorrhoidoplasty versus hemorrhoidectomy in the treatment of surgically indicated hemorrhoids in inflammatory bowel patients: a randomized comparative clinical study
Laser easier recovery, but more leftover hemorrhoids.Randomised trialLow qualityRelated question
48 people2025
Laser surgery had less pain, shorter operation time, less bleeding, fewer complications, and faster recovery, but more residual hemorrhoids than traditional surgery
Who was studied
patients who had inflammatory bowel disease along with hemorrhoids
What they received
laser hemorrhoidoplasty
Compared with
traditional hemorrhoidectomy surgery
Main outcome
operation time, pain, bleeding, anal stenosis, recovery, patient satisfaction, and residual hemorrhoids
Quality
Small study of only 48 patients from a single center, limiting how confident we can be in the results.
Limitations
Small sample size; single-center study; conducted specifically in patients with inflammatory bowel disease, which may not reflect the general hemorrhoid population.
Taken word for word from the abstract
- n The study comprised 48 patients who were admitted during this period and had inflammatory bowel disease along with hemorrhoids.
- population had inflammatory bowel disease along with hemorrhoids
- intervention 24 patients who underwent laser hemorrhoidoplasty
- comparator 24 patients who underwent traditional surgery
- primaryOutcome operation time, pain score and duration, postoperative anal discharge, return to work time, and patient satisfaction
- result demonstrated significantly better outcomes than traditional surgery (p < 0.001) regarding operation time, pain score and duration, postoperative anal discharge, return to work time, and patient satisfaction
- result there was a higher frequency of residual hemorrhoids in laser group
Surg Endosc · PMID 39511001 · Read it on PubMed ↗
Şahin et al. 2024
Comparison of Pudendal Nerve Block and Spinal Anesthesia in Proctological Surgeries: Efficacy, Safety, and Patient Outcomes
Compares anesthesia types, not surgery typesProspective cohortLow qualityRelated question
590 people2024
patients given pudendal nerve block had less pain, better functional recovery, less urinary retention, and shorter surgery and hospital stay than those given spinal anesthesia
Who was studied
patients having proctological surgery, including hemorrhoidectomy and laser hemorrhoidoplasty
What they received
pudendal nerve block anesthesia
Compared with
spinal anesthesia
Main outcome
postoperative pain and functional recovery after surgery
Quality
it's an observational study comparing anesthesia types, not a randomized trial, and it does not directly compare laser surgery with traditional hemorrhoidectomy.
Limitations
not randomized; groups unequal in size; compares anesthesia method rather than surgical technique for hemorrhoids
Taken word for word from the abstract
- n A prospective observational study was conducted on 590 patients who underwent proctological surgery under either PNB (n = 435) or SA (n = 155).
- population patients undergoing surgical treatment for various proctological conditions
- intervention Pudendal nerve block (PNB)
- comparator spinal anesthesia (SA)
- primaryOutcome postoperative pain management, functional outcomes, and complication rates
- result Patients in the PNB group reported significantly lower postoperative VAS scores compared to those in the SA group, particularly in hemorrhoidectomy and laser hemorrhoidoplasty procedures.
Medicina (Kaunas) · PMID 39459438 · Read it on PubMed ↗
Brillantino et al. 2024
The Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colonproctologia) guidelines for the management of acute and chronic hemorrhoidal disease
Laser best for mild cases only.GuidelineLow qualityRelated question
size not given2024
guideline recommends laser or other non-excisional options mainly for milder grades, while hemorrhoidectomy and stapled hemorrhoidopexy are preferred for more severe grades
Who was studied
people with hemorrhoids of varying severity (grades 1 to 4)
What they received
laser hemorrhoidoplasty and other non-excisional procedures
Compared with
traditional excisional surgery (hemorrhoidectomy) and stapled hemorrhoidopexy
Main outcome
recommended treatment choice by severity of hemorrhoidal prolapse
Quality
this is an expert consensus guideline based on existing literature rather than a new study comparing treatments head-to-head.
Limitations
abstract does not describe the underlying studies, their sizes, or specific outcome data; recommendations are based on expert consensus (Delphi/GRADE) rather than a single trial.
Taken word for word from the abstract
- population In cases of grade 1 hemorrhoidal prolapse
- intervention outpatient procedures including hemorrhoidal laser procedure and sclerotherapy may be considered the preferred surgical options
- comparator stapled hemorrhoidopexy and hemorrhoidectomy may represent the most effective procedures
- primaryOutcome guiding physicians in the choice of the best treatment option
- result For grade 2 prolapse, nonexcisional procedures including outpatient treatments, hemorrhoidal artery ligation and mucopexy, laser hemorrhoidoplasty, the Rafaelo procedure, and stapled hemorrhoidopexy may represent the first-line treatment options, whereas excisional surgery may be considered in selected cases.
- result In cases of grades 3 and 4, stapled hemorrhoidopexy and hemorrhoidectomy may represent the most effective procedures, even if, in the expert panel opinion, stapled hemorrhoidopexy represents the gold-standard treatment for grade 3 hemorrhoidal prolapse.
Ann Coloproctol · PMID 39228195 · Read it on PubMed ↗
Cheng et al. 2024
Diode laser hemorrhoidoplasty versus conventional Milligan-Morgan and Ferguson hemorrhoidectomy for symptomatic hemorrhoids: Meta-analysis
Laser caused less bleeding and pain, similar recurrence.Meta-analysisModerate quality
1,196 people2024
Laser treatment had less blood loss, less bleeding, shorter operative time, less day-1 pain, and less anal narrowing, but no difference in incontinence, urinary retention, or hemorrhoid recurrence
Who was studied
patients with symptomatic hemorrhoids
What they received
diode laser hemorrhoidoplasty
Compared with
conventional hemorrhoidectomy (Milligan-Morgan and Ferguson techniques)
Main outcome
operative blood loss and postoperative hemorrhage/bleeding
Quality
It pools 17 trials with over a thousand patients and consistent subgroup results, but it is a meta-analysis of mixed-quality original studies so true certainty is limited.
Limitations
Abstract does not describe limitations of included trials in detail beyond mentioning subgroup analysis by risk of bias.
Taken word for word from the abstract
- n we included 17 trials with 1196 patients, of whom 596 (49.8 %) underwent laser hemorrhoidoplasty and 600 (50.2 %) underwent conventional hemorrhoidectomy
- population symptomatic haemorrhoids
- intervention laser hemorrhoidoplasty
- comparator conventional hemorrhoidectomies, including Milligan-Morgan and Ferguson techniques
- primaryOutcome The primary outcomes were operative blood loss and postoperative haemorrhage
- result laser hemorrhoidoplasty showed benefits in operative blood loss (weighted mean difference [WMD]: -16.43 ml, 95 % confidence interval [CI]: -23.82 to -9.04), postoperative hemorrhage/bleeding (odds ratio [OR]: 0.16, 95 % CI: 0.10 to 0.28), operative time (WMD: -12.42 min, 95 % CI: -14.56 to -10.28), postoperative pain score on day 1 (WMD: -2.50, 95 % CI: -3.13 to -1.88), and anal stenosis (OR: 0.14, 95 % CI: 0.03 to 0.65) in comparison with conventional hemorrhoidectomy. However, incidence of fecal/flatus incontinence, urinary retention and hemorrhoid recurrence were not significantly different between the 2 groups.
Asian J Surg · PMID 38762410 · Read it on PubMed ↗
Cemil et al. 2024
Comparison of Laser Hemorrhoidoplasty and Milligan-Morgan Hemorrhoidectomy Techniques in the Treatment of Grade 2 and 3 Hemorrhoidal Disease
Less bleeding, no overall advantageRandomised trialModerate quality
85 peoplewithin 10 days
Laser group had less bleeding and lower pain scores early on, but overall was not more advantageous than traditional surgery for comfort or cost
Who was studied
patients aged 18-70 with symptomatic Grade 2 and Grade 3 hemorrhoidal disease whose symptoms persisted despite at least one month of medical treatment
What they received
laser hemorrhoidoplasty
Compared with
Milligan-Morgan hemorrhoidectomy
Main outcome
postoperative pain (VAS score) and complications
Quality
It was a randomized trial but with a modest number of patients and only short-term (10-day) follow-up, so results may not reflect longer-term outcomes.
Limitations
Small sample size, short follow-up period of only 10 days, and unequal group sizes (54 vs 31 patients).
Taken word for word from the abstract
- n total 85 patients
- population total 85 patients aged 18-70 years old with symptomatic Grade 2 and Grade 3 hemorrhoidal disease whose symptoms persisted despite at least one month of medical treatment
- intervention Laser hemorrhoidoplasty (LH)
- comparator Milligan-Morgan (MM) hemorrhoidectomy
- primaryOutcome Postoperative VAS score and complications were recorded within 10 days.
- result The incidence of minor perioperative hemorrhage was significantly lower in Group L compared to Group M (P = .035). The postoperative 3rd-hour VAS scores were statistically significantly lower in Group L compared to Group (P < .001).
- result We believe that it is not an advantageous method compared to MM hemorrhoidectomy, both in terms of patient comfort and cost-effectiveness
Am Surg · PMID 37846728 · Read it on PubMed ↗
Solari et al. 2023
Laser technology in proctological diseases: is it really the wave of the future?
Less pain, but costs more.Systematic reviewLow quality
55 people2023
Laser treatment for hemorrhoids had shorter operative time and less postoperative pain and bleeding than conventional hemorrhoidectomy, but cost more; evidence is limited and heterogeneous with only 3 RCTs
Who was studied
people with proctological conditions including hemorrhoids, anal fistula, and pilonidal sinus disease
What they received
laser-based surgical treatments (including laser hemorrhoid surgery, FiLaC, SiLaT)
Compared with
conventional surgical techniques (e.g. traditional hemorrhoidectomy)
Main outcome
operative time, postoperative pain, bleeding, healing rates, and cost compared to conventional techniques
Quality
This is a scoping review of mostly non-randomized, heterogeneous studies with only three randomized trials and no pooled statistical analysis.
Limitations
Studies are heterogeneous in design, endpoints, postoperative assessment, length of follow-up and outcome measures; only 3 RCTs available; meta-analysis not performed due to heterogeneity.
Taken word for word from the abstract
- n 55 studies were included for the final revision
- population Different types of lasers have been applied for various proctological conditions.
- intervention Laser treatments for hemorrhoids require a shorter operative time and show less postoperative pain and bleeding compared to conventional hemorrhoidectomy, but are more expensive.
- comparator compared to conventional hemorrhoidectomy
- primaryOutcome require a shorter operative time and show less postoperative pain and bleeding compared to conventional hemorrhoidectomy, but are more expensive
- result Laser treatments for hemorrhoids require a shorter operative time and show less postoperative pain and bleeding compared to conventional hemorrhoidectomy, but are more expensive. Studies are heterogeneous in design, endpoints, postoperative assessment, length of follow-up and outcome measures. Only 3 RCTs are available and only three studies evaluate long-term outcomes.
Updates Surg · PMID 37438655 · Read it on PubMed ↗
De Nardi et al. 2023
Hemorrhoid laser dearterialization: systematic review and meta-analysis
More symptom relief than banding, not hemorrhoidectomy.Meta-analysisLow qualityRelated question
size not given2023
laser treatment improved or resolved symptoms in most patients; in the one randomized study, symptoms resolved in 90% after laser versus 53.3% after rubber band ligation
Who was studied
people with symptomatic hemorrhoids
What they received
laser treatment to close off blood vessels feeding hemorrhoids (HeLP)
Compared with
rubber band ligation (in one trial); other studies had no comparator
Main outcome
whether symptoms went away
Quality
most included studies were non-randomized and the evidence was graded as low certainty, with only one randomized trial and no long-term data.
Limitations
only one randomized study, most evidence from non-randomized cohorts, short to medium follow-up, and lack of comparison to traditional excisional hemorrhoidectomy
Taken word for word from the abstract
- population Hemorrhoidal disease is a common and troublesome condition
- intervention a doppler-guided hemorrhoidal dearterialization with laser (the hemorrhoidal laser procedure; HeLP)
- comparator after HeLP and 53.3% after rubber band ligation as comparator
- primaryOutcome Primary outcome was to assess the efficacy of HeLP on symptoms' resolution.
- result HeLP improved or resolved preoperative symptoms in 83.6 to 100% of patients during follow-up. In the randomized study symptoms resolved in 90% of patients after HeLP and 53.3% after rubber band ligation as comparator.
Lasers Med Sci · PMID 36695928 · Read it on PubMed ↗
Mert 2023
Comparison of Laser Haemorrhoidoplasty and Ferguson Haemorrhoidectomy in Treating Grade III and Grade IV Haemorrhoids: A Prospective Randomised Study
Faster healing, less pain, fewer complications.Randomised trialLow quality
size not given2023
Laser surgery had shorter operation time, faster wound healing, quicker symptom relief, lower pain scores, and fewer complications than traditional surgery
Who was studied
adults with grade III or grade IV hemorrhoids needing surgery
What they received
laser hemorrhoidoplasty
Compared with
Ferguson hemorrhoidectomy (traditional surgery)
Main outcome
surgery time, wound healing time, pain scores, and complications
Quality
It is a randomized trial but very small and short follow-up with no participant numbers given, so results are uncertain.
Limitations
Abstract does not report number of participants or length of follow-up beyond the perioperative period.
Taken word for word from the abstract
- population patients who had an indication for surgery for grade III or grade IV haemorrhoidal disease (HD) and who were 18 years and older
- intervention While LH was performed using a 980-diode laser in the patients enrolled in the laser group
- comparator a standard FH was performed using diathermy in the patients in the second study group
- primaryOutcome The length of surgery (LOS), the number of excised lumps, wound healing time, time to symptom relief, pre- and postoperative Visual Analogue Scale (VAS) scores and the difference between them (Δ VAS), and complication rates were compared between two study groups.
- result LH had less LOS with a similar number of excised lumps, furthermore, it provided faster-wound healing and less time-to-symptom relief when compared to FH.
- result LH also had better outcomes than FH in terms of having any type of postoperative complication.
J Coll Physicians Surg Pak · PMID 36597234 · Read it on PubMed ↗
Lim et al. 2022
Comparison of post-operative bleeding incidence in laser hemorrhoidoplasty with and without hemorrhoidal artery ligation: a double-blinded randomized controlled trial
No added benefit from artery ligation.Randomised trialModerate qualityRelated question
76 people6-weeks
no significant difference in bleeding incidence between both groups at any of the measured timepoints
Who was studied
patients undergoing laser treatment for hemorrhoids
What they received
laser hemorrhoidoplasty plus hemorrhoidal artery ligation
Compared with
laser hemorrhoidoplasty alone
Main outcome
rate of bleeding after surgery
Quality
It was a double-blind randomized trial but with a modest number of patients and it compared two laser-based approaches, not laser versus traditional surgery.
Limitations
Abstract does not mention blinding of outcome assessors beyond 'double-blind', single trial registration details, and small sample size.
Taken word for word from the abstract
- n Seventy-six patients were randomized.
- population patients undergoing laser hemorrhoidoplasty (LHP) only versus LHP with hemorrhoidal artery ligation (HAL)
- intervention LHP with hemorrhoidal artery ligation
- comparator laser hemorrhoidoplasty (LHP) only
- primaryOutcome Outcome measures included post-operative bleeding and its severity
- result There was no significant difference in bleeding incidence between both groups at any of the measured timepoints (P > 0.05).
- followUp 6-weeks post-operatively
BMC Surg · PMID 35449097 · Read it on PubMed ↗
Giamundo et al. 2022
Doppler-guided hemorrhoidal dearterialization with laser (HeLP): indications and clinical outcome in the long-term. Results of a multicenter trial
Symptoms improved with laser treatment.Prospective cohortLow qualityRelated question
284 people2-year follow-up
89.9% of patients had symptom resolution at 2 years, with improved quality of life, pain, and bleeding
Who was studied
adults with hemorrhoids, including low and high grade
What they received
Doppler-guided laser treatment to close hemorrhoid blood vessels
Compared with
none - no comparison group, before-and-after results only
Main outcome
resolution of hemorrhoid symptoms
Quality
This study had no comparison group, so it cannot show whether laser treatment works better than traditional surgery.
Limitations
No control or comparison group; this study only tracked patients before and after laser treatment without comparing to traditional hemorrhoidectomy.
Taken word for word from the abstract
- n Two-hundred-eighty-four patients (183 males, 101 females; mean age: 47.5 years) were included in the trial
- population patients with low-grade hemorrhoids suffering from bleeding, pain and recurrent acute symptoms
- intervention Doppler-guided hemorrhoidal laser procedure consists of sutureless closure of terminal branches of the superior hemorrhoidal artery by laser energy
- comparator Clinical results of patients treated with this procedure were analyzed at the completion of 2-year follow-up
- primaryOutcome Primary endpoint was resolution of symptoms
- result Analysis of 276 patients who completed the 2-year follow-up showed an overall resolution of symptoms in 89.9% (248/276) of patients.
Surg Endosc · PMID 33415419 · Read it on PubMed ↗
Longchamp et al. 2021
Non-excisional laser therapies for hemorrhoidal disease: a systematic review of the literature
Similar healing, less pain, mixed recurrence.Systematic reviewLow quality
1,570 people2021
similar symptom resolution to surgery, less pain, but mixed and conflicting recurrence results compared with hemorrhoidectomy
Who was studied
adults with grade II or III hemorrhoids
What they received
non-excisional laser treatments (laser hemorrhoidoplasty or hemorrhoidal laser procedure)
Compared with
traditional hemorrhoidectomy, mucopexy, or rubber band ligation
Main outcome
symptom resolution, recurrence, complications, and postoperative pain
Quality
This review combined many small, differently designed studies with few true randomized trials, so the comparisons are not strong enough to be sure.
Limitations
Few randomized controlled trials were included, and results on recurrence after laser versus hemorrhoidectomy conflicted between the two trials that compared them directly.
Taken word for word from the abstract
- population non-excisional laser therapies are emerging treatment for grades II and III hemorrhoidal disease (HD)
- intervention laser hemorrhoidoplasty (LH) and hemorrhoidal laser procedure (HeLP)
- comparator similar resolution after LH compared with hemorrhoidectomy or mucopexy and after HeLP compared with rubber band ligation
- primaryOutcome studies reporting at least one of surgical indicators of postoperative outcomes of laser therapies
- result When compared with hemorrhoidectomy, LH showed conflicting results with one randomized controlled trial reporting similar recurrence rate, but another reporting decreased recurrences associated with hemorrhoidectomy. Laser therapies showed lower postoperative pain than hemorrhoidectomy or rubber band ligation.
- n Fourteen studies describing LH and HeLP were included, representing 1570 patients.
Lasers Med Sci · PMID 32914275 · Read it on PubMed ↗
Ng et al. 2020
Still a Case of "No Pain, No Gain"? An Updated and Critical Review of the Pathogenesis, Diagnosis, and Management Options for Hemorrhoids in 2020
Not enough evidence yet.Narrative reviewLow qualityRelated question
size not given2020
not clearly reported for laser vs conventional hemorrhoidectomy specifically; laser said to need more study
Who was studied
people with hemorrhoids of varying grades
What they received
laser treatment and other newer 'walk-in-walk-out' techniques
Compared with
conventional surgical hemorrhoidectomy and other established treatments
Main outcome
effectiveness and complications of hemorrhoid treatments
Quality
This is a narrative review summarising existing evidence rather than a new study, and it states laser treatment evidence is not yet established.
Limitations
Review does not present original comparative data for laser vs conventional hemorrhoidectomy and explicitly says laser needs further evaluation.
Taken word for word from the abstract
- intervention Novel "walk-in-walk-out" techniques such as radiofrequency ablations or laser treatments will need further evaluation to define their role in modern-day haemorrhoid management.
- comparator Conventional haemorrhoidectomies (Ferguson/Milligan-Morgan/Ligasure haemorrhoidectomy) still have their role in third- and fourth-degree haemorrhoids, being associated with lowest recurrence
- population patients who present with varying haemorrhoidal grades
- primaryOutcome We review the current evidence for management options in patients who present with varying haemorrhoidal grades.
- result Novel "walk-in-walk-out" techniques such as radiofrequency ablations or laser treatments will need further evaluation to define their role in modern-day haemorrhoid management.
Ann Coloproctol · PMID 32674545 · Read it on PubMed ↗
Brodovskyi et al. 2017
[ОPTIMIZATION OF SURGICAL TREATMENT OF HEMORRHOIDAL DISEASE STAGES III-IV]
Less bleeding, fewer complications.RetrospectiveVery low qualityRelated question
size not given2017
the new method group had lower rates of intraoperative complications and less severe blood loss, and reduced early and late postoperative morbidity with faster return to normal activity
Who was studied
patients with chronic hemorrhoidal disease stages III-IV
What they received
hemorrhoidectomy using a radio-wave scalpel ("Surgitron TM") with welding of the vascular pedicle using a high-frequency electrocoagulator
Compared with
a comparison group (method not specified in abstract)
Main outcome
rate of intraoperative complications, blood loss, and postoperative morbidity
Quality
The study gives no participant numbers, no clear description of the comparison group, and no indication of randomization, so it's hard to trust the comparison.
Limitations
No sample size reported, comparison group not well described, method of comparison unclear, and the abstract does not mention laser surgery at all.
Taken word for word from the abstract
- population patients, suffering chronic hemorrhoidal disease stages III- IV
- intervention method of hemorrhoidectomy, using radio-wave scalpel «Surgitron TM» with further welding of vascular pedicle, applying high-frequency electrocoagulator ЕК-301М1
- comparator comparison group
- primaryOutcome intraoperative complications rate and the blood loss severity
- result the intraoperative complications rate and the blood loss severity were essentially lesser than in a comparison group
- result guarantees the reduction of early and late postoperative morbidity, rapid coming back to routine way of living postoperatively
Klin Khir · PMID 30272930 · Read it on PubMed ↗
Naderan et al. 2017
A Randomized Controlled Trial Comparing Laser Intra-Hemorrhoidal Coagulation and Milligan-Morgan Hemorrhoidectomy
Less pain, similar long-term cure.Randomised trialModerate quality
size not givenone year
Laser treatment caused less pain, less bleeding, and less blood loss during surgery, but had similar symptom resolution after one year and a couple of cases of thrombosis complication
Who was studied
patients with symptomatic grade II or III internal hemorrhoids not improved by medication
What they received
laser intra-hemorrhoidal coagulation (980-nm diode laser)
Compared with
Milligan-Morgan hemorrhoidectomy (traditional surgery)
Main outcome
operative time, postoperative pain, complications, and symptom resolution
Quality
it was a randomized trial with one-year follow-up, but the abstract does not report the number of patients, limiting confidence in how reliable the results are.
Limitations
Number of participants not reported; two patients in the laser group had thrombosis complications not seen in the surgery group.
Taken word for word from the abstract
- population Patients with symptomatic grade II or III internal hemorrhoids according to the Goligher's classification (refractory to medical treatment) were enrolled
- intervention hemorrhoidal columns were coagulated using a 980-nanometer (nm) radial laser emitting fiber
- comparator Milligan-Morgan (MM) hemorrhoidectomy
- primaryOutcome Operative time, postoperative pain and complications, and recovery or resolution of symptoms were measured.
- result Postoperative pain scores (at 12, 18, and 24 hr after surgery) were significantly lower in the laser group compared with the MM group (p <.01).
- result One-year follow-up showed comparable results in terms of the resolution of symptoms and sustainable cure.
- result Two patients in the laser group were presented with thrombosis of external hemorrhoid 7-10 days after the procedure
J Invest Surg · PMID 27806213 · Read it on PubMed ↗
Maloku et al. 2014
Laser Hemorrhoidoplasty Procedure vs Open Surgical Hemorrhoidectomy: a Trial Comparing 2 Treatments for Hemorrhoids of Third and Fourth Degree
Less pain, faster surgery with laser.Randomised trialLow quality
40 people1 month
laser procedure had shorter operative time and less postoperative pain at 1 week, 2 weeks, 3 weeks and 1 month
Who was studied
adults with grade III or IV hemorrhoids with minimal or complete mucosal prolapse
What they received
laser hemorrhoidoplasty procedure
Compared with
open surgical hemorrhoidectomy
Main outcome
operative time and postoperative pain
Quality
Very small trial of only 40 patients with few outcome details, so results are not very reliable.
Limitations
Small sample size; abstract gives little detail on randomization or blinding methods.
Taken word for word from the abstract
- n A total number of 40 patients (23 men and 17 women, mean age, 46 years) entered the trial.
- population Patients with symptomatic grade III or grade IV hemorrhoids with minimal or complete mucosal prolapse were eligible for the study
- intervention 20 patients treated with the laser hemorrhoidoplasty
- comparator 20 patients-with open surgery hemorrhoidectomy
- primaryOutcome Operative time and postoperative pain with visual analog scale, were evaluated.
- result There was a statistically significant difference between the two groups regarding the early postoperative period: 1 week, 2 weeks, 3 weeks and 1 month after respective procedure (p<0.01). The procedure time for LHP was 15.94 min vs. 26.76 min for open surgery (p<0.01).
Acta Inform Med · PMID 25684841 · Read it on PubMed ↗
Pandini et al. 2006
Surgical treatment of haemorrhoidal disease with CO2 laser and Milligan-Morgan cold scalpel technique
No difference between laser and scalpel.Randomised trialLow quality
40 people2006
no significant differences between laser and scalpel groups in pain, complications, healing time, return to activity, or satisfaction, though pain at first bowel movement was higher with laser
Who was studied
patients with grade III/IV hemorrhoids
What they received
Milligan-Morgan hemorrhoid surgery using CO2 laser
Compared with
Milligan-Morgan hemorrhoid surgery using cold scalpel
Main outcome
postoperative pain, complications, healing time, return to normal activity, and patient satisfaction
Quality
Very small study of only 40 patients, which limits confidence in finding no difference.
Limitations
Small sample size of 20 patients per group.
Taken word for word from the abstract
- n Forty patients with grade III/IV HD were prospectively randomized
- population Forty patients with grade III/IV HD
- intervention CO(2) laser (group A)
- comparator cold scalpel method (group B)
- primaryOutcome postoperative pain, complications, healing time, return to normal activity and patient satisfaction
- result There were no differences in the immediate results after Milligan-Morgan haemorrhoidectomy using either the CO(2) laser or cold scalpel regarding postoperative pain, complications, healing time, return to normal activities or patient satisfaction.
Colorectal Dis · PMID 16919112 · Read it on PubMed ↗
Gupta 2003
Radio-ablation of advanced grades of hemorrhoids with radiofrequency
Few complications with radiofrequency, no direct comparison.Case seriesLow qualityRelated question
50 people12 months
low complication rates, no stenosis or incontinence, 7 patients developed skin tags
Who was studied
patients with advanced grade hemorrhoids with mucosal prolapse
What they received
radiofrequency ablation of the hemorrhoid tissue
Compared with
no concurrent control group; discussed in relation to conventional hemorrhoidectomy
Main outcome
postoperative symptoms and complications over 12 months
Quality
this is a single-arm case series with no control group, so it cannot show whether radiofrequency is better than laser or traditional surgery.
Limitations
no comparator group, small sample size, single surgeon/center, not randomized
Taken word for word from the abstract
- n This study included 50 patients (34 males and 16 females)
- population For advanced degree of hemorrhoids with prolapse of the rectal mucosa
- intervention in situ radio-frequency ablation of the pile mass
- comparator has been found to be quite efficacious with many added advantages over the conventional hemorrhoidectomy procedures in practice
- primaryOutcome A subsequent follow-up of the patients at an interval of 12 weeks and 12 months showed significant relief in all of the above early postoperative symptoms
- result complications like anal stenosis or stricture or incontinence was not found in any of the patients
Curr Surg · PMID 14972240 · Read it on PubMed ↗
Senagore et al. 1993
Treatment of advanced hemorrhoidal disease: a prospective, randomized comparison of cold scalpel vs. contact Nd:YAG laser
No benefit over scalpel surgery.Randomised trialModerate quality
86 people10 days (wound assessment); time to return to work not specified numerically
no significant differences between groups except more wound inflammation and separation at 10 days with laser, and higher cost with laser
Who was studied
patients with advanced hemorrhoids needing internal-external hemorrhoidectomy
What they received
Nd:YAG laser excision during hemorrhoidectomy
Compared with
cold scalpel excision during hemorrhoidectomy
Main outcome
blood loss, operative time, postoperative pain, wound healing, return to work
Quality
it was a randomized trial but modest in size and only compared surgical techniques within one procedure type
Limitations
small sample size; single outcome measure showed laser was worse, not better
Taken word for word from the abstract
- n Eighty-six patients were eligible for study (laser, N = 51; scalpel, N = 35).
- population Patients presenting for internal-external hemorrhoidectomy were eligible for study.
- intervention a prospective randomized study of the Nd:YAG laser vs. scalpel excision, when performing a standard Ferguson-closed hemorrhoidectomy
- comparator vs. scalpel excision
- primaryOutcome Data evaluated included: age, sex, estimated blood loss, operative time, postoperative pain scores, postoperative analgesic use, wound healing, and time for return to work.
- result There were no significant differences between the groups, except for a greater degree of wound inflammation and dehiscence at the 10 day postoperative visit for the laser group (laser, 1.7 +/- .2; scalpel, 0.8 +/- .2; P < 0.05, t-test).
Dis Colon Rectum · PMID 8223057 · Read it on PubMed ↗
Enriquez-Navascues et al. 1993
[Hemorrhoidectomy: conventional or by Nd:Yag contact laser? A prospective and randomized study]
No benefit; healing slower with laser.Randomised trialLow quality
35 people6 moths later
no significant difference in pain or complications; healing took longer with laser
Who was studied
patients with symptomatic hemorrhoids needing surgery
What they received
laser hemorrhoidectomy (Nd:YAG laser)
Compared with
conventional hemorrhoidectomy surgery
Main outcome
postoperative pain, complications, healing time
Quality
Small number of patients and poor follow-up at 6 months limit confidence in the findings.
Limitations
Small sample size; few patients returned for 6-month follow-up assessment.
Taken word for word from the abstract
- n a total of 35 consecutive patients
- population symptomatic hemorrhoidal disease requiring surgery
- intervention laser hemorrhoidectomy (17 patients)
- comparator surgery (18 patients)
- primaryOutcome postoperative complications, pain (assessed daily for five days using a standard 10 mm. linear analogue scale), wound healing, time until full recovery and sequelae
- result This study has failed to confirm any reduction in postoperative pain, complications, or healing time laser when performing a hemorrhoidectomy.
Rev Esp Enferm Dig · PMID 8292434 · Read it on PubMed ↗
Wang et al. 1991
The role of lasers in hemorrhoidectomy
Less pain, faster recovery with laser.Randomised trialLow quality
88 peopleOne year follow-up
Laser group needed less narcotic pain relief (11% vs 56%), less urinary retention (7% vs 39%), no enemas needed, faster discharge (day 2 vs day 5), and 20% lower cost, but had prolonged wound healing
Who was studied
patients being treated for hemorrhoids
What they received
laser treatment (Nd-YAG laser for internal hemorrhoids combined with CO2 laser for external hemorrhoids)
Compared with
closed Ferguson hemorrhoidectomy (traditional surgery)
Main outcome
need for pain medication, urinary retention, recovery time, and cost
Quality
Although randomized, this is a small, old trial from a single center with limited detail on methods and blinding, and some outcomes like wound healing favored the comparison surgery.
Limitations
Small sample size, older trial (1991) using outdated laser methods, and some conflicting results such as slower wound healing with laser treatment.
Taken word for word from the abstract
- n Eighty-eight patients who received treatment for hemorrhoids were randomized into two groups
- population Eighty-eight patients who received treatment for hemorrhoids were randomized into two groups
- intervention Group A received the Nd-YAG laser phototherapy for internal hemorrhoid combined with the CO2 laser for external hemorrhoid
- comparator Group B was treated with closed Ferguson hemorrhoidectomy
- primaryOutcome The need of narcotic injections for pain relief was 11 percent in group A vs. 56 percent in group B
- result The need of narcotic injections for pain relief was 11 percent in group A vs. 56 percent in group B (P less than 0.001). The incidence of postoperative urinary retention was 7 percent in group A, vs. 39 percent in group B (P less than 0.05). No enema was required postoperatively in group A, vs. 9 percent in group B; 84 percent of the patients in group A were discharged on the second postoperative day, vs. 83 percent of the patients in group B discharged on the fifth postoperative day. The cost was 20 percent less in the former group.
- followUp One year follow-up showed satisfactory results.
Dis Colon Rectum · PMID 1991426 · Read it on PubMed ↗

How we searchedThe exact query, the date it ran, and what came back — so you can run it yourself.

Searched: PubMed · ClinicalTrials.gov · Crossref on 2026-10-05
The exact search — paste this into PubMed to repeat it: ("Hemorrhoidectomy"[Mesh] OR hemorrhoidectomy) AND (laser[tiab] OR "Laser Therapy"[Mesh]) AND ("Hemorrhoids"[Mesh] OR hemorrhoid*[tiab]) AND (conventional[tiab] OR comparison[tiab] OR randomized[tiab] OR trial[tiab]); PubMed expanded that to: ("Hemorrhoidectomy"[MeSH Terms] OR ("haemorrhoidectomies"[All Fields] OR "haemorrhoidectomy"[All Fields] OR "Hemorrhoidectomy"[MeSH Terms] OR "Hemorrhoidectomy"[All Fields] OR "hemorrhoidectomies"[All Fields])) AND ("laser"[Title/Abstract] OR "Laser Therapy"[MeSH Terms]) AND ("Hemorrhoids"[MeSH Terms] OR "hemorrhoid*"[Title/Abstract]) AND ("conventional"[Title/Abstract] OR "comparison"[Title/Abstract] OR "randomized"[Title/Abstract] OR "trial"[Title/Abstract])
What came back: 44 records found · 44 read · 33 answered the question
Included: Human, animal or laboratory studies reporting an outcome relevant to the question
Excluded: Records about a different condition or intervention
Records reporting no outcome
Retracted publications, which are listed but excluded from every count
Limits: Details were read from abstracts, not full papers, so anything reported only in a paper's methods section is not captured here.
Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured.
Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.

44records came back from the search
44were read
33actually answered the question

Risks and safetyReported side effects and who should be careful.

In one trial of patients with inflammatory bowel disease, laser surgery left more residual hemorrhoid tissue behind compared with traditional surgery.
One trial found wound inflammation and separation was more common with laser at 10 days after surgery.
A small number of patients developed blood clots (thrombosis) in the laser group in one trial, not seen in the traditional surgery group.
Laser equipment and procedures were reported as more expensive in some studies.

Why people try thisThe reasoning behind the question — not a claim that it works.

"Laser" sounds modern, precise, and less invasive, which can feel reassuring compared to traditional cutting surgery.
Fear of pain after surgery — traditional hemorrhoid surgery has a reputation for being very painful, and laser is marketed as a gentler option.
Clinics and surgeons market laser treatment as faster, with quicker return to normal life, which appeals to people who can't take much time off work.
Word of mouth from others who had less pain with laser surgery, even though long-term outcomes weren't part of that experience.

Common questionsShort answers, drawn from the same studies.

Will laser surgery hurt less than traditional surgery?: In most of these studies, yes — people reported less pain in the days and weeks right after laser surgery. This was one of the most consistent findings across the studies.
Is laser surgery more likely to fail or need a repeat procedure later?: Several studies, including one that followed people for 5 years, found hemorrhoids came back more often after laser surgery than after traditional surgery. This isn't true in every single study, which is part of why the overall picture is unclear.
Which one should I choose?: This depends on how severe your hemorrhoids are and what matters more to you — less pain right after surgery, or the lowest chance of the problem coming back. Talk this tradeoff through with your surgeon, since guidelines suggest the choice may depend on your hemorrhoid grade.
Is laser surgery more expensive?: Some studies reported higher cost for laser treatment, though cost wasn't measured consistently across all the studies.
If I've already had traditional surgery, did I make the wrong choice?: No. Traditional hemorrhoidectomy had the lowest recurrence rate in several studies, including a 5-year trial, so it remains a solid, well-tested option.

This is information, not advice

This page summarises published research. It cannot tell you what is happening in your own body, and evidence changes. If something is bleeding, painful, or new, it is worth being looked at — that is a different question from the one on this page, and a better one to bring to a consultation.

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Automated evidence review — PubMed, ClinicalTrials.gov, Crossref. Search strategy, grading rules and the checks that must pass before anything publishes were written by Allen Kamrava, MD, MBA, FACS, FASCRS, colon & rectal surgery, Beverly Hills. The pages themselves are compiled by software running that method and are not read one by one before publication — saying otherwise would be the one claim here that could not be checked.

Allen Kamrava, MD, MBA, FACS, FASCRS · 435 N. Bedford Dr., Suite 308, Beverly Hills, CA 90210 · 424.279.8222

Educational information — not medical advice.