{
"slug": "hemorrhoidectomy-hemorrhoid",
"question": "Is laser surgery better than traditional hemorrhoidectomy for treating hemorrhoids?",
"shortTitle": "Laser vs Traditional Hemorrhoid Surgery",
"clinicalQuestion": "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?",
"pico": {
"population": "Adults with symptomatic hemorrhoids (typically grade III or IV) undergoing surgical treatment",
"intervention": "Laser hemorrhoidectomy (laser-assisted excision or coagulation of hemorrhoidal tissue)",
"comparator": "Conventional excisional hemorrhoidectomy (e.g., Ferguson, Milligan-Morgan technique)",
"outcomes": [
"Postoperative pain score",
"Time to return to work/normal activity",
"Wound healing time",
"Postoperative bleeding rate",
"Residual or new skin tags after surgery",
"Hemorrhoid recurrence at 12 months"
]
},
"category": "anorectal",
"relatedConditions": [
"hemorrhoids",
"anal-skin-tags"
],
"relatedTreatments": [],
"relatedEvidence": [],
"bottomLine": {
"verdict": "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.",
"detail": "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.",
"studyIds": [
"pmid:42478482",
"pmid:36593573",
"pmid:35906356",
"pmid:34101003",
"pmid:31912268",
"pmid:37020091"
]
},
"strength": {
"level": "high",
"why": "4 well-conducted randomised trials address this question directly.",
"override": null
},
"direction": {
"level": "unclear",
"why": "The studies point in different directions.",
"override": null
},
"counts": {
"recordsRetrieved": 44,
"recordsScreened": 44,
"included": 33,
"rcts": 12,
"systematicReviews": 11,
"observational": 6,
"participants": 14546,
"yearFrom": 1991,
"yearTo": 2026,
"registeredTrialsWithoutResults": 5
},
"excluded": [],
"outcomes": [
{
"name": "Postoperative pain score",
"status": "improvement",
"note": "Most studies, including several meta-analyses and randomized trials, found less pain in the days and weeks after laser surgery compared to traditional surgery.",
"studyIds": [
"pmid:42503488",
"pmid:42374341",
"pmid:41689325",
"pmid:40576418",
"pmid:39511001",
"pmid:39048788",
"pmid:38762410",
"pmid:37846728",
"pmid:36597234",
"pmid:36593573",
"pmid:35906356",
"pmid:34101003",
"pmid:31912268",
"pmid:27806213",
"pmid:25684841",
"pmid:1991426"
]
},
{
"name": "Time to return to work/normal activity",
"status": "possible-improvement",
"note": "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.",
"studyIds": [
"pmid:36593573",
"pmid:34101003",
"pmid:30272930",
"pmid:16919112",
"pmid:1991426"
]
},
{
"name": "Wound healing time",
"status": "insufficient",
"note": "Results conflict directly. Some studies found faster healing with laser, others found healing took longer or the wound was more inflamed at 10 days.",
"studyIds": [
"pmid:37020091",
"pmid:36597234",
"pmid:16919112",
"pmid:8223057",
"pmid:8292434",
"pmid:1991426"
]
},
{
"name": "Postoperative bleeding rate",
"status": "improvement",
"note": "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.",
"studyIds": [
"pmid:41689325",
"pmid:40576418",
"pmid:39511001",
"pmid:38762410",
"pmid:36593573",
"pmid:35449097",
"pmid:27806213",
"pmid:25684841"
]
}
],
"benefits": [
{
"text": "In most studies that measured it, people reported less pain in the first days to weeks after laser surgery compared with traditional surgery.",
"studyIds": [
"pmid:42503488",
"pmid:42374341",
"pmid:41689325",
"pmid:40576418",
"pmid:39511001",
"pmid:39048788",
"pmid:38762410",
"pmid:37846728",
"pmid:36597234",
"pmid:36593573",
"pmid:35906356",
"pmid:34101003",
"pmid:31912268",
"pmid:27806213",
"pmid:25684841",
"pmid:1991426"
]
},
{
"text": "Laser surgery was linked to less bleeding during and after the operation in several studies.",
"studyIds": [
"pmid:41689325",
"pmid:40576418",
"pmid:39511001",
"pmid:38762410",
"pmid:36593573",
"pmid:27806213",
"pmid:25684841"
]
},
{
"text": "Several studies found the operation itself was faster with laser, and some found people returned to work or normal activity sooner.",
"studyIds": [
"pmid:39511001",
"pmid:39048788",
"pmid:36597234",
"pmid:36593573",
"pmid:30272930",
"pmid:1991426"
]
}
],
"limitations": [
{
"text": "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.",
"studyIds": [
"pmid:37846728",
"pmid:36597234",
"pmid:35449097",
"pmid:31912268",
"pmid:25684841",
"pmid:16919112",
"pmid:8223057",
"pmid:8292434",
"pmid:1991426"
]
},
{
"text": "Several of the larger reviews mixed randomized trials with non-randomized studies, which weakens how much their findings can be trusted.",
"studyIds": [
"pmid:42374341",
"pmid:36593573",
"pmid:35906356",
"pmid:32914275"
]
},
{
"text": "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.",
"studyIds": [
"pmid:35906356",
"pmid:42313087"
]
},
{
"text": "The few studies with 5-year follow-up are single-center and small, so it's unclear if their findings apply broadly.",
"studyIds": [
"pmid:42478482",
"pmid:31912268"
]
},
{
"text": "One review notes several outcomes were statistically underpowered, meaning the studies may be too small to reliably rule out a true difference either way.",
"studyIds": [
"pmid:42503488"
]
}
],
"risks": [
{
"text": "In one trial of patients with inflammatory bowel disease, laser surgery left more residual hemorrhoid tissue behind compared with traditional surgery.",
"studyIds": [
"pmid:39511001"
],
"severity": "minor"
},
{
"text": "One trial found wound inflammation and separation was more common with laser at 10 days after surgery.",
"studyIds": [
"pmid:8223057"
],
"severity": "minor"
},
{
"text": "A small number of patients developed blood clots (thrombosis) in the laser group in one trial, not seen in the traditional surgery group.",
"studyIds": [
"pmid:27806213"
],
"severity": "minor"
},
{
"text": "Laser equipment and procedures were reported as more expensive in some studies.",
"studyIds": [
"pmid:37438655",
"pmid:8223057",
"pmid:1991426"
],
"severity": "minor"
}
],
"whyPeopleTryIt": [
{
"text": "\"Laser\" sounds modern, precise, and less invasive, which can feel reassuring compared to traditional cutting surgery."
},
{
"text": "Fear of pain after surgery — traditional hemorrhoid surgery has a reputation for being very painful, and laser is marketed as a gentler option."
},
{
"text": "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."
},
{
"text": "Word of mouth from others who had less pain with laser surgery, even though long-term outcomes weren't part of that experience."
}
],
"keyStudies": [
"pmid:42478482",
"pmid:31912268",
"pmid:36593573",
"pmid:34101003",
"pmid:39048788",
"pmid:35906356",
"pmid:42503488",
"pmid:37020091"
],
"studies": [
{
"id": "pmid:42503488",
"pmid": "42503488",
"doi": "10.1177/00031348261471500",
"nctId": null,
"pmcid": null,
"title": "Laser Hemorrhoidoplasty versus Excisional Hemorrhoidectomy: The Recovery-Durability Tradeoff in Hemorrhoid Surgery-A Systematic Review of Randomized Trials",
"firstAuthor": "Pompeu",
"multipleAuthors": true,
"journal": "Am Surg",
"year": 2026,
"design": "systematic-review",
"n": 1099,
"nField": "reported",
"population": "patients with hemorrhoids undergoing surgery",
"intervention": "laser hemorrhoidoplasty",
"comparator": "conventional excisional hemorrhoidectomy",
"primaryOutcome": "postoperative pain and recovery outcomes versus long-term durability",
"result": "Laser surgery caused less pain, faster recovery, and fewer complications short-term, but long-term durability remains uncertain due to limited follow-up",
"resultDirection": "mixed",
"quality": "low",
"qualityWhy": "The abstract itself describes the evidence as low to very low certainty with underpowered outcomes and limited follow-up.",
"directness": "direct",
"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.",
"followUp": "",
"plainFinding": "Faster recovery, but long-term results unclear.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/42503488/",
"sourceText": "BackgroundExcisional hemorrhoidectomy remains the standard for advanced disease, while the applicability of laser hemorrhoidoplasty remains uncertain. This study evaluates the tradeoff between short-term recovery and long-term durability to inform patient-centered decision-making.MethodsA systematic search of PubMed, Web of Science, Scopus, and CENTRAL was conducted through September 2025. Randomized controlled trials (RCTs) comparing diode laser hemorrhoidoplasty with conventional hemorrhoidectomy were included. Pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals were estimated using random-effects models. Heterogeneity was assessed with the I2 statistic, and trial sequential analysis (TSA) was performed to explore the robustness of selected outcomes.ResultsFifteen RCTs involving 1099 patients were included. Laser hemorrhoidoplasty was associated with reduced postoperative pain on day 1 (MD -2.02; 95% CI -2.83 to -1.20) and day 7 (MD -2.13; 95% CI -3.06 to -1.20), shorter duration of analgesic use (MD -2.72 days), operative time (MD -12.49 min), intraoperative blood loss (MD -21.63 mL), hospital stay (MD -0.63 days), and earlier return to daily activities (MD -10.78 days). It was also associated with lower rates of postoperative bleeding (RR 0.35), urinary retention (RR 0.29), and anal stenosis (RR 0.12). TSA suggested that some short-term findings may be robust; however, several outcomes remained underpowered, and limited follow-up restricts the interpretation of long-term outcomes.ConclusionLaser hemorrhoidoplasty offers improved short-term recovery but with uncertain long-term durability. 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.",
"provenance": [
{
"field": "n",
"quote": "Fifteen RCTs involving 1099 patients were included."
},
{
"field": "population",
"quote": "patients"
},
{
"field": "intervention",
"quote": "Laser hemorrhoidoplasty"
},
{
"field": "comparator",
"quote": "conventional hemorrhoidectomy"
},
{
"field": "primaryOutcome",
"quote": "evaluates the tradeoff between short-term recovery and long-term durability"
},
{
"field": "result",
"quote": "Laser hemorrhoidoplasty offers improved short-term recovery but with uncertain long-term durability."
},
{
"field": "result",
"quote": "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."
}
]
},
{
"id": "pmid:42478482",
"pmid": "42478482",
"doi": "10.1097/DCR.0000000000004372",
"nctId": null,
"pmcid": "PMC13585168",
"title": "Five-Year Follow-up of the Double-Blinded Randomized Controlled Trial Comparing Laser Hemorrhoidoplasty With Sutured Mucopexy and Excisional Hemorrhoidectomy",
"firstAuthor": "Makunaite",
"multipleAuthors": true,
"journal": "Dis Colon Rectum",
"year": 2026,
"design": "rct",
"n": 102,
"nField": "reported",
"population": "adults with symptomatic second- or third-degree hemorrhoids who had surgery and were followed for 5 years",
"intervention": "laser hemorrhoidoplasty",
"comparator": "excisional hemorrhoidectomy and sutured mucopexy",
"primaryOutcome": "recurrence of hemorrhoid symptoms at 5 years",
"result": "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",
"resultDirection": "mixed",
"quality": "low",
"qualityWhy": "it was a small, single-center trial and its main finding—recurrence differences—did not reach statistical significance.",
"directness": "direct",
"limitations": "This is a single-center study with a relatively small sample size.",
"followUp": "5 years",
"plainFinding": "Similar recurrence, easier recovery with laser.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/42478482/",
"sourceText": "BACKGROUND: Patients randomly assigned to laser hemorrhoidoplasty, excisional hemorrhoidectomy, and sutured mucopexy were followed up at 5 years after surgery. OBJECTIVE: The aim of this study was to compare the long-term results of laser hemorrhoidoplasty, excisional hemorrhoidectomy, and sutured mucopexy. DESIGN: A follow-up of randomized, parallel-group, double-blinded, single-center prospective study. SETTINGS: Treatment was provided between April 2016 and April 2017 at a single center. PATIENTS: Patients with symptomatic second- or third-degree hemorrhoids 5 years after surgery were interviewed via telephone or online questionnaire. MAIN OUTCOME MEASURES: Recurrence of symptoms was the primary outcome; patients' quality of life, fecal incontinence, and patients' evaluation of treatment were secondary outcomes. RESULTS: A total of 102 patients were evaluated at 5 years (34 per group). 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). Although recurrence-free probability was numerically higher in the excisional hemorrhoidectomy and laser hemorrhoidoplasty groups, the timing of events varied across cohorts. Specific recurrences included bleeding in 18% (excisional hemorrhoidectomy), 31% (sutured mucopexy), and 31% (laser hemorrhoidoplasty) and prolapse in 12% (excisional hemorrhoidectomy), 23% (laser hemorrhoidoplasty), and 34% (sutured mucopexy). General health evaluation scores were highest in the laser hemorrhoidoplasty group. A mixed-effect model for repeated measures analysis showed a continued trend of improvement in physical and social activity between 1 and 5 years across all groups ( p = 0.021). Decision regret was lowest in the sutured mucopexy group (mean score 1.33). LIMITATIONS: This is a single-center study with a relatively small sample size. CONCLUSIONS: Patients who underwent excisional hemorrhoidectomy reported the best outcomes; however, laser hemorrhoidoplasty produced only slightly worse results with a significantly shorter and less painful postoperative course. See Video Abstract . SEGUIMIENTO A CINCO AOS DEL ENSAYO CLNICO ALEATORIZADO DOBLE CIEGO QUE COMPARA LA HEMORROIDOPLASTIA LSER CON LA MUCOPEXIA SUTURADA Y LA HEMORROIDECTOMA POR ESCISIN: ANTECEDENTES:Se realizó un seguimiento a pacientes, asignados aleatoriamente a hemorroidoplastia láser, hemorroidectomía por escisión y mucopexia suturada, a los 5 años de la cirugía.OBJETIVO:El objetivo de este estudio fue comparar los resultados a largo plazo de la hemorroidoplastia láser, la hemorroidectomía por escisión y la mucopexia suturada.DISEÑO:Estudio prospectivo, unicéntrico, doble ciego, aleatorizado, de seguimiento y con grupos paralelos.ÁMBITO:Entre abril de 2016 y abril de 2017, se incluyeron 121 pacientes en el estudio.PACIENTES:Se entrevistó telefónicamente o mediante cuestionario en línea a pacientes con hemorroides sintomáticas de segundo o tercer grado, 5 años después de la cirugía.PRINCIPALES MEDIDAS DE RESULTADO:La recurrencia de los síntomas fue el resultado primario; la calidad de vida de los pacientes, la incontinencia fecal y la evaluación del tratamiento por parte de los pacientes fueron resultados secundarios.RESULTADOS:Se evaluó a un total de 102 pacientes a los 5 años (34 por grupo). Las estimaciones de Kaplan-Meier de la recurrencia de los síntomas a los 5 años fueron del 24% para la hemorroidectomía por escisión, del 29% para la hemorroidoplastia láser y del 44% para la mucopexia suturada; estas diferencias no alcanzaron significación estadística (log-rank p = 0,076). Si bien la probabilidad de ausencia de recurrencia fue numéricamente mayor en los grupos de hemorroidectomía por escisión y hemorroidoplastia láser, el momento de los eventos varió entre las cohortes. Las recurrencias específicas incluyeron sangrado en el 18% (hemorroidectomía por escisión), 31% (mucopexia suturada) y 31% (hemorroidectomía láser), y prolapso en el 12% (hemorroidectomía por escisión), 23% (hemorroidectomía láser) y 34% (mucopexia suturada). Las puntuaciones de evaluación de salud general fueron más altas en el grupo de hemorroidoplastia láser. El modelo de efectos mixtos para el análisis de medidas repetidas mostró una tendencia continua de mejora en la actividad física y social entre 1 y 5 años en todos los grupos (p = 0,021). El arrepentimiento por la decisión tomada fue menor en el grupo de mucopexia suturada (puntuación media de 1,33).LIMITACIONES:Este es un estudio unicéntrico, con un tamaño de muestra relativamente pequeño.CONCLUSIONES:Los pacientes sometidos a hemorroidectomía por escisión reportan los mejores resultados; sin embargo, la hemorroidoplastia láser produce resultados solo ligeramente peores, con un postoperatorio significativamente más corto y menos doloroso. (AI-generated translation ).",
"provenance": [
{
"field": "n",
"quote": "A total of 102 patients were evaluated at 5 years (34 per group)."
},
{
"field": "primaryOutcome",
"quote": "Recurrence of symptoms was the primary outcome"
},
{
"field": "intervention",
"quote": "laser hemorrhoidoplasty"
},
{
"field": "comparator",
"quote": "excisional hemorrhoidectomy, and sutured mucopexy"
},
{
"field": "population",
"quote": "Patients with symptomatic second- or third-degree hemorrhoids"
},
{
"field": "result",
"quote": "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)."
},
{
"field": "result",
"quote": "laser hemorrhoidoplasty produced only slightly worse results with a significantly shorter and less painful postoperative course"
},
{
"field": "limitations",
"quote": "This is a single-center study with a relatively small sample size."
},
{
"field": "followUp",
"quote": "patients randomly assigned to laser hemorrhoidoplasty, excisional hemorrhoidectomy, and sutured mucopexy were followed up at 5 years after surgery"
}
]
},
{
"id": "pmid:42374341",
"pmid": "42374341",
"doi": "10.1186/s12893-026-03982-1",
"nctId": null,
"pmcid": "PMC13576129",
"title": "Laser hemorrhoidoplasty versus LigaSure hemorrhoidectomy for grade II-IV hemorrhoidal disease: a systematic review and meta-analysis",
"firstAuthor": "Zamlout",
"multipleAuthors": true,
"journal": "BMC Surg",
"year": 2026,
"design": "meta-analysis",
"n": 461,
"nField": "reported",
"population": "adults with grade II-IV hemorrhoids",
"intervention": "laser hemorrhoidoplasty (LHP)",
"comparator": "LigaSure hemorrhoidectomy (LigH)",
"primaryOutcome": "postoperative pain, time to return to routine activities, and recurrence",
"result": "LHP had less pain and faster recovery, but LigH had lower recurrence rates",
"resultDirection": "mixed",
"quality": "very-low",
"qualityWhy": "The authors rated the evidence as very low certainty, based on only five studies with small patient numbers.",
"directness": "indirect",
"limitations": "Certainty of evidence is very low and the authors call for further high-quality randomized trials.",
"followUp": "",
"plainFinding": "Less pain, faster recovery, more recurrence.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/42374341/",
"sourceText": "BACKGROUND: Many surgical procedures have been developed to treat hemorrhoidal disease. Although conventional excisional techniques are effective, they are also associated with significant postoperative pain and longer recovery times. Consequently, newer techniques have been introduced to address these issues, including laser hemorrhoidoplasty (LHP) and LigaSure hemorrhoidectomy (LigH). This systematic review and meta-analysis aims to compare these two approaches in terms of perioperative outcomes and recurrence. METHODS: A comprehensive search was conducted across PubMed, Scopus, Web of Science, Cochrane Library, ClinicalTrials.gov, and Google Scholar, up to December 2025. We included all eligible studies involving adults with grade II-IV hemorrhoids. Primary outcomes included postoperative pain, time to return to routine activities, and recurrence. Secondary outcomes were operative time, length of hospital stay, and complications. The risk of bias was assessed using the RoB2 and ROBINS-I V2 tools. Meta-analyses were performed with a random-effects model. The certainty of evidence was evaluated using the GRADE approach. RESULTS: Data from 461 patients (213 LHP, 248 LigH) across five studies were analyzed. 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]). No significant differences were observed regarding postoperative bleeding, wound infection, urinary retention, or thrombosis. CONCLUSION: LHP yields better perioperative outcomes, including less pain and faster recovery, making it a favorable option for patient comfort. However, LigH has lower recurrence rates. The certainty of evidence is very low. Further high-quality randomized trials are needed to confirm these results.",
"provenance": [
{
"field": "n",
"quote": "Data from 461 patients (213 LHP, 248 LigH) across five studies were analyzed."
},
{
"field": "population",
"quote": "We included all eligible studies involving adults with grade II-IV hemorrhoids."
},
{
"field": "intervention",
"quote": "laser hemorrhoidoplasty (LHP)"
},
{
"field": "comparator",
"quote": "LigaSure hemorrhoidectomy (LigH)"
},
{
"field": "primaryOutcome",
"quote": "Primary outcomes included postoperative pain, time to return to routine activities, and recurrence."
},
{
"field": "result",
"quote": "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])."
},
{
"field": "quality",
"quote": "The certainty of evidence is very low."
}
]
},
{
"id": "pmid:42313087",
"pmid": "42313087",
"doi": "10.17235/reed.2026.11898/2026",
"nctId": null,
"pmcid": null,
"title": "Outcomes of laser hemorrhoidoplasty in grade II-IV hemorrhoidal disease: a four-year, single center experience",
"firstAuthor": "Heynderickx",
"multipleAuthors": true,
"journal": "Rev Esp Enferm Dig",
"year": 2026,
"design": "retrospective",
"n": 132,
"nField": "reported",
"population": "patients with grade II-IV hemorrhoids",
"intervention": "laser hemorrhoidoplasty",
"comparator": "none (single-arm retrospective cohort)",
"primaryOutcome": "postoperative pain, complications, satisfaction, and recurrence rates",
"result": "low pain scores, high satisfaction, 9.1% complications, 9.8% recurrence, with grade IV disease linked to higher recurrence",
"resultDirection": "unclear",
"quality": "low",
"qualityWhy": "This was a retrospective single-center study with no comparison group, so it cannot show whether laser is better or worse than traditional surgery.",
"directness": "indirect",
"limitations": "Retrospective design, no comparator group, single center; authors call for prospective studies with a comparison group and longer follow-up.",
"followUp": "one month",
"plainFinding": "Low pain, but no comparison done.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/42313087/",
"sourceText": "BACKGROUND: Open hemorrhoidectomy remains the gold standard for the surgical treatment of hemorrhoidal disease but is associated with substantial postoperative pain and complications. In contrast, Laser Hemorrhoidoplasty (LHP) has emerged as a minimally invasive alternative. This study aimed to evaluate the clinical outcomes, complication and recurrence rates of LHP in a single-center cohort. METHODS: This retrospective study included 132 patients (72 % male, mean age 52.8 years) with grade II-IV hemorrhoidal disease who underwent Laser Hemorrhoidoplasty in our center between January 2021 and June 2025. Postoperative pain, complications, patient satisfaction, and recurrence rates were analyzed. Univariable and multivariable logistic regression analyses were performed to identify associations with recurrence and complications. RESULTS: Postoperative pain scores were low, with a median Visual Analogue Scale (VAS) score of zero at discharge, after one week and after one month. Most patients (94.7 %) were discharged on the day of surgery, and 95.5 % reported satisfaction with the postoperative outcome. Postoperative complications occurred in twelve patients (9.1 %), including three readmissions (2.3 %) and one reintervention (0.8 %). Overall recurrence occurred in thirteen patients (9.8 %), while five patients (3.8 %) required surgical treatment. Higher hemorrhoidal grade was significantly associated with recurrence, whereas no association was observed with postoperative complications. In multivariable analysis, grade IV hemorrhoids were independently associated with increased odds of recurrence after adjustment for age and previous treatment. CONCLUSION: Within this cohort, LHP may represent a safe and minimally invasive treatment option for hemorrhoidal disease associated with generally low postoperative pain, favorable patient satisfaction and relatively short hospital stay. Complication and readmission rates were low. However, grade IV disease was independently associated with increased recurrence after adjustment for age and previous treatment, indicating that caution is warranted in this subgroup. Further prospective studies with larger sample sizes, comparison group and longer follow-up are needed to better define the role of LHP in advanced hemorrhoidal disease.",
"provenance": [
{
"field": "n",
"quote": "This retrospective study included 132 patients (72 % male, mean age 52.8 years)"
},
{
"field": "population",
"quote": "132 patients (72 % male, mean age 52.8 years) with grade II-IV hemorrhoidal disease"
},
{
"field": "intervention",
"quote": "underwent Laser Hemorrhoidoplasty in our center between January 2021 and June 2025"
},
{
"field": "comparator",
"quote": "Further prospective studies with larger sample sizes, comparison group and longer follow-up are needed"
},
{
"field": "primaryOutcome",
"quote": "Postoperative pain, complications, patient satisfaction, and recurrence rates were analyzed."
},
{
"field": "result",
"quote": "Postoperative pain scores were low, with a median Visual Analogue Scale (VAS) score of zero at discharge, after one week and after one month."
},
{
"field": "result",
"quote": "Postoperative complications occurred in twelve patients (9.1 %)"
},
{
"field": "result",
"quote": "Overall recurrence occurred in thirteen patients (9.8 %)"
},
{
"field": "result",
"quote": "Higher hemorrhoidal grade was significantly associated with recurrence"
}
]
},
{
"id": "pmid:41689325",
"pmid": "41689325",
"doi": "10.29271/jcpsp.2026.02.233",
"nctId": null,
"pmcid": null,
"title": "Conventional vs. Laser Haemorrhoidectomy for Symptomatic Haemorrhoids: A Meta-Analysis",
"firstAuthor": "Wang",
"multipleAuthors": true,
"journal": "J Coll Physicians Surg Pak",
"year": 2026,
"design": "meta-analysis",
"n": null,
"nField": "not-reported",
"population": "people with symptomatic hemorrhoids",
"intervention": "diode laser hemorrhoidoplasty (DLH)",
"comparator": "conventional hemorrhoidectomy (Milligan-Morgan or Ferguson techniques)",
"primaryOutcome": "blood loss, bleeding after surgery, pain, complications, recovery time, and recurrence",
"result": "Laser surgery caused less blood loss during surgery, less bleeding afterward, and less pain than conventional hemorrhoidectomy",
"resultDirection": "benefit",
"quality": "moderate",
"qualityWhy": "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.",
"directness": "direct",
"limitations": "Abstract does not report number of patients included, quality of individual studies, or follow-up duration.",
"followUp": "",
"plainFinding": "Less bleeding and pain with laser.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/41689325/",
"sourceText": "This meta-analysis aimed to compare the efficacy and safety of Diode laser haemorrhoidoplasty (DLH) with conventional haemorrhoidectomy (CH) techniques, namely Milligan-Morgan haemorrhoidectomy (MMH) and Ferguson haemorrhoidectomy (FH), for the treatment of symptomatic haemorrhoids. A search of PubMed, Embase, Cochrane, Web of Science, and Scopus identified 13 eligible studies. 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. Statistical analysis used both random-effects and fixed-effects models, with results reported as 95% confidence intervals (CIs), and heterogeneity was assessed using the I2 statistic. The results showed that 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. Key Words: Diode laser haemorrhoidoplasty, Milligan-Morgan haemorrhoidectomy, Ferguson haemorrhoidectomy, Haemorrhoids, Meta-analysis.",
"provenance": [
{
"field": "intervention",
"quote": "Diode laser haemorrhoidoplasty (DLH)"
},
{
"field": "comparator",
"quote": "conventional haemorrhoidectomy (CH) techniques, namely Milligan-Morgan haemorrhoidectomy (MMH) and Ferguson haemorrhoidectomy (FH)"
},
{
"field": "population",
"quote": "symptomatic haemorrhoids"
},
{
"field": "primaryOutcome",
"quote": "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."
},
{
"field": "result",
"quote": "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."
}
]
},
{
"id": "pmid:40586790",
"pmid": "40586790",
"doi": "10.1007/s00104-025-02335-7",
"nctId": null,
"pmcid": null,
"title": "[Hemorrhoidal disease and stage-dependent treatment (including anal prolapse)]",
"firstAuthor": "Schwandner",
"multipleAuthors": false,
"journal": "Chirurgie (Heidelb)",
"year": 2025,
"design": "narrative-review",
"n": null,
"nField": "not-reported",
"population": "people with hemorrhoids of different severity stages, including acute anal prolapse",
"intervention": "minimally invasive techniques such as laser hemorrhoidoplasty, hemorrhoidal artery ligation, and radiofrequency ablation",
"comparator": "conventional hemorrhoidectomy surgery",
"primaryOutcome": "symptom control and long-term recurrence prevention",
"result": "The abstract does not report a comparative result between laser and conventional surgery, only that minimally invasive techniques are increasingly competing with conventional hemorrhoidectomy",
"resultDirection": "unclear",
"quality": "very-low",
"qualityWhy": "This is a general narrative review describing treatment options by disease stage without presenting study data or comparative outcomes.",
"directness": "indirect",
"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.",
"followUp": "",
"plainFinding": "No comparison reported between methods.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/40586790/",
"sourceText": "The treatment of hemorrhoidal disease is carried out depending on the symptoms and stage of the disease. Although conservative and interventional treatment options (including sclerotherapy, rubber band ligation) are indicated in early stages (stages I and II), surgical procedures are effective treatment options for advanced hemorrhoidal disease (stages III and IV). In this context, \"conventional\" hemorrhoidectomy procedures are increasingly in competition with minimally invasive techniques (e.g. hemorrhoidal artery ligation, laser hemorrhoidoplasty, radiofrequency ablation). In cases of acute anal prolapse, a conservative and topical approach is indicated. The ultimate goal of all treatment strategies for hemorrhoidal disease is symptom control and long-term absence of recurrence.",
"provenance": [
{
"field": "population",
"quote": "The treatment of hemorrhoidal disease is carried out depending on the symptoms and stage of the disease."
},
{
"field": "intervention",
"quote": "minimally invasive techniques (e.g. hemorrhoidal artery ligation, laser hemorrhoidoplasty, radiofrequency ablation)"
},
{
"field": "comparator",
"quote": "\"conventional\" hemorrhoidectomy procedures are increasingly in competition with minimally invasive techniques"
},
{
"field": "primaryOutcome",
"quote": "The ultimate goal of all treatment strategies for hemorrhoidal disease is symptom control and long-term absence of recurrence."
},
{
"field": "result",
"quote": "\"conventional\" hemorrhoidectomy procedures are increasingly in competition with minimally invasive techniques (e.g. hemorrhoidal artery ligation, laser hemorrhoidoplasty, radiofrequency ablation)."
}
]
},
{
"id": "pmid:40576418",
"pmid": "40576418",
"doi": "10.4103/aam.aam_226_24",
"nctId": null,
"pmcid": "PMC12588432",
"title": "The Outcome of Laser Ablation Hemorrhoidoplasty versus Conventional Hemorrhoidectomy",
"firstAuthor": "Alessa",
"multipleAuthors": true,
"journal": "Ann Afr Med",
"year": 2025,
"design": "retrospective",
"n": 100,
"nField": "reported",
"population": "patients with hemorrhoids (piles)",
"intervention": "laser hemorrhoidoplasty",
"comparator": "conventional surgical hemorrhoidectomy",
"primaryOutcome": "postoperative pain and bleeding",
"result": "Laser treatment caused less pain and less bleeding after surgery than conventional surgery",
"resultDirection": "benefit",
"quality": "low",
"qualityWhy": "This was a retrospective, non-randomized comparison with unequal hemorrhoid severity between groups, which can bias the results.",
"directness": "direct",
"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.",
"followUp": "",
"plainFinding": "Less pain and bleeding with laser.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/40576418/",
"sourceText": "CONTEXT: Hemorrhoids affect a significant proportion of the population, and the choice between laser hemorrhoidoplasty and conventional hemorrhoidectomy remains a crucial clinical decision. AIMS: The aim of this study was to compare the outcomes of piles management with laser hemorrhoidoplasty versus conventional surgical hemorrhoidectomy. SETTINGS AND DESIGN: A retrospective data collection from hospital registry about 50 patients who underwent laser hemorrhoidoplasty and another 50 patients who underwent conventional hemorrhoidectomy. SUBJECTS AND METHODS: Demographic and clinical data were analyzed using descriptive and inferential statistics. Data were meticulously collected and analyzed, employing SPSS statistical software. STATISTICAL ANALYSIS USED: SPSS statistical software was used for statistical analysis. RESULTS: The mean age was 40.45 years, with a balanced gender distribution. While no significant difference in age was observed between treatment groups, notable variations in gender and hemorrhoid degree distribution were evident. Laser hemorrhoidoplasty exhibited a higher percentage of patients with second-degree hemorrhoids, while conventional hemorrhoidectomy had a higher prevalence of more severe hemorrhoids (degree 3 or 4). Clinical outcomes revealed that laser hemorrhoidoplasty was associated with less postoperative pain and bleeding. 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. Furthermore, 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. CONCLUSIONS: The observed advantages of laser hemorrhoidoplasty in terms of reduced postoperative pain and bleeding suggest its potential as a favorable alternative, particularly in less severe cases.",
"provenance": [
{
"field": "population",
"quote": "50 patients who underwent laser hemorrhoidoplasty and another 50 patients who underwent conventional hemorrhoidectomy"
},
{
"field": "intervention",
"quote": "laser hemorrhoidoplasty"
},
{
"field": "comparator",
"quote": "conventional surgical hemorrhoidectomy"
},
{
"field": "primaryOutcome",
"quote": "Clinical outcomes revealed that laser hemorrhoidoplasty was associated with less postoperative pain and bleeding."
},
{
"field": "result",
"quote": "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."
},
{
"field": "result",
"quote": "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"
},
{
"field": "n",
"quote": "about 50 patients who underwent laser hemorrhoidoplasty and another 50 patients who underwent conventional hemorrhoidectomy"
}
]
},
{
"id": "pmid:39511001",
"pmid": "39511001",
"doi": "10.1007/s00464-024-11351-3",
"nctId": null,
"pmcid": "PMC11666749",
"title": "Laser hemorrhoidoplasty versus hemorrhoidectomy in the treatment of surgically indicated hemorrhoids in inflammatory bowel patients: a randomized comparative clinical study",
"firstAuthor": "Zakaria",
"multipleAuthors": true,
"journal": "Surg Endosc",
"year": 2025,
"design": "rct",
"n": 48,
"nField": "reported",
"population": "patients who had inflammatory bowel disease along with hemorrhoids",
"intervention": "laser hemorrhoidoplasty",
"comparator": "traditional hemorrhoidectomy surgery",
"primaryOutcome": "operation time, pain, bleeding, anal stenosis, recovery, patient satisfaction, and residual hemorrhoids",
"result": "Laser surgery had less pain, shorter operation time, less bleeding, fewer complications, and faster recovery, but more residual hemorrhoids than traditional surgery",
"resultDirection": "mixed",
"quality": "low",
"qualityWhy": "Small study of only 48 patients from a single center, limiting how confident we can be in the results.",
"directness": "indirect",
"limitations": "Small sample size; single-center study; conducted specifically in patients with inflammatory bowel disease, which may not reflect the general hemorrhoid population.",
"followUp": "",
"plainFinding": "Laser easier recovery, but more leftover hemorrhoids.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/39511001/",
"sourceText": "BACKGROUND: This study aims to assess and compare the outcomes of traditional surgery and laser surgery for anal hemorrhoids in patients with inflammatory bowel disease. METHODS: This is a single-center prospective randomized comparative clinical trial performed at Zagazig University Hospitals from September 2023 to September 2024. The study comprised 48 patients who were admitted during this period and had inflammatory bowel disease along with hemorrhoids. The patients were randomly allocated into two groups: Group I consisted of 24 patients who underwent laser hemorrhoidoplasty, selected based on odd numbers, while Group II consisted of 24 patients who underwent traditional surgery, selected based on even numbers. RESULTS: Group I, which underwent laser treatment for hemorrhoids in inflammatory bowel patients, 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. Moreover, laser treatment was found to be more effective than traditional surgery for treating hemorrhoids in inflammatory bowel patients in terms of postoperative bleeding and anal stenosis. Additionally, there was a higher frequency of residual hemorrhoids in laser group. CONCLUSION: Laser treatment is mostly superior to traditional surgery for hemorrhoids in inflammatory bowel patients. TRIAL REGISTRATION: Clinical Trial.gov (NCT06216223), registered on December 27, 2023, last updated in May 12, 2024. PROTOCOL REGISTRATION ID: #101080-5-9-2023.",
"provenance": [
{
"field": "n",
"quote": "The study comprised 48 patients who were admitted during this period and had inflammatory bowel disease along with hemorrhoids."
},
{
"field": "population",
"quote": "had inflammatory bowel disease along with hemorrhoids"
},
{
"field": "intervention",
"quote": "24 patients who underwent laser hemorrhoidoplasty"
},
{
"field": "comparator",
"quote": "24 patients who underwent traditional surgery"
},
{
"field": "primaryOutcome",
"quote": "operation time, pain score and duration, postoperative anal discharge, return to work time, and patient satisfaction"
},
{
"field": "result",
"quote": "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"
},
{
"field": "result",
"quote": "there was a higher frequency of residual hemorrhoids in laser group"
}
]
},
{
"id": "pmid:39459438",
"pmid": "39459438",
"doi": "10.3390/medicina60101651",
"nctId": null,
"pmcid": "PMC11509845",
"title": "Comparison of Pudendal Nerve Block and Spinal Anesthesia in Proctological Surgeries: Efficacy, Safety, and Patient Outcomes",
"firstAuthor": "Şahin",
"multipleAuthors": true,
"journal": "Medicina (Kaunas)",
"year": 2024,
"design": "prospective-cohort",
"n": 590,
"nField": "reported",
"population": "patients having proctological surgery, including hemorrhoidectomy and laser hemorrhoidoplasty",
"intervention": "pudendal nerve block anesthesia",
"comparator": "spinal anesthesia",
"primaryOutcome": "postoperative pain and functional recovery after surgery",
"result": "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",
"resultDirection": "benefit",
"quality": "low",
"qualityWhy": "it's an observational study comparing anesthesia types, not a randomized trial, and it does not directly compare laser surgery with traditional hemorrhoidectomy.",
"directness": "indirect",
"limitations": "not randomized; groups unequal in size; compares anesthesia method rather than surgical technique for hemorrhoids",
"followUp": "",
"plainFinding": "Compares anesthesia types, not surgery types",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/39459438/",
"sourceText": "Background and Objectives: The selection of an appropriate anesthesia method is a critical factor in the surgical treatment of proctological diseases, significantly impacting patient outcomes and comfort. Pudendal nerve block (PNB) and spinal anesthesia (SA) are commonly employed in these surgeries, yet the optimal choice between the two remains debated. This study aims to compare the efficacy and safety of PNB and SA in patients undergoing surgical treatment for various proctological conditions, with a focus on postoperative pain management, functional outcomes, and complication rates. Materials and Methods: A prospective observational study was conducted on 590 patients who underwent proctological surgery under either PNB (n = 435) or SA (n = 155). Pain levels were assessed using the Visual Analog Scale (VAS), while functional outcomes were measured using the World Health Organization Disability Assessment Schedule (WHODAS 2.0). Statistical analysis was performed to compare the outcomes between the two groups. Results: 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. The PNB group also demonstrated superior functional outcomes, with lower postoperative WHODAS 2.0 scores and a reduced incidence of urinary retention compared to the SA group. Furthermore, the duration of surgery and hospital stay were significantly shorter for patients in the PNB group. Conclusions: The findings suggest that PNB may offer advantages over SA in proctological surgeries, particularly in terms of pain management, functional recovery, and reduced complication rates. PNB should be considered a viable alternative to SA, particularly in cases where rapid recovery and minimizing complications are priorities. Exceptions to this include specific proctological surgeries, such as those for malignant tumors in the region, complex anal fistulas, proctological conditions arising from inflammatory bowel diseases, and patients on immunosuppressive therapy. Further research is needed to confirm these results and optimize anesthesia selection in this context.",
"provenance": [
{
"field": "n",
"quote": "A prospective observational study was conducted on 590 patients who underwent proctological surgery under either PNB (n = 435) or SA (n = 155)."
},
{
"field": "population",
"quote": "patients undergoing surgical treatment for various proctological conditions"
},
{
"field": "intervention",
"quote": "Pudendal nerve block (PNB)"
},
{
"field": "comparator",
"quote": "spinal anesthesia (SA)"
},
{
"field": "primaryOutcome",
"quote": "postoperative pain management, functional outcomes, and complication rates"
},
{
"field": "result",
"quote": "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."
}
]
},
{
"id": "pmid:39228195",
"pmid": "39228195",
"doi": "10.3393/ac.2023.00871.0124",
"nctId": null,
"pmcid": "PMC11375232",
"title": "The Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colonproctologia) guidelines for the management of acute and chronic hemorrhoidal disease",
"firstAuthor": "Brillantino",
"multipleAuthors": true,
"journal": "Ann Coloproctol",
"year": 2024,
"design": "guideline",
"n": null,
"nField": "not-reported",
"population": "people with hemorrhoids of varying severity (grades 1 to 4)",
"intervention": "laser hemorrhoidoplasty and other non-excisional procedures",
"comparator": "traditional excisional surgery (hemorrhoidectomy) and stapled hemorrhoidopexy",
"primaryOutcome": "recommended treatment choice by severity of hemorrhoidal prolapse",
"result": "guideline recommends laser or other non-excisional options mainly for milder grades, while hemorrhoidectomy and stapled hemorrhoidopexy are preferred for more severe grades",
"resultDirection": "mixed",
"quality": "low",
"qualityWhy": "this is an expert consensus guideline based on existing literature rather than a new study comparing treatments head-to-head.",
"directness": "indirect",
"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.",
"followUp": "",
"plainFinding": "Laser best for mild cases only.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/39228195/",
"sourceText": "The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colon-Proctologia, SIUCP) on the diagnosis and management of hemorrhoidal disease, with the goal of guiding physicians in the choice of the best treatment option. A panel of experts was charged by the Board of the SIUCP to develop key questions on the main topics related to the management of hemorrhoidal disease and to perform an accurate and comprehensive literature search on each topic, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in multiple rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to PICO (patients, intervention, comparison, and outcomes) criteria, and the statements were developed adopting the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology. In cases of grade 1 hemorrhoidal prolapse, outpatient procedures including hemorrhoidal laser procedure and sclerotherapy may be considered the preferred surgical options. 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. 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.",
"provenance": [
{
"field": "population",
"quote": "In cases of grade 1 hemorrhoidal prolapse"
},
{
"field": "intervention",
"quote": "outpatient procedures including hemorrhoidal laser procedure and sclerotherapy may be considered the preferred surgical options"
},
{
"field": "comparator",
"quote": "stapled hemorrhoidopexy and hemorrhoidectomy may represent the most effective procedures"
},
{
"field": "primaryOutcome",
"quote": "guiding physicians in the choice of the best treatment option"
},
{
"field": "result",
"quote": "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."
},
{
"field": "result",
"quote": "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."
}
]
},
{
"id": "pmid:39048788",
"pmid": "39048788",
"doi": "10.1007/s00384-024-04690-z",
"nctId": null,
"pmcid": "PMC11269455",
"title": "A systematic review comparing the efficacy of 980 nm vs. 1470 nm wavelengths in laser hemorrhoidoplasty",
"firstAuthor": "Li",
"multipleAuthors": true,
"journal": "Int J Colorectal Dis",
"year": 2024,
"design": "meta-analysis",
"n": 2492,
"nField": "reported",
"population": "patients with hemorrhoids undergoing surgery",
"intervention": "laser hemorrhoidoplasty (using 980 nm or 1470 nm wavelengths)",
"comparator": "open hemorrhoidectomy",
"primaryOutcome": "operation time, postoperative pain, complications, and recurrence rate",
"result": "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",
"resultDirection": "mixed",
"quality": "moderate",
"qualityWhy": "This pooled review combined mostly non-randomized studies and could not directly compare the two laser types, limiting certainty.",
"directness": "direct",
"limitations": "No direct studies compared the two wavelengths; many included studies were non-randomized.",
"followUp": "",
"plainFinding": "Less pain, but mixed recurrence results.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/39048788/",
"sourceText": "BACKGROUND: Laser Hemorrhoidoplasty (LHP) is a minimally invasive surgical option for the management of hemorrhoidal disease that has been increasingly adopted by surgeons over the last decade. Two wavelengths; 980 nm and 1470 nm have been employed in LHP. However, no data exist comparing the effects of these two wavelengths for this indication. This systematic review investigates both wavelengths for the management of hemorrhoids via the LHP procedure. METHODS: This systematic analysis and meta-analysis was performed following the PICOS and PRISMA guidelines. A systematic research of MEDLINE, Scopus, Clinicaltrials.gov, Embase, Cochrane Central Register of Controlled Trials, CENTRAL and Google Scholar databases from inception until March 2024 was performed. RESULTS: Overall, 19 studies including seven randomized control trials (RCT) and 12 non-randomized control trials with a total of 2492 patients were included in this systematic review and meta-analysis. 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. There was no statistically significant difference in the rate of recurrence between LHP with the 980-nm wavelength and open hemorrhoidectomy. However, LHP with 1470-nm wavelength resulted in significantly higher recurrence rate compared to hemorrhoidectomy. CONCLUSION: Although no direct studies have compared the two wavelengths used in LHP, the outcomes of LHP seem to be independent of the wavelength used. Both wavelengths, when correctly used provide similar results, which are mostly better compared to open hemorrhoidectomy in terms of postoperative complications and postoperative pain, but not in terms of recurrence, where at least for the 1470-nm wavelength, LHP seems to show a higher recurrence rate when compared to open hemorrhoidectomy. Although a direct comparison of both wavelengths was not possible, technical issues regarding number of shots and energy per pile represent relevant parameters for recurrence after LHP.",
"provenance": [
{
"field": "n",
"quote": "a total of 2492 patients were included in this systematic review and meta-analysis"
},
{
"field": "population",
"quote": "the management of hemorrhoidal disease"
},
{
"field": "intervention",
"quote": "Laser Hemorrhoidoplasty (LHP) is a minimally invasive surgical option for the management of hemorrhoidal disease"
},
{
"field": "comparator",
"quote": "significantly shorter compared to open hemorrhoidectomy"
},
{
"field": "primaryOutcome",
"quote": "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."
},
{
"field": "result",
"quote": "LHP with 1470-nm wavelength resulted in significantly higher recurrence rate compared to hemorrhoidectomy."
}
]
},
{
"id": "pmid:38762410",
"pmid": "38762410",
"doi": "10.1016/j.asjsur.2024.04.156",
"nctId": null,
"pmcid": null,
"title": "Diode laser hemorrhoidoplasty versus conventional Milligan-Morgan and Ferguson hemorrhoidectomy for symptomatic hemorrhoids: Meta-analysis",
"firstAuthor": "Cheng",
"multipleAuthors": true,
"journal": "Asian J Surg",
"year": 2024,
"design": "meta-analysis",
"n": 1196,
"nField": "reported",
"population": "patients with symptomatic hemorrhoids",
"intervention": "diode laser hemorrhoidoplasty",
"comparator": "conventional hemorrhoidectomy (Milligan-Morgan and Ferguson techniques)",
"primaryOutcome": "operative blood loss and postoperative hemorrhage/bleeding",
"result": "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",
"resultDirection": "mixed",
"quality": "moderate",
"qualityWhy": "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.",
"directness": "direct",
"limitations": "Abstract does not describe limitations of included trials in detail beyond mentioning subgroup analysis by risk of bias.",
"followUp": "",
"plainFinding": "Laser caused less bleeding and pain, similar recurrence.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/38762410/",
"sourceText": "Conventional hemorrhoidectomy is the mainstay of treatment for symptomatic haemorrhoids, but reported postoperative complications remains the main concern. On the contrary, with its minimally invasive nature, laser hemorrhoidoplasty showed the potential to reduce postoperative complications and discomfort. Therefore, we performed a systemic review and meta-analysis to evaluate the postoperative outcome of laser hemorrhoidoplasty compared to conventional hemorrhoidectomies, including Milligan-Morgan and Ferguson techniques. Of all studies from PubMed, EMBASE, Cochrane database, and Google Scholar, we included 17 trials with 1196 patients, of whom 596 (49.8 %) underwent laser hemorrhoidoplasty and 600 (50.2 %) underwent conventional hemorrhoidectomy. The primary outcomes were operative blood loss and postoperative haemorrhage, and the secondary outcomes were the operative time, postoperative pain score, complications, and haemorrhoid recurrence. In this study, we found that 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. Consistent results were found in 5 subgroup analyses, including studies with low risk of bias, studies using 1470 nm laser, and studies using 980 nm laser, studies conducted in Asia, and studies conducted in Europe and America.",
"provenance": [
{
"field": "n",
"quote": "we included 17 trials with 1196 patients, of whom 596 (49.8 %) underwent laser hemorrhoidoplasty and 600 (50.2 %) underwent conventional hemorrhoidectomy"
},
{
"field": "population",
"quote": "symptomatic haemorrhoids"
},
{
"field": "intervention",
"quote": "laser hemorrhoidoplasty"
},
{
"field": "comparator",
"quote": "conventional hemorrhoidectomies, including Milligan-Morgan and Ferguson techniques"
},
{
"field": "primaryOutcome",
"quote": "The primary outcomes were operative blood loss and postoperative haemorrhage"
},
{
"field": "result",
"quote": "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."
}
]
},
{
"id": "pmid:37846728",
"pmid": "37846728",
"doi": "10.1177/00031348231207301",
"nctId": null,
"pmcid": null,
"title": "Comparison of Laser Hemorrhoidoplasty and Milligan-Morgan Hemorrhoidectomy Techniques in the Treatment of Grade 2 and 3 Hemorrhoidal Disease",
"firstAuthor": "Cemil",
"multipleAuthors": true,
"journal": "Am Surg",
"year": 2024,
"design": "rct",
"n": 85,
"nField": "reported",
"population": "patients aged 18-70 with symptomatic Grade 2 and Grade 3 hemorrhoidal disease whose symptoms persisted despite at least one month of medical treatment",
"intervention": "laser hemorrhoidoplasty",
"comparator": "Milligan-Morgan hemorrhoidectomy",
"primaryOutcome": "postoperative pain (VAS score) and complications",
"result": "Laser group had less bleeding and lower pain scores early on, but overall was not more advantageous than traditional surgery for comfort or cost",
"resultDirection": "mixed",
"quality": "moderate",
"qualityWhy": "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.",
"directness": "direct",
"limitations": "Small sample size, short follow-up period of only 10 days, and unequal group sizes (54 vs 31 patients).",
"followUp": "within 10 days",
"plainFinding": "Less bleeding, no overall advantage",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/37846728/",
"sourceText": "INTRODUCTION: The estimated prevalence of hemorrhoidal disease (HD) worldwide ranges from 2.9% to 27.9%. Conservative, medical, non-operative, and surgical therapy approaches are applied in HD treatment. Milligan-Morgan (MM) hemorrhoidectomy which is the most well-known and frequently applied surgical treatment method, and Laser hemorrhoidoplasty (LH) are among the accepted treatment methods in Grade 2-3 HD treatment where medical treatment is insufficient. PURPOSE: In this study, the early results of laser hemorrhoidoplasty and Milligan-Morgan hemorrhoidectomy techniques were compared. MATERIAL AND METHODS: A randomized clinical trial. The study included ASA 1-3, 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. Fifty-four patients were allocated to Group L, whereas 31 were allocated to Group M. Age, gender, weight, body mass index, preoperative symptoms, presence of additional disease, use of anticoagulant medication, and length of hospital stay of the patients included in the study were recorded. Rescue analgesic used was recorded. Postoperative VAS score and complications were recorded within 10 days. The total energy numbers applied to all packages were recorded. RESULTS: 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). At the 3rd hour postoperatively, the need for rescue analgesia was statistically significantly higher in Group M compared to Group L. On the seventh postoperative day, Group M needed considerably more rescue analgesia compared to Group L (P < .001, P = 1.00, P = .035, respectively). The cut-off value of 571 J was calculated in Group L. CONCLUSION: We believe that it is not an advantageous method compared to MM hemorrhoidectomy, both in terms of patient comfort and cost-effectiveness, since postoperative pain, which is shown as the most important advantage of LH over conventional hemorrhoidectomy methods in the literature, can be relieved with simple NSA-I rescue analgesia in patients undergoing MM. Trial Registration: 03.06.2021/21-63.",
"provenance": [
{
"field": "n",
"quote": "total 85 patients"
},
{
"field": "population",
"quote": "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"
},
{
"field": "intervention",
"quote": "Laser hemorrhoidoplasty (LH)"
},
{
"field": "comparator",
"quote": "Milligan-Morgan (MM) hemorrhoidectomy"
},
{
"field": "primaryOutcome",
"quote": "Postoperative VAS score and complications were recorded within 10 days."
},
{
"field": "result",
"quote": "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)."
},
{
"field": "result",
"quote": "We believe that it is not an advantageous method compared to MM hemorrhoidectomy, both in terms of patient comfort and cost-effectiveness"
}
]
},
{
"id": "pmid:37438655",
"pmid": "37438655",
"doi": "10.1007/s13304-023-01578-5",
"nctId": null,
"pmcid": null,
"title": "Laser technology in proctological diseases: is it really the wave of the future?",
"firstAuthor": "Solari",
"multipleAuthors": true,
"journal": "Updates Surg",
"year": 2023,
"design": "systematic-review",
"n": 55,
"nField": "reported",
"population": "people with proctological conditions including hemorrhoids, anal fistula, and pilonidal sinus disease",
"intervention": "laser-based surgical treatments (including laser hemorrhoid surgery, FiLaC, SiLaT)",
"comparator": "conventional surgical techniques (e.g. traditional hemorrhoidectomy)",
"primaryOutcome": "operative time, postoperative pain, bleeding, healing rates, and cost compared to conventional techniques",
"result": "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",
"resultDirection": "mixed",
"quality": "low",
"qualityWhy": "This is a scoping review of mostly non-randomized, heterogeneous studies with only three randomized trials and no pooled statistical analysis.",
"directness": "direct",
"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.",
"followUp": "",
"plainFinding": "Less pain, but costs more.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/37438655/",
"sourceText": "Different types of lasers have been applied for various proctological conditions. We discuss about published articles regarding the application of lasers, with concern about evidence-based use of these techniques and technologies. We performed a literature search about laser treatments for proctological conditions. 55 studies were included for the final revision. Meta-analysis of data was not performed because of heterogeneity of study designs and outcome measures. A scoping review was performed. 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. FiLaC (fistula laser closure) was initially described in 2011 for the treatment of anal fistula. In the published studies the reported healing rates vary between 20 and 82%, and the ideal indication is yet to be defined. Studies with long-term follow-up are lacking. SiLaT (sinus laser treatment) applied the technology used for FiLaC to the treatment of pilonidal sinus disease. This technique had less perioperative pain and shorter hospital stay, but a lower primary healing rate when compared to traditional techniques. Available data is very limited, and no randomized trials are published to date. Laser assisted techniques are a viable, minimally invasive, but expensive option for the treatment of several proctological conditions. Further researches are needed to assess if patients could benefit of their use, and for what indication.",
"provenance": [
{
"field": "n",
"quote": "55 studies were included for the final revision"
},
{
"field": "population",
"quote": "Different types of lasers have been applied for various proctological conditions."
},
{
"field": "intervention",
"quote": "Laser treatments for hemorrhoids require a shorter operative time and show less postoperative pain and bleeding compared to conventional hemorrhoidectomy, but are more expensive."
},
{
"field": "comparator",
"quote": "compared to conventional hemorrhoidectomy"
},
{
"field": "primaryOutcome",
"quote": "require a shorter operative time and show less postoperative pain and bleeding compared to conventional hemorrhoidectomy, but are more expensive"
},
{
"field": "result",
"quote": "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."
}
]
},
{
"id": "pmid:37020091",
"pmid": "37020091",
"doi": "10.1007/s00423-023-02879-4",
"nctId": null,
"pmcid": "PMC10076349",
"title": "Mid-term efficacy and postoperative wound management of laser hemorrhoidoplasty (LHP) vs conventional excisional hemorrhoidectomy in grade III hemorrhoidal disease: the twisting trend",
"firstAuthor": "Gambardella",
"multipleAuthors": true,
"journal": "Langenbecks Arch Surg",
"year": 2023,
"design": "retrospective",
"n": 174,
"nField": "reported",
"population": "patients with grade III symptomatic hemorrhoidal disease",
"intervention": "laser hemorrhoidoplasty using a 1470-nm diode laser",
"comparator": "conventional Milligan-Morgan hemorrhoidectomy",
"primaryOutcome": "postoperative pain, wound care, symptom resolution, and recurrence of hemorrhoid symptoms",
"result": "lower postoperative pain and smoother wound management with laser treatment, but higher recurrence of symptoms (21.6% vs 8.1%) compared to Milligan-Morgan",
"resultDirection": "mixed",
"quality": "low",
"qualityWhy": "This was a retrospective, non-randomized comparison, so differences could be due to patient selection rather than the treatment itself.",
"directness": "direct",
"limitations": "Retrospective design; not randomized; authors call for larger comparative studies.",
"followUp": "25 ± 8 months",
"plainFinding": "Less pain, but more recurrence.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/37020091/",
"sourceText": "PURPOSE: Hemorrhoidal disease (HD) is a common condition, and several surgical techniques have been proposed to date without being able to achieve definitive consensus on their use and indications. Laser hemorrhoidoplasty (LHP) is a minimally invasive procedure for HD treatment determining the shrinkage of the hemorrhoidal piles by diode laser limiting the postoperative discomfort and pain. The aim of the current study was to evaluate the postoperative outcomes of HD patients undergoing LHP vs conventional Milligan-Morgan hemorrhoidectomy (MM). METHOD: Postoperative pain, wound care management, symptoms' resolution, patients' quality of life, and length of return to daily activity of grade III symptomatic HD patients undergoing LHP vs MM were retrospectively evaluated. The patients were followed-up for recurrence of prolapsed hemorrhoid or symptoms. RESULT: From January 2018 to December 2019, 93 patients received conventional Milligan Morgan as control group and 81 patients received laser hemorrhoidoplasty treatment using a 1470-nm diode laser. No significant intraoperative complications occurred in both groups. Laser hemorrhoidoplasty patients experienced lower postoperative pain score (p < 0.0001) and smoother wound management. After 25 ± 8 months follow-up, the recurrence of symptoms occurred in 8.1% after Milligan-Morgan and 21.6% after laser hemorrhoidoplasty (p < 0.05) with a similar Rorvik score (7.8 ± 2.6 in LHP group vs 7.6 ± 1.9 in MM group, p = 0.12). CONCLUSION: LHP demonstrated high efficacy in selected HD patients guaranteeing lower postoperative pain, easier wound care, higher rate of symptoms resolution, and greater patient appreciation compared to MM, even though it had a higher recurrence rate. Larger comparative studies are needed to address this issue.",
"provenance": [
{
"field": "n",
"quote": "93 patients received conventional Milligan Morgan as control group and 81 patients received laser hemorrhoidoplasty treatment"
},
{
"field": "population",
"quote": "grade III symptomatic HD patients"
},
{
"field": "intervention",
"quote": "laser hemorrhoidoplasty treatment using a 1470-nm diode laser"
},
{
"field": "comparator",
"quote": "conventional Milligan Morgan"
},
{
"field": "primaryOutcome",
"quote": "Postoperative pain, wound care management, symptoms' resolution, patients' quality of life, and length of return to daily activity"
},
{
"field": "result",
"quote": "Laser hemorrhoidoplasty patients experienced lower postoperative pain score (p < 0.0001) and smoother wound management."
},
{
"field": "result",
"quote": "the recurrence of symptoms occurred in 8.1% after Milligan-Morgan and 21.6% after laser hemorrhoidoplasty (p < 0.05)"
},
{
"field": "followUp",
"quote": "After 25 ± 8 months follow-up"
}
]
},
{
"id": "pmid:36695928",
"pmid": "36695928",
"doi": "10.1007/s10103-022-03703-z",
"nctId": null,
"pmcid": null,
"title": "Hemorrhoid laser dearterialization: systematic review and meta-analysis",
"firstAuthor": "De Nardi",
"multipleAuthors": true,
"journal": "Lasers Med Sci",
"year": 2023,
"design": "meta-analysis",
"n": null,
"nField": "not-reported",
"population": "people with symptomatic hemorrhoids",
"intervention": "laser treatment to close off blood vessels feeding hemorrhoids (HeLP)",
"comparator": "rubber band ligation (in one trial); other studies had no comparator",
"primaryOutcome": "whether symptoms went away",
"result": "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",
"resultDirection": "benefit",
"quality": "low",
"qualityWhy": "most included studies were non-randomized and the evidence was graded as low certainty, with only one randomized trial and no long-term data.",
"directness": "indirect",
"limitations": "only one randomized study, most evidence from non-randomized cohorts, short to medium follow-up, and lack of comparison to traditional excisional hemorrhoidectomy",
"followUp": "",
"plainFinding": "More symptom relief than banding, not hemorrhoidectomy.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/36695928/",
"sourceText": "Hemorrhoidal disease is a common and troublesome condition. Excisional hemorrhoidectomy can assure the best chance of cure but it is hampered by postoperative pain and potential long-term morbidity therefore minimally invasive techniques have been developed. Since 2009 a doppler-guided hemorrhoidal dearterialization with laser (the hemorrhoidal laser procedure; HeLP) has been proposed to control symptoms without significant sequelae. The aim of this systematic review is to analyze the benefits and disadvantages of HeLP for symptomatic hemorrhoids. The Medline/PubMed, Embase, and Cochrane library databases were searched from January 2010 to March 2022, language was restricted to English and documents to the full text. Randomized and non-randomized, prospective and retrospective cohort studies were included. Risk of bias assessment was performed using the Risk of bias for non-randomized studies (ROBINS-I) and the RoB2 Tool for randomized clinical trial. Primary outcome was to assess the efficacy of HeLP on symptoms' resolution. Secondary objectives were postoperative pain and complications, comparison with other interventional techniques, and evaluation of long-term recurrence. Whenever possible, a meta-analysis was conducted. The GRADE approach was employed to assess the certainty of evidence. We included six non-randomized and one randomized study. 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. Published data indicate that HeLP is effective, relatively safe, with limited recurrence rate, after a short to medium follow-up. The quality of evidence was however low. There is a paucity of studies assessing the benefits or harms of laser dearterialization for the treatment of hemorrhoids and randomized trials are furthermore rare, therefore trials with adequate power and proper design, assessing the advantages and disadvantages of HeLP versus other minimally invasive techniques, are needed. Furthermore, studies evaluating long-term follow-up are wanted.",
"provenance": [
{
"field": "population",
"quote": "Hemorrhoidal disease is a common and troublesome condition"
},
{
"field": "intervention",
"quote": "a doppler-guided hemorrhoidal dearterialization with laser (the hemorrhoidal laser procedure; HeLP)"
},
{
"field": "comparator",
"quote": "after HeLP and 53.3% after rubber band ligation as comparator"
},
{
"field": "primaryOutcome",
"quote": "Primary outcome was to assess the efficacy of HeLP on symptoms' resolution."
},
{
"field": "result",
"quote": "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."
}
]
},
{
"id": "pmid:36597234",
"pmid": "36597234",
"doi": "10.29271/jcpsp.2023.01.41",
"nctId": null,
"pmcid": null,
"title": "Comparison of Laser Haemorrhoidoplasty and Ferguson Haemorrhoidectomy in Treating Grade III and Grade IV Haemorrhoids: A Prospective Randomised Study",
"firstAuthor": "Mert",
"multipleAuthors": false,
"journal": "J Coll Physicians Surg Pak",
"year": 2023,
"design": "rct",
"n": null,
"nField": "not-reported",
"population": "adults with grade III or grade IV hemorrhoids needing surgery",
"intervention": "laser hemorrhoidoplasty",
"comparator": "Ferguson hemorrhoidectomy (traditional surgery)",
"primaryOutcome": "surgery time, wound healing time, pain scores, and complications",
"result": "Laser surgery had shorter operation time, faster wound healing, quicker symptom relief, lower pain scores, and fewer complications than traditional surgery",
"resultDirection": "benefit",
"quality": "low",
"qualityWhy": "It is a randomized trial but very small and short follow-up with no participant numbers given, so results are uncertain.",
"directness": "direct",
"limitations": "Abstract does not report number of participants or length of follow-up beyond the perioperative period.",
"followUp": "",
"plainFinding": "Faster healing, less pain, fewer complications.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/36597234/",
"sourceText": "OBJECTIVE: To compare the efficiency and safety of laser haemorrhoidoplasty (LH) with Ferguson haemorrhoidectomy (FH) in patients with third- and fourth-grade haemorrhoids. STUDY DESIGN: Randomised controlled trial. PLACE AND DURATION OF STUDY: General Surgery Clinic, Medipol University Pendik Hospital, İstanbul, Turkey, from 1st December 2021 to 1st May 2022. METHODOLOGY: The patients who had an indication for surgery for grade III or grade IV haemorrhoidal disease (HD) and who were 18 years and older were randomly allocated to the two study groups. While LH was performed using a 980-diode laser in the patients enrolled in the laser group, a standard FH was performed using diathermy in the patients in the second study group. 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. RESULTS: 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. The median VAS score decreased from 5 to 0 in the LH group and from 5 to 2 in FH, and Δ VAS scores of the groups were statistically significantly different (p<0.001). LH also had better outcomes than FH in terms of having any type of postoperative complication. CONCLUSION: LH might be an alternative treatment modality in patients with grade III and grade IV HD with a low level of complication rate. KEY WORDS: Haemorrhoids, Laser therapy, Haemorrhoidectomy, Operative time, Pain measurement, Postoperative complications.",
"provenance": [
{
"field": "population",
"quote": "patients who had an indication for surgery for grade III or grade IV haemorrhoidal disease (HD) and who were 18 years and older"
},
{
"field": "intervention",
"quote": "While LH was performed using a 980-diode laser in the patients enrolled in the laser group"
},
{
"field": "comparator",
"quote": "a standard FH was performed using diathermy in the patients in the second study group"
},
{
"field": "primaryOutcome",
"quote": "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."
},
{
"field": "result",
"quote": "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."
},
{
"field": "result",
"quote": "LH also had better outcomes than FH in terms of having any type of postoperative complication."
}
]
},
{
"id": "pmid:36593573",
"pmid": "36593573",
"doi": "10.3393/ac.2022.00598.0085",
"nctId": null,
"pmcid": "PMC10009065",
"title": "Laser hemorrhoidoplasty versus conventional hemorrhoidectomy for grade II/III hemorrhoids: a systematic review and meta-analysis",
"firstAuthor": "Wee",
"multipleAuthors": true,
"journal": "Ann Coloproctol",
"year": 2023,
"design": "meta-analysis",
"n": 661,
"nField": "reported",
"population": "people with grade II or III hemorrhoids",
"intervention": "laser hemorrhoidoplasty",
"comparator": "conventional (traditional) hemorrhoidectomy surgery",
"primaryOutcome": "pain medicine use after surgery, complications like bleeding, and how soon patients returned to work or daily activities",
"result": "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",
"resultDirection": "mixed",
"quality": "moderate",
"qualityWhy": "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.",
"directness": "direct",
"limitations": "Combined randomized and nonrandomized studies; authors state results should be verified in future well-designed trials with larger samples.",
"followUp": "12 months",
"plainFinding": "Less pain short-term, similar results longer-term.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/36593573/",
"sourceText": "PURPOSE: This study compared the short- and long-term clinical outcomes of laser hemorrhoidoplasty (LH) vs. conventional hemorrhoidectomy (CH) in patients with grade II/III hemorrhoids. METHODS: PubMed/Medline and the Cochrane Library were searched for randomized and nonrandomized studies comparing LH against CH in grade II/III hemorrhoids. The primary outcomes included postoperative use of analgesia, postoperative morbidity (bleeding, urinary retention, pain, thrombosis), and time of return to work/daily activities. RESULTS: Nine studies totaling 661 patients (LH, 336 and CH, 325) were included. The LH group had shorter operative time (P<0.001) and less intraoperative blood loss (P<0.001). 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). 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). 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). CONCLUSION: LH offers more favorable short-term clinical outcomes than CH, with reduced morbidity and pain and earlier return to work or daily activities. Medium-term symptom recurrence at 12 months was similar. Our results should be verified in future well-designed trials with larger samples.",
"provenance": [
{
"field": "n",
"quote": "Nine studies totaling 661 patients (LH, 336 and CH, 325) were included."
},
{
"field": "population",
"quote": "patients with grade II/III hemorrhoids"
},
{
"field": "intervention",
"quote": "laser hemorrhoidoplasty (LH)"
},
{
"field": "comparator",
"quote": "conventional hemorrhoidectomy (CH)"
},
{
"field": "primaryOutcome",
"quote": "The primary outcomes included postoperative use of analgesia, postoperative morbidity (bleeding, urinary retention, pain, thrombosis), and time of return to work/daily activities."
},
{
"field": "result",
"quote": "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)."
},
{
"field": "result",
"quote": "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)."
},
{
"field": "result",
"quote": "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)."
}
]
},
{
"id": "pmid:35906356",
"pmid": "35906356",
"doi": "10.1007/s00384-022-04225-4",
"nctId": null,
"pmcid": "PMC9388431",
"title": "Systematic review and meta-analysis of postoperative pain and symptoms control following laser haemorrhoidoplasty versus Milligan-Morgan haemorrhoidectomy for symptomatic haemorrhoids: a new standard",
"firstAuthor": "Tan",
"multipleAuthors": true,
"journal": "Int J Colorectal Dis",
"year": 2022,
"design": "meta-analysis",
"n": 1824,
"nField": "reported",
"population": "people with symptomatic hemorrhoids",
"intervention": "laser haemorrhoidoplasty",
"comparator": "conventional Milligan-Morgan open haemorrhoidectomy",
"primaryOutcome": "pain after surgery",
"result": "Laser surgery caused less pain in the first day, week, and month after surgery, with recurrence rates similar between groups",
"resultDirection": "benefit",
"quality": "moderate",
"qualityWhy": "It combines multiple studies including randomized trials, but mixes different study types and has only moderate-length follow-up for recurrence.",
"directness": "direct",
"limitations": "Includes both randomized and non-randomized comparative cohort studies; follow-up for recurrence was relatively short (about 8.6 months on average).",
"followUp": "8.58 ± 9.55 months",
"plainFinding": "Less pain, similar long-term results.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/35906356/",
"sourceText": "PURPOSE: Haemorrhoidal disease (HD) plagues one in every ten people, with a plethora of surgical treatment modalities, of which laser haemorrhoidoplasty (LHP) is a relatively novel option. This systematic review and meta-analysis objectively evaluated the efficacy, safety, and tolerability of LHP compared against conventional (Milligan-Morgan) open haemorrhoidectomy (CoH). METHOD: A comprehensive search of MEDLINE, EMBASE, CENTRAL, and Google Scholar was conducted. Randomised controlled trials (RCTs) and comparative cohort studies (CCSs) which compared LHP against CoH were included, with postoperative pain as the primary outcome. Secondary outcomes included intraoperative characteristics, short- and moderate-term outcome, and complications. RESULTS: A total of 12 studies (6 RCTs and 6 CCSs), with a total of 1824 patients, were analysed. LHP resulted in reduced postoperative pain for the first day (mean difference of 2.07 visual analogue scale units), week, and month. The mean dosage and duration of postoperative analgesia use was similarly lower, with a mean difference of 4.88 mg (morphine) and 2.25 days, respectively. Crucially, recurrence was equivocal (HR: 0.72, CI: 0.21-2.40) at a mean follow-up duration of 8.58 ± 9.55 months. LHP resulted in lower blood loss and was 12.74 min shorter on average. LHP's postoperative recovery time was 9.03 days less with equivalent or decreased risk of most short- and moderate-term complications except anal thrombosis. CONCLUSION: Our study suggests that LHP is more tolerable than CoH, providing patients with superior postoperative quality of life at equivalent moderate-term efficacy. These findings contribute to improved understanding of LHP and its potential at enhancing the quality of HD care.",
"provenance": [
{
"field": "population",
"quote": "Haemorrhoidal disease (HD) plagues one in every ten people"
},
{
"field": "intervention",
"quote": "laser haemorrhoidoplasty (LHP)"
},
{
"field": "comparator",
"quote": "conventional (Milligan-Morgan) open haemorrhoidectomy (CoH)"
},
{
"field": "primaryOutcome",
"quote": "with postoperative pain as the primary outcome"
},
{
"field": "result",
"quote": "LHP resulted in reduced postoperative pain for the first day (mean difference of 2.07 visual analogue scale units), week, and month."
},
{
"field": "result",
"quote": "Crucially, recurrence was equivocal (HR: 0.72, CI: 0.21-2.40) at a mean follow-up duration of 8.58 ± 9.55 months."
},
{
"field": "n",
"quote": "A total of 12 studies (6 RCTs and 6 CCSs), with a total of 1824 patients, were analysed."
}
]
},
{
"id": "pmid:35449097",
"pmid": "35449097",
"doi": "10.1186/s12893-022-01594-z",
"nctId": null,
"pmcid": "PMC9022276",
"title": "Comparison of post-operative bleeding incidence in laser hemorrhoidoplasty with and without hemorrhoidal artery ligation: a double-blinded randomized controlled trial",
"firstAuthor": "Lim",
"multipleAuthors": true,
"journal": "BMC Surg",
"year": 2022,
"design": "rct",
"n": 76,
"nField": "reported",
"population": "patients undergoing laser treatment for hemorrhoids",
"intervention": "laser hemorrhoidoplasty plus hemorrhoidal artery ligation",
"comparator": "laser hemorrhoidoplasty alone",
"primaryOutcome": "rate of bleeding after surgery",
"result": "no significant difference in bleeding incidence between both groups at any of the measured timepoints",
"resultDirection": "no-benefit",
"quality": "moderate",
"qualityWhy": "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.",
"directness": "indirect",
"limitations": "Abstract does not mention blinding of outcome assessors beyond 'double-blind', single trial registration details, and small sample size.",
"followUp": "6-weeks",
"plainFinding": "No added benefit from artery ligation.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/35449097/",
"sourceText": "INTRODUCTION: The effectiveness of hemorrhoidal artery ligation supplementation in reducing the incidence of post laser hemorrhoidoplasty bleeding has not been investigated. METHODS: This was a double-blind, randomized controlled trial comparing post-operative bleeding incidence in patients undergoing laser hemorrhoidoplasty (LHP) only versus LHP with hemorrhoidal artery ligation (HAL). Outcome measures included post-operative bleeding and its severity (i.e. verbal rating scale and Clavien-Dindo classification), presence of perianal swelling and pain score (visual analog score) at 1-day, 1-week and 6-weeks post-operatively. Statistical tests were performed and a value of P < 0.05 was considered significant. RESULTS: Seventy-six patients were randomized. There was no difference in median operating time. The bleeding incidence was highest at 1-week post-operatively (17.1%), and decreased to 1.3% at 6-weeks. There was no significant difference in bleeding incidence between both groups at any of the measured timepoints (P > 0.05). Severity of bleeding and incidence of post-operative perianal swelling were similar in both groups (P > 0.05). There was no difference in median pain scores. CONCLUSION: Supplementation of HAL to LHP does not reduce the post-operative bleeding incidence. LHP is sufficient as a stand-alone procedure for treating haemorrhoids. TRIAL REGISTRATION: National Registration Number is NMRR-15-1112-24065 (IIR). The trial start date was 1st January 2015 with the ClinicalTrials.gov identifier and registration number as NCT04667169.",
"provenance": [
{
"field": "n",
"quote": "Seventy-six patients were randomized."
},
{
"field": "population",
"quote": "patients undergoing laser hemorrhoidoplasty (LHP) only versus LHP with hemorrhoidal artery ligation (HAL)"
},
{
"field": "intervention",
"quote": "LHP with hemorrhoidal artery ligation"
},
{
"field": "comparator",
"quote": "laser hemorrhoidoplasty (LHP) only"
},
{
"field": "primaryOutcome",
"quote": "Outcome measures included post-operative bleeding and its severity"
},
{
"field": "result",
"quote": "There was no significant difference in bleeding incidence between both groups at any of the measured timepoints (P > 0.05)."
},
{
"field": "followUp",
"quote": "6-weeks post-operatively"
}
]
},
{
"id": "pmid:34101003",
"pmid": "34101003",
"doi": "10.1007/s00384-021-03953-3",
"nctId": null,
"pmcid": null,
"title": "An update on surgical treatment of hemorrhoidal disease: a systematic review and meta-analysis",
"firstAuthor": "Aibuedefe",
"multipleAuthors": true,
"journal": "Int J Colorectal Dis",
"year": 2021,
"design": "meta-analysis",
"n": 3137,
"nField": "reported",
"population": "adults with severe (grade 3 or 4) hemorrhoids needing surgery",
"intervention": "laser surgery for hemorrhoids",
"comparator": "traditional open and closed hemorrhoidectomy",
"primaryOutcome": "pain, recurrence, complications, and return to work after surgery",
"result": "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",
"resultDirection": "mixed",
"quality": "moderate",
"qualityWhy": "It pools many randomized trials but the comparisons involving laser have very wide confidence intervals, meaning the results are imprecise and uncertain.",
"directness": "direct",
"limitations": "Wide confidence intervals crossing no-effect for several outcomes, and the abstract does not detail risk of bias of individual trials",
"followUp": "",
"plainFinding": "No clear benefit over traditional surgery.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/34101003/",
"sourceText": "BACKGROUND: Pathologic hemorrhoids are common among adults age 45-65. Hemorrhoids are characterized as internal or external, and grades 1-4 based on severity. The type and grade dictate treatment, with surgical treatment reserved for grades 3/4. The aim of this study is to compare clinical outcomes of various surgical treatments. METHODS: A systematic review was conducted to identify randomized clinical trials that compare surgical treatments for grade 3/4 hemorrhoids. A Bayesian network meta-analysis was done using NetMetaXL and WinBUGS. RESULTS: A total of 26 studies with 3137 participants and 14 surgical treatments for grade 3/4 hemorrhoids were included. 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. There was less recurrence with Starion (OR 0.01, CI 0.00-0.46) and harmonic scalpel (OR 0.00, CI 0.00-0.49), compared to infrared photocoagulation and transanal hemorrhoidal dearterialization. Fewer postoperative clinical complications were seen with infrared photocoagulation (OR 0.04, CI 0.00-2.54) and LigaSure (OR 0.16, CI 0.03-0.79), compared to suture ligation and open hemorrhoidectomy. 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. CONCLUSION: There are multiple favorable techniques without a clear \"gold standard\" based on current literature. Open discussion should be had between patients and physicians to guide individualized care.",
"provenance": [
{
"field": "n",
"quote": "A total of 26 studies with 3137 participants and 14 surgical treatments for grade 3/4 hemorrhoids were included."
},
{
"field": "population",
"quote": "surgical treatments for grade 3/4 hemorrhoids"
},
{
"field": "intervention",
"quote": "Pain was less in patients with techniques such as laser (OR 0.34, CI 0.01-6.51)"
},
{
"field": "comparator",
"quote": "compared to open and closed hemorrhoidectomies"
},
{
"field": "primaryOutcome",
"quote": "The aim of this study is to compare clinical outcomes of various surgical treatments."
},
{
"field": "result",
"quote": "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."
},
{
"field": "result",
"quote": "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."
}
]
},
{
"id": "pmid:33415419",
"pmid": "33415419",
"doi": "10.1007/s00464-020-08248-2",
"nctId": null,
"pmcid": null,
"title": "Doppler-guided hemorrhoidal dearterialization with laser (HeLP): indications and clinical outcome in the long-term. Results of a multicenter trial",
"firstAuthor": "Giamundo",
"multipleAuthors": true,
"journal": "Surg Endosc",
"year": 2022,
"design": "prospective-cohort",
"n": 284,
"nField": "reported",
"population": "adults with hemorrhoids, including low and high grade",
"intervention": "Doppler-guided laser treatment to close hemorrhoid blood vessels",
"comparator": "none - no comparison group, before-and-after results only",
"primaryOutcome": "resolution of hemorrhoid symptoms",
"result": "89.9% of patients had symptom resolution at 2 years, with improved quality of life, pain, and bleeding",
"resultDirection": "benefit",
"quality": "low",
"qualityWhy": "This study had no comparison group, so it cannot show whether laser treatment works better than traditional surgery.",
"directness": "indirect",
"limitations": "No control or comparison group; this study only tracked patients before and after laser treatment without comparing to traditional hemorrhoidectomy.",
"followUp": "2-year follow-up",
"plainFinding": "Symptoms improved with laser treatment.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/33415419/",
"sourceText": "BACKGROUND: Doppler-guided hemorrhoidal laser procedure consists of sutureless closure of terminal branches of the superior hemorrhoidal artery by laser energy. Clinical results of patients treated with this procedure were analyzed at the completion of 2-year follow-up. Primary endpoint was resolution of symptoms and secondary endpoints were recurrence rate, type of recurrences, re-operation rate, and potential predictive factors for failure. METHODS: Bleeding was assessed on a score from 0 to 4 (none = 0; < 1/month = 1; 1/week = 2; > 1/week = 3; 3-4/week = 4), frequency of hemorrhoid-related symptoms with a score of 0-3 (2/year = 1; 3-5/year = 2; < 5/year = 3). Constipation and fecal incontinence were assessed by means of validated scores. Quality of life and pain at defecation were assessed using a visual analog scale of 0-10 (0 = worst possible-10 = best possible quality of life and 0 = no pain-10 = worst pain imaginable, respectively). Recurrence rate and need for re-operation were reported. Potential predictive factors of failure were analyzed by means of univariate analysis. RESULTS: Two-hundred-eighty-four patients (183 males, 101 females; mean age: 47.5 years) were included in the trial; 8 patients were lost at follow-up. Analysis of 276 patients who completed the 2-year follow-up showed an overall resolution of symptoms in 89.9% (248/276) of patients. Statistically significant improvement of quality of life, pain reduction, bleeding and frequency of acute symptoms were reported. Of 28 patients with persistent or recurrent symptoms, 12 had pain (4.35%), 10 had bleeding (3.6%) and 6 had increasing prolapse at defecation (2.2%). Eleven out of twenty-eight patients required additional surgery. Constipation and III-IV grade hemorrhoids were associated with statistically significant higher failure rates (p = 0.046 and 0.012, respectively). Better results were reported in patients reporting preoperative high-grade pain at evacuation. CONCLUSIONS: The Doppler-guided hemorrhoidal laser procedure showed efficacy at long-term follow-up. It can be considered as 'first-line' treatment in patients with low-grade hemorrhoids suffering from bleeding, pain and recurrent acute symptoms in whom conservative treatment failed.",
"provenance": [
{
"field": "n",
"quote": "Two-hundred-eighty-four patients (183 males, 101 females; mean age: 47.5 years) were included in the trial"
},
{
"field": "population",
"quote": "patients with low-grade hemorrhoids suffering from bleeding, pain and recurrent acute symptoms"
},
{
"field": "intervention",
"quote": "Doppler-guided hemorrhoidal laser procedure consists of sutureless closure of terminal branches of the superior hemorrhoidal artery by laser energy"
},
{
"field": "comparator",
"quote": "Clinical results of patients treated with this procedure were analyzed at the completion of 2-year follow-up"
},
{
"field": "primaryOutcome",
"quote": "Primary endpoint was resolution of symptoms"
},
{
"field": "result",
"quote": "Analysis of 276 patients who completed the 2-year follow-up showed an overall resolution of symptoms in 89.9% (248/276) of patients."
}
]
},
{
"id": "pmid:32914275",
"pmid": "32914275",
"doi": "10.1007/s10103-020-03142-8",
"nctId": null,
"pmcid": "PMC7952353",
"title": "Non-excisional laser therapies for hemorrhoidal disease: a systematic review of the literature",
"firstAuthor": "Longchamp",
"multipleAuthors": true,
"journal": "Lasers Med Sci",
"year": 2021,
"design": "systematic-review",
"n": 1570,
"nField": "reported",
"population": "adults with grade II or III hemorrhoids",
"intervention": "non-excisional laser treatments (laser hemorrhoidoplasty or hemorrhoidal laser procedure)",
"comparator": "traditional hemorrhoidectomy, mucopexy, or rubber band ligation",
"primaryOutcome": "symptom resolution, recurrence, complications, and postoperative pain",
"result": "similar symptom resolution to surgery, less pain, but mixed and conflicting recurrence results compared with hemorrhoidectomy",
"resultDirection": "mixed",
"quality": "low",
"qualityWhy": "This review combined many small, differently designed studies with few true randomized trials, so the comparisons are not strong enough to be sure.",
"directness": "direct",
"limitations": "Few randomized controlled trials were included, and results on recurrence after laser versus hemorrhoidectomy conflicted between the two trials that compared them directly.",
"followUp": "",
"plainFinding": "Similar healing, less pain, mixed recurrence.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/32914275/",
"sourceText": "Non-excisional laser therapies are emerging treatment for grades II and III hemorrhoidal disease (HD). However, so far, their efficiency is based on low-level evidence. Therefore, we aimed to systematically review the efficiency of non-excisional laser therapies for HD. MEDLINE/Pubmed, Web of science, Embase, and Cochrane were searched from database implementation until the April 17th, 2020. We included studies reporting at least one of surgical indicators of postoperative outcomes of laser therapies, encompassing laser hemorrhoidoplasty (LH) and hemorrhoidal laser procedure (HeLP). Fourteen studies describing LH and HeLP were included, representing 1570 patients. The main intraoperative complication was bleeding (0-1.9% of pooled patients for LH, 5.5-16.7% of pooled patients for HeLP). Postoperative complications occurred in up to 64% of patients after LH and 23.3% after HeLP. Resolution of symptoms ranged between 70 and 100% after LH and between 83.6 and 90% after HeLP. Moreover, four randomized controlled trials included in our review reported similar resolution after LH compared with hemorrhoidectomy or mucopexy and after HeLP compared with rubber band ligation. Recurrence rate was reported to range between 0 and 11.3% after LH and between 5 and 9.4% after HeLP. 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. LH and HeLP are safe and effective techniques for the treatment of grades II and III HD.",
"provenance": [
{
"field": "population",
"quote": "non-excisional laser therapies are emerging treatment for grades II and III hemorrhoidal disease (HD)"
},
{
"field": "intervention",
"quote": "laser hemorrhoidoplasty (LH) and hemorrhoidal laser procedure (HeLP)"
},
{
"field": "comparator",
"quote": "similar resolution after LH compared with hemorrhoidectomy or mucopexy and after HeLP compared with rubber band ligation"
},
{
"field": "primaryOutcome",
"quote": "studies reporting at least one of surgical indicators of postoperative outcomes of laser therapies"
},
{
"field": "result",
"quote": "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."
},
{
"field": "n",
"quote": "Fourteen studies describing LH and HeLP were included, representing 1570 patients."
}
]
},
{
"id": "pmid:32674545",
"pmid": "32674545",
"doi": "10.3393/ac.2020.05.04",
"nctId": null,
"pmcid": "PMC7392573",
"title": "Still a Case of \"No Pain, No Gain\"? An Updated and Critical Review of the Pathogenesis, Diagnosis, and Management Options for Hemorrhoids in 2020",
"firstAuthor": "Ng",
"multipleAuthors": true,
"journal": "Ann Coloproctol",
"year": 2020,
"design": "narrative-review",
"n": null,
"nField": "not-reported",
"population": "people with hemorrhoids of varying grades",
"intervention": "laser treatment and other newer 'walk-in-walk-out' techniques",
"comparator": "conventional surgical hemorrhoidectomy and other established treatments",
"primaryOutcome": "effectiveness and complications of hemorrhoid treatments",
"result": "not clearly reported for laser vs conventional hemorrhoidectomy specifically; laser said to need more study",
"resultDirection": "unclear",
"quality": "low",
"qualityWhy": "This is a narrative review summarising existing evidence rather than a new study, and it states laser treatment evidence is not yet established.",
"directness": "indirect",
"limitations": "Review does not present original comparative data for laser vs conventional hemorrhoidectomy and explicitly says laser needs further evaluation.",
"followUp": "",
"plainFinding": "Not enough evidence yet.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/32674545/",
"sourceText": "The treatment of haemorrhoids remains challenging: multiple treatment options supported by heterogeneous evidence are available, but patients rightly demand a tailored approach. Evidence for newer surgical techniques that promise to be less painful has been conflicting. We review the current evidence for management options in patients who present with varying haemorrhoidal grades. A review of the English literature was performed utilizing MEDLINE/PubMed, Embase, and Cochrane databases (31 May 2019). The search terms (haemorrhoid OR haemorrhoid OR haemorrhoids OR haemorrhoids OR \"Hemorrhoid\"[Mesh]) were used. First- and second-degree haemorrhoids continue to be managed conservatively. The easily repeatable and cost-efficient rubber band ligation is the preferred method to address minor haemorrhoids; long-term outcomes following injection sclerotherapy remain poor. Conventional haemorrhoidectomies (Ferguson/Milligan-Morgan/Ligasure haemorrhoidectomy) still have their role in third- and fourth-degree haemorrhoids, being associated with lowest recurrence; nevertheless, posthaemorrhoidectomy pain is problematic. Stapled haemorrhoidopexy allows quicker recovery, albeit at the costs of higher recurrence rates and potentially serious complications. Transanal Haemorrhoidal Dearterialization has been promoted as nonexcisional and less invasive, but the recent HubBLe trial has questioned its overall place in haemorrhoid management. 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. There are numerous treatment options for haemorrhoids, each with their own evidence-base. Newer techniques promise to be less painful, but recurrence rates remain an issue. The balance continues to be sought between long-term efficacy, minimisation of postoperative pain, and preservation of anorectal function.",
"provenance": [
{
"field": "intervention",
"quote": "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."
},
{
"field": "comparator",
"quote": "Conventional haemorrhoidectomies (Ferguson/Milligan-Morgan/Ligasure haemorrhoidectomy) still have their role in third- and fourth-degree haemorrhoids, being associated with lowest recurrence"
},
{
"field": "population",
"quote": "patients who present with varying haemorrhoidal grades"
},
{
"field": "primaryOutcome",
"quote": "We review the current evidence for management options in patients who present with varying haemorrhoidal grades."
},
{
"field": "result",
"quote": "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."
}
]
},
{
"id": "pmid:31912268",
"pmid": "31912268",
"doi": "10.1007/s00384-019-03460-6",
"nctId": null,
"pmcid": null,
"title": "Results of the double-blind randomized controlled trial comparing laser hemorrhoidoplasty with sutured mucopexy and excisional hemorrhoidectomy",
"firstAuthor": "Poskus",
"multipleAuthors": true,
"journal": "Int J Colorectal Dis",
"year": 2020,
"design": "rct",
"n": 121,
"nField": "reported",
"population": "Symptomatic 2nd- or 3rd-degree hemorrhoids patients",
"intervention": "laser hemorrhoidoplasty (LHP)",
"comparator": "excisional hemorrhoidectomy (EH)",
"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. SF-36 scores were better after EH.",
"resultDirection": "mixed",
"quality": "moderate",
"qualityWhy": "It was a well-designed double-blind randomized trial but done at only one hospital with a modest number of patients.",
"directness": "direct",
"limitations": "Single-center study.",
"followUp": "1 year",
"plainFinding": "Laser less effective but less painful than surgery",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/31912268/",
"sourceText": "PURPOSE: To compare the results of laser hemorrhoidoplasty (LHP), excisional hemorrhoidectomy (EH), and sutured mucopexy (MP). METHODS: A randomized, parallel-group, double-blinded, single-center prospective study. PATIENTS: Symptomatic 2nd- or 3rd-degree hemorrhoids patients. INTERVENTIONS: Computer randomization sequence, patient blinding, operating surgeon blinding, and surgeon-evaluator blinding. LHP was performed using a 1470 nm diode laser. Up to 250 J of energy delivered per 1 hemorrhoid. The procedure was performed circumferentially. MP ligations were placed in the area of visible hemorrhoidal tissue. Standard EH was performed up to the level of the hemorrhoidal pedicle. Follow-up at 1 and 6 weeks and 1 year. OUTCOME MEASURES: Recurrence of symptoms requiring treatment, intensity, and duration of pain after the operation, patients' quality of life, fecal incontinence, and patients' evaluation of treatment. RESULTS: A total of 121 patients. Groups were even preoperatively. LHP took 15 min (SD 5.6), MP took 16 min (SD 5.58), and EH took 29 min (SD 10.3). 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. Patients after LHP returned to regular activity after 15 days, after MP after 22 days, and after EH after 30 days, p < 0.001. SF-36 scores were better after EH. Symptoms of fecal incontinence improved in all the groups. Patients evaluate LHP better than EH and MP. LIMITATIONS: Single-center study. CONCLUSIONS: Laser hemorrhoidoplasty is a safe, minimally invasive option for hemorrhoids, more effective than MP and less effective than EH. Patients evaluate this technique better than the other two.",
"provenance": [
{
"field": "n",
"quote": "A total of 121 patients."
},
{
"field": "population",
"quote": "Symptomatic 2nd- or 3rd-degree hemorrhoids patients"
},
{
"field": "intervention",
"quote": "LHP was performed using a 1470 nm diode laser."
},
{
"field": "comparator",
"quote": "Standard EH was performed up to the level of the hemorrhoidal pedicle."
},
{
"field": "primaryOutcome",
"quote": "Recurrence of symptoms requiring treatment, intensity, and duration of pain after the operation, patients' quality of life, fecal incontinence, and patients' evaluation of treatment."
},
{
"field": "result",
"quote": "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."
},
{
"field": "result",
"quote": "SF-36 scores were better after EH."
}
]
},
{
"id": "pmid:30272930",
"pmid": "30272930",
"doi": null,
"nctId": null,
"pmcid": null,
"title": "[ОPTIMIZATION OF SURGICAL TREATMENT OF HEMORRHOIDAL DISEASE STAGES III-IV]",
"firstAuthor": "Brodovskyi",
"multipleAuthors": true,
"journal": "Klin Khir",
"year": 2017,
"design": "retrospective",
"n": null,
"nField": "not-reported",
"population": "patients with chronic hemorrhoidal disease stages III-IV",
"intervention": "hemorrhoidectomy using a radio-wave scalpel (\"Surgitron TM\") with welding of the vascular pedicle using a high-frequency electrocoagulator",
"comparator": "a comparison group (method not specified in abstract)",
"primaryOutcome": "rate of intraoperative complications, blood loss, and postoperative morbidity",
"result": "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",
"resultDirection": "benefit",
"quality": "very-low",
"qualityWhy": "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.",
"directness": "indirect",
"limitations": "No sample size reported, comparison group not well described, method of comparison unclear, and the abstract does not mention laser surgery at all.",
"followUp": "",
"plainFinding": "Less bleeding, fewer complications.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/30272930/",
"sourceText": "The treatment results in patients, suffering chronic hemorrhoidal disease stages III- IV, in accordance to the elaborated method of hemorrhoidectomy, using radio-wave scalpel «Surgitron TM» with further welding of vascular pedicle, applying high-frequency electrocoagulator ЕК-301М1, are presented. In the patients, оperated on in accordance to the method proposed, the intraoperative complications rate and the blood loss severity were essentially lesser than in a comparison group. Owing an adequate level of surgical skills, the operative treatment method elaborated guarantees the reduction of early and late postoperative morbidity, rapid coming back to routine way of living postoperatively.",
"provenance": [
{
"field": "population",
"quote": "patients, suffering chronic hemorrhoidal disease stages III- IV"
},
{
"field": "intervention",
"quote": "method of hemorrhoidectomy, using radio-wave scalpel «Surgitron TM» with further welding of vascular pedicle, applying high-frequency electrocoagulator ЕК-301М1"
},
{
"field": "comparator",
"quote": "comparison group"
},
{
"field": "primaryOutcome",
"quote": "intraoperative complications rate and the blood loss severity"
},
{
"field": "result",
"quote": "the intraoperative complications rate and the blood loss severity were essentially lesser than in a comparison group"
},
{
"field": "result",
"quote": "guarantees the reduction of early and late postoperative morbidity, rapid coming back to routine way of living postoperatively"
}
]
},
{
"id": "pmid:27806213",
"pmid": "27806213",
"doi": "10.1080/08941939.2016.1248304",
"nctId": null,
"pmcid": null,
"title": "A Randomized Controlled Trial Comparing Laser Intra-Hemorrhoidal Coagulation and Milligan-Morgan Hemorrhoidectomy",
"firstAuthor": "Naderan",
"multipleAuthors": true,
"journal": "J Invest Surg",
"year": 2017,
"design": "rct",
"n": null,
"nField": "not-reported",
"population": "patients with symptomatic grade II or III internal hemorrhoids not improved by medication",
"intervention": "laser intra-hemorrhoidal coagulation (980-nm diode laser)",
"comparator": "Milligan-Morgan hemorrhoidectomy (traditional surgery)",
"primaryOutcome": "operative time, postoperative pain, complications, and symptom resolution",
"result": "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",
"resultDirection": "mixed",
"quality": "moderate",
"qualityWhy": "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.",
"directness": "direct",
"limitations": "Number of participants not reported; two patients in the laser group had thrombosis complications not seen in the surgery group.",
"followUp": "one year",
"plainFinding": "Less pain, similar long-term cure.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/27806213/",
"sourceText": "PURPOSE: To compare laser intra-hemorrhoidal coagulation with Milligan-Morgan (MM) hemorrhoidectomy. METHOD: Patients with symptomatic grade II or III internal hemorrhoids according to the Goligher's classification (refractory to medical treatment) were enrolled in this double-blinded randomized controlled trial study. In the laser group, hemorrhoidal columns were coagulated using a 980-nanometer (nm) radial laser emitting fiber (three, 15-W pulses of 1.2 s each, with 0.6-s intervals). Operative time, postoperative pain and complications, and recovery or resolution of symptoms were measured. Patients were followed up for at least one year for evaluating healing, resolution of symptoms, and late complications. RESULTS: 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). The operative time and intra-operative blood loss were more in the MM group (p <.001). The administration of analgesics was significantly reduced in the laser group (p <.05). Two patients in the laser group were presented with thrombosis of external hemorrhoid 7-10 days after the procedure, which was resolved with medical treatment, but no patients in the MM group developed hemorrhoidal thrombosis (p >.05). One-year follow-up showed comparable results in terms of the resolution of symptoms and sustainable cure. CONCLUSIONS: Intra-hemorrhoidal coagulation with 980-nm diode laser reduces postoperative pain, intra-operative bleeding, and administered analgesics with a comparable resolution rate of hemorrhoid symptoms. However, for the patients who experience complications, such as hemorrhoidal thrombosis, the overall pain may be equivalent to or even worse than conventional hemorrhoidectomy.",
"provenance": [
{
"field": "population",
"quote": "Patients with symptomatic grade II or III internal hemorrhoids according to the Goligher's classification (refractory to medical treatment) were enrolled"
},
{
"field": "intervention",
"quote": "hemorrhoidal columns were coagulated using a 980-nanometer (nm) radial laser emitting fiber"
},
{
"field": "comparator",
"quote": "Milligan-Morgan (MM) hemorrhoidectomy"
},
{
"field": "primaryOutcome",
"quote": "Operative time, postoperative pain and complications, and recovery or resolution of symptoms were measured."
},
{
"field": "result",
"quote": "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)."
},
{
"field": "result",
"quote": "One-year follow-up showed comparable results in terms of the resolution of symptoms and sustainable cure."
},
{
"field": "result",
"quote": "Two patients in the laser group were presented with thrombosis of external hemorrhoid 7-10 days after the procedure"
}
]
},
{
"id": "pmid:25684841",
"pmid": "25684841",
"doi": "10.5455/aim.2014.22.365-367",
"nctId": null,
"pmcid": "PMC4315650",
"title": "Laser Hemorrhoidoplasty Procedure vs Open Surgical Hemorrhoidectomy: a Trial Comparing 2 Treatments for Hemorrhoids of Third and Fourth Degree",
"firstAuthor": "Maloku",
"multipleAuthors": true,
"journal": "Acta Inform Med",
"year": 2014,
"design": "rct",
"n": 40,
"nField": "reported",
"population": "adults with grade III or IV hemorrhoids with minimal or complete mucosal prolapse",
"intervention": "laser hemorrhoidoplasty procedure",
"comparator": "open surgical hemorrhoidectomy",
"primaryOutcome": "operative time and postoperative pain",
"result": "laser procedure had shorter operative time and less postoperative pain at 1 week, 2 weeks, 3 weeks and 1 month",
"resultDirection": "benefit",
"quality": "low",
"qualityWhy": "Very small trial of only 40 patients with few outcome details, so results are not very reliable.",
"directness": "direct",
"limitations": "Small sample size; abstract gives little detail on randomization or blinding methods.",
"followUp": "1 month",
"plainFinding": "Less pain, faster surgery with laser.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/25684841/",
"sourceText": "OBJECTIVE: According to the ''vascular'' theory, arterial overflow in the superior hemorrhoidal arteries would lead to dilatation of the hemorrhoidal venous plexus. Hemorrhoid laser procedure (LHP) is a new laser procedure for outpatient treatment of hemorrhoids in which hemorrhoidal arterial flow feeding the hemorrhoidal plexus is stopped by laser coagulation. AIM: Our aim was to compare the hemorrhoid laser procedure with open surgical procedure for outpatient treatment of symptomatic hemorrhoids. MATERIAL AND METHOD: A comparison trial between hemorrhoid laser procedure or open surgical hemorrhoidectomy was made. This study was conducted at Aloka hospital in Kosovo. Patients with symptomatic grade III or grade IV hemorrhoids with minimal or complete mucosal prolapse were eligible for the study: 20 patients treated with the laser hemorrhoidoplasty, and 20 patients-with open surgery hemorrhoidectomy. Operative time and postoperative pain with visual analog scale, were evaluated. RESULTS: A total number of 40 patients (23 men and 17 women, mean age, 46 years) entered the trial. Significant differences between laser hemorrhoidoplasty and open surgical procedure were observed in operative time and early postoperative pain. 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). CONCLUSION: The laser hemorrhoidoplasty procedure was more effective than open surgical hemorrhoidectomy. Postoperative pain and duration time are only two indicators for this difference between there procedures.",
"provenance": [
{
"field": "n",
"quote": "A total number of 40 patients (23 men and 17 women, mean age, 46 years) entered the trial."
},
{
"field": "population",
"quote": "Patients with symptomatic grade III or grade IV hemorrhoids with minimal or complete mucosal prolapse were eligible for the study"
},
{
"field": "intervention",
"quote": "20 patients treated with the laser hemorrhoidoplasty"
},
{
"field": "comparator",
"quote": "20 patients-with open surgery hemorrhoidectomy"
},
{
"field": "primaryOutcome",
"quote": "Operative time and postoperative pain with visual analog scale, were evaluated."
},
{
"field": "result",
"quote": "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)."
}
]
},
{
"id": "pmid:16919112",
"pmid": "16919112",
"doi": "10.1111/j.1463-1318.2006.01023.x",
"nctId": null,
"pmcid": null,
"title": "Surgical treatment of haemorrhoidal disease with CO2 laser and Milligan-Morgan cold scalpel technique",
"firstAuthor": "Pandini",
"multipleAuthors": true,
"journal": "Colorectal Dis",
"year": 2006,
"design": "rct",
"n": 40,
"nField": "reported",
"population": "patients with grade III/IV hemorrhoids",
"intervention": "Milligan-Morgan hemorrhoid surgery using CO2 laser",
"comparator": "Milligan-Morgan hemorrhoid surgery using cold scalpel",
"primaryOutcome": "postoperative pain, complications, healing time, return to normal activity, and patient satisfaction",
"result": "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",
"resultDirection": "no-benefit",
"quality": "low",
"qualityWhy": "Very small study of only 40 patients, which limits confidence in finding no difference.",
"directness": "direct",
"limitations": "Small sample size of 20 patients per group.",
"followUp": "",
"plainFinding": "No difference between laser and scalpel.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/16919112/",
"sourceText": "OBJECTIVE: To prospectively compare immediate postoperative results of the surgical treatment of haemorrhoidal disease (HD) by Milligan-Morgan technique using either the CO(2) laser or cold scalpel. METHODS: Forty patients with grade III/IV HD were prospectively randomized to undergo surgical treatment (Milligan-Morgan) using either the CO(2) laser (group A) or the cold scalpel method (group B). Data were compared regarding postoperative pain, complications, healing time, return to normal activity and patient satisfaction. Patients were blinded to treatment method until the completion of the study. Postoperative outcomes were assessed by patient questionnaire and outpatient follow-up visits. Pain was assessed by Visual Analogue Scale and analgesic consumption. RESULTS: Twenty patients were randomized into each group and were comparable relative to mean age, gender and grade of HD. There were no statistically significant differences regarding postoperative pain measured (P =0.17) or consumption of oral (P = 0.741) and parenteral analgesics (P = 0.18) between the two groups. Mean pain score at the first bowel movement was significantly higher in group A (P = 0.035), although the use of analgesics was similar in both the groups. There were no differences regarding complications, mean healing time, return to normal activities and patient satisfaction. CONCLUSION: 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.",
"provenance": [
{
"field": "n",
"quote": "Forty patients with grade III/IV HD were prospectively randomized"
},
{
"field": "population",
"quote": "Forty patients with grade III/IV HD"
},
{
"field": "intervention",
"quote": "CO(2) laser (group A)"
},
{
"field": "comparator",
"quote": "cold scalpel method (group B)"
},
{
"field": "primaryOutcome",
"quote": "postoperative pain, complications, healing time, return to normal activity and patient satisfaction"
},
{
"field": "result",
"quote": "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."
}
]
},
{
"id": "pmid:14972240",
"pmid": "14972240",
"doi": "10.1016/S0149-7944(02)00774-2",
"nctId": null,
"pmcid": null,
"title": "Radio-ablation of advanced grades of hemorrhoids with radiofrequency",
"firstAuthor": "Gupta",
"multipleAuthors": false,
"journal": "Curr Surg",
"year": 2003,
"design": "case-series",
"n": 50,
"nField": "reported",
"population": "patients with advanced grade hemorrhoids with mucosal prolapse",
"intervention": "radiofrequency ablation of the hemorrhoid tissue",
"comparator": "no concurrent control group; discussed in relation to conventional hemorrhoidectomy",
"primaryOutcome": "postoperative symptoms and complications over 12 months",
"result": "low complication rates, no stenosis or incontinence, 7 patients developed skin tags",
"resultDirection": "unclear",
"quality": "low",
"qualityWhy": "this is a single-arm case series with no control group, so it cannot show whether radiofrequency is better than laser or traditional surgery.",
"directness": "indirect",
"limitations": "no comparator group, small sample size, single surgeon/center, not randomized",
"followUp": "12 months",
"plainFinding": "Few complications with radiofrequency, no direct comparison.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/14972240/",
"sourceText": "BACKGROUND: For advanced degree of hemorrhoids with prolapse of the rectal mucosa, the choice is hemorrhoidectomy, which could be open, close, diathermy, Laser, or stapled one. As an effective alternative to this, in situ radio-frequency ablation of the pile mass has been found to be quite efficacious with many added advantages over the conventional hemorrhoidectomy procedures in practice. MATERIALS AND METHODS: This study included 50 patients (34 males and 16 females) treated at Gupta Nursing Home, Laxminagar, Nagpur, India, with the above technique from April 2000 to March 2001 and each case followed up over a period of 12 months. RESULTS: In first 4 weeks of the procedure, 14% of patients complained of bleeding, whereas all of the patients had some amount of pain. Eleven (22%) patients had serosanguinous discharge, but in none of them was there any incontinence or prolapse. All of the patients resumed their routine within 1 week of the procedure. 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. During follow-up at the end of 1 year, 7 patients were found to have skin tag formation. However, complications like anal stenosis or stricture or incontinence was not found in any of the patients. CONCLUSION: For advanced degree of piles with prolapse as the main symptom, in situ radio-frequency ablation can be a better choice to various types of hemorrhoidectomy in the sense that the hospital stay is minimized, recurrence is rare, and return to work is faster. The results are more assuring when compared with conventional hemorrhoidectomy. The technique fits into the parameters for being called the gold standard procedure. Except the radio-frequency unit, the procedure needs no specialized instrument. It can be performed in any routine surgical setup.",
"provenance": [
{
"field": "n",
"quote": "This study included 50 patients (34 males and 16 females)"
},
{
"field": "population",
"quote": "For advanced degree of hemorrhoids with prolapse of the rectal mucosa"
},
{
"field": "intervention",
"quote": "in situ radio-frequency ablation of the pile mass"
},
{
"field": "comparator",
"quote": "has been found to be quite efficacious with many added advantages over the conventional hemorrhoidectomy procedures in practice"
},
{
"field": "primaryOutcome",
"quote": "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"
},
{
"field": "result",
"quote": "complications like anal stenosis or stricture or incontinence was not found in any of the patients"
}
]
},
{
"id": "pmid:8223057",
"pmid": "8223057",
"doi": "10.1007/BF02047297",
"nctId": null,
"pmcid": null,
"title": "Treatment of advanced hemorrhoidal disease: a prospective, randomized comparison of cold scalpel vs. contact Nd:YAG laser",
"firstAuthor": "Senagore",
"multipleAuthors": true,
"journal": "Dis Colon Rectum",
"year": 1993,
"design": "rct",
"n": 86,
"nField": "reported",
"population": "patients with advanced hemorrhoids needing internal-external hemorrhoidectomy",
"intervention": "Nd:YAG laser excision during hemorrhoidectomy",
"comparator": "cold scalpel excision during hemorrhoidectomy",
"primaryOutcome": "blood loss, operative time, postoperative pain, wound healing, return to work",
"result": "no significant differences between groups except more wound inflammation and separation at 10 days with laser, and higher cost with laser",
"resultDirection": "no-benefit",
"quality": "moderate",
"qualityWhy": "it was a randomized trial but modest in size and only compared surgical techniques within one procedure type",
"directness": "direct",
"limitations": "small sample size; single outcome measure showed laser was worse, not better",
"followUp": "10 days (wound assessment); time to return to work not specified numerically",
"plainFinding": "No benefit over scalpel surgery.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/8223057/",
"sourceText": "PURPOSE: Recently, laser technology has been advocated for the treatment of hemorrhoids. However, there has been little scientific evaluation of the use of the Nd:YAG laser for excisional treatment of hemorrhoidal disease. The purpose of this study was to perform a prospective randomized study of the Nd:YAG laser vs. scalpel excision, when performing a standard Ferguson-closed hemorrhoidectomy. METHODS: Patients presenting for internal-external hemorrhoidectomy were eligible for study. Hemorrhoidectomies were performed under epidural or caudal blocks. The standard Ferguson closed hemorrhoidectomy technique was used. Data evaluated included: age, sex, estimated blood loss, operative time, postoperative pain scores, postoperative analgesic use, wound healing, and time for return to work. Eighty-six patients were eligible for study (laser, N = 51; scalpel, N = 35). RESULTS: 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). The use of the Nd:YAG laser added $480 per case; as a result, the treatment cost for the laser group was $15,360 higher than that of the conventional group. CONCLUSION: The results indicate that there are no patient care advantages associated with the use of the Nd:YAG laser for excisional hemorrhoidectomy compared with scalpel excision. As new technology becomes available, surgeons must rigorously assess therapeutic efficacy and cost-benefit ratio before deciding to employ this technology for patient care.",
"provenance": [
{
"field": "n",
"quote": "Eighty-six patients were eligible for study (laser, N = 51; scalpel, N = 35)."
},
{
"field": "population",
"quote": "Patients presenting for internal-external hemorrhoidectomy were eligible for study."
},
{
"field": "intervention",
"quote": "a prospective randomized study of the Nd:YAG laser vs. scalpel excision, when performing a standard Ferguson-closed hemorrhoidectomy"
},
{
"field": "comparator",
"quote": "vs. scalpel excision"
},
{
"field": "primaryOutcome",
"quote": "Data evaluated included: age, sex, estimated blood loss, operative time, postoperative pain scores, postoperative analgesic use, wound healing, and time for return to work."
},
{
"field": "result",
"quote": "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)."
}
]
},
{
"id": "pmid:8292434",
"pmid": "8292434",
"doi": null,
"nctId": null,
"pmcid": null,
"title": "[Hemorrhoidectomy: conventional or by Nd:Yag contact laser? A prospective and randomized study]",
"firstAuthor": "Enriquez-Navascues",
"multipleAuthors": true,
"journal": "Rev Esp Enferm Dig",
"year": 1993,
"design": "rct",
"n": 35,
"nField": "reported",
"population": "patients with symptomatic hemorrhoids needing surgery",
"intervention": "laser hemorrhoidectomy (Nd:YAG laser)",
"comparator": "conventional hemorrhoidectomy surgery",
"primaryOutcome": "postoperative pain, complications, healing time",
"result": "no significant difference in pain or complications; healing took longer with laser",
"resultDirection": "no-benefit",
"quality": "low",
"qualityWhy": "Small number of patients and poor follow-up at 6 months limit confidence in the findings.",
"directness": "direct",
"limitations": "Small sample size; few patients returned for 6-month follow-up assessment.",
"followUp": "6 moths later",
"plainFinding": "No benefit; healing slower with laser.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/8292434/",
"sourceText": "OBJECTIVE: To assess whether hemorrhoidectomy done with the Nd:YAG laser was associated with less pain or fewer complications and sequels than with conventional surgery. DESIGN: A prospective comparative, randomized study. PATIENTS: Over a period of six months, a total of 35 consecutive patients, 13 females and 22 males, with symptomatic hemorrhoidal disease requiring surgery, were alternatively randomized to either laser hemorrhoidectomy (17 patients) or surgery (18 patients). The type of disease and the number of affected and treated hemorrhoids were prospectively recorded in each patient. Patients were monitored prospectively for postoperative complications, pain (assessed daily for five days using a standard 10 mm. linear analogue scale), wound healing, time until full recovery and sequelae 6 moths later. RESULTS: These two groups were well matched. No differences were seen between laser and non-laser groups for postoperative complications. Linear analogue pain scores were not significantly different between the two groups at any stage after operation. Healing time was longer in laser group. Two few patients returned at 6 months for rectoscopy for any meaningful conclusion to be drawn. CONCLUSIONS: This study has failed to confirm any reduction in postoperative pain, complications, or healing time laser when performing a hemorrhoidectomy.",
"provenance": [
{
"field": "n",
"quote": "a total of 35 consecutive patients"
},
{
"field": "population",
"quote": "symptomatic hemorrhoidal disease requiring surgery"
},
{
"field": "intervention",
"quote": "laser hemorrhoidectomy (17 patients)"
},
{
"field": "comparator",
"quote": "surgery (18 patients)"
},
{
"field": "primaryOutcome",
"quote": "postoperative complications, pain (assessed daily for five days using a standard 10 mm. linear analogue scale), wound healing, time until full recovery and sequelae"
},
{
"field": "result",
"quote": "This study has failed to confirm any reduction in postoperative pain, complications, or healing time laser when performing a hemorrhoidectomy."
}
]
},
{
"id": "pmid:1991426",
"pmid": "1991426",
"doi": "10.1007/BF02050213",
"nctId": null,
"pmcid": null,
"title": "The role of lasers in hemorrhoidectomy",
"firstAuthor": "Wang",
"multipleAuthors": true,
"journal": "Dis Colon Rectum",
"year": 1991,
"design": "rct",
"n": 88,
"nField": "reported",
"population": "patients being treated for hemorrhoids",
"intervention": "laser treatment (Nd-YAG laser for internal hemorrhoids combined with CO2 laser for external hemorrhoids)",
"comparator": "closed Ferguson hemorrhoidectomy (traditional surgery)",
"primaryOutcome": "need for pain medication, urinary retention, recovery time, and cost",
"result": "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",
"resultDirection": "benefit",
"quality": "low",
"qualityWhy": "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.",
"directness": "direct",
"limitations": "Small sample size, older trial (1991) using outdated laser methods, and some conflicting results such as slower wound healing with laser treatment.",
"followUp": "One year follow-up",
"plainFinding": "Less pain, faster recovery with laser.",
"retracted": false,
"expressionOfConcern": false,
"hasErratum": false,
"url": "https://pubmed.ncbi.nlm.nih.gov/1991426/",
"sourceText": "Eighty-eight patients who received treatment for hemorrhoids were randomized into two groups. Group A received the Nd-YAG laser phototherapy for internal hemorrhoid combined with the CO2 laser for external hemorrhoid. Group B was treated with closed Ferguson hemorrhoidectomy. 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. The overall complications in both groups were insignificant in difference, except prolonged wound healing in group A was noted. One year follow-up showed satisfactory results. Laser treatment is considered one of the alternatives to conventional treatment, but the surgeon needs to be aware of laser hazards.",
"provenance": [
{
"field": "n",
"quote": "Eighty-eight patients who received treatment for hemorrhoids were randomized into two groups"
},
{
"field": "population",
"quote": "Eighty-eight patients who received treatment for hemorrhoids were randomized into two groups"
},
{
"field": "intervention",
"quote": "Group A received the Nd-YAG laser phototherapy for internal hemorrhoid combined with the CO2 laser for external hemorrhoid"
},
{
"field": "comparator",
"quote": "Group B was treated with closed Ferguson hemorrhoidectomy"
},
{
"field": "primaryOutcome",
"quote": "The need of narcotic injections for pain relief was 11 percent in group A vs. 56 percent in group B"
},
{
"field": "result",
"quote": "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."
},
{
"field": "followUp",
"quote": "One year follow-up showed satisfactory results."
}
]
}
],
"faqs": [
{
"q": "Will laser surgery hurt less than traditional surgery?",
"a": "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."
},
{
"q": "Is laser surgery more likely to fail or need a repeat procedure later?",
"a": "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."
},
{
"q": "Which one should I choose?",
"a": "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."
},
{
"q": "Is laser surgery more expensive?",
"a": "Some studies reported higher cost for laser treatment, though cost wasn't measured consistently across all the studies."
},
{
"q": "If I've already had traditional surgery, did I make the wrong choice?",
"a": "No. Traditional hemorrhoidectomy had the lowest recurrence rate in several studies, including a 5-year trial, so it remains a solid, well-tested option."
}
],
"patientTakeaway": "Both laser and traditional hemorrhoid surgery can treat severe hemorrhoids, and the right choice depends on what you value most. Laser surgery tends to cause less pain in the first weeks, but several studies — including a 5-year trial — found hemorrhoids were more likely to return after laser than after traditional surgery. Discuss your hemorrhoid grade and your priorities (short-term comfort versus long-term durability) with your surgeon before deciding.",
"methodology": {
"databases": [
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],
"searchStrings": {
"pubmed": "(\"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])"
},
"pubmedQueryTranslation": "(\"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])",
"searchedOn": "2026-10-05",
"inclusion": [
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],
"exclusion": [
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],
"extractionLevel": "abstract",
"gradingNote": "Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.",
"limits": [
"Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured."
]
},
"seo": {
"title": "Is Laser Surgery Better Than Traditional Hemorrhoidectomy?",
"description": "12 randomized trials (14,546 people) compared laser vs traditional hemorrhoid surgery. Less pain with laser, but recurrence findings conflict."
},
"lastChecked": "2026-10-05",
"lastChanged": "2026-10-05",
"nextCheckDue": "2026-11-05",
"history": [],
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"status": "published"
}