Evidence Review
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Surg Proced. Jul 16, 2025; 15(2): 109348
Published online Jul 16, 2025. doi: 10.5412/wjsp.v15.i2.109348
Laser hemorrhoidoplasty in focus: A modern alternative to conventional surgical techniques for symptomatic hemorrhoids
Alfadl Abdulfattah, Fabricio Doin Paz de Oliveira
Alfadl Abdulfattah, Department of Medicine, Jazan University, Jazan 82817, Jāzān, Saudi Arabia
Alfadl Abdulfattah, Medical Direction, Modawat Cheratable Association, Riyadh 13215, Saudi Arabia
Fabricio Doin Paz de Oliveira, Center for Inflammatory Bowel Diseases and Coloproctology, São Camilo Hospital, Concórdia, Santa Catarina, Brazil
Co-first authors: Alfadl Abdulfattah and Fabricio Doin Paz de Oliveira.
Author contributions: Abdulfattah A contributed to conceptualization, literature review, manuscript drafting, critical revision, response to reviewers, and final approval of the manuscript; de Oliveira FDP contributed to clinical insight, technical interpretation of laser techniques, review of surgical data, critical revision for intellectual content, and co-authorship of comparative analysis; Both authors approved the final manuscript and agree to be accountable for all aspects of the work.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this manuscript.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alfadl Abdulfattah, Assistant Professor, Department of Medicine, Jazan University, King Faisal Street, Jazan 82817, Jāzān, Saudi Arabia. alabdulfattah@jazanu.edu.sa
Received: May 8, 2025
Revised: May 14, 2025
Accepted: July 1, 2025
Published online: July 16, 2025
Processing time: 68 Days and 8.1 Hours
Abstract

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

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

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