EPD508 - Short-term Efficacy And Safety Of Laser Hemorrhoidoplasty For Grade II–III Hemorrhoids: A Single-Center Prospective Cohort Study

Purpose/Background: Conventional excisional hemorrhoidectomy remains the gold standard for advanced hemorrhoids, but is associate with considerable postoperative pain, delayed recovery and morbidity limiting patient acceptance. Laser hemorrhoidoplasty (LHP)-a near-infrared photo-thermal technique that coagulates the hemorrhoidal vessels without excising tissue, has been proposed as a less painful alternative with quicker recovery, Nevertheless, large-scale, long-term evidence validating its efficacy and safety in Goligher grade II-III disease is lacking.

Methods/Interventions: This prospective, single-center cohort study was conducted at the Department of Coloproctology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine. From June 2024 to September 2025, we enrolled Consecutive adults (18-75y) with grade II-III primary hemorrhoids, a modified Goligher symptom score ≥6 and failure of conservative therapy. Exclusion criteria were coagulopathy, anal fissure, fistula, previous anorectal surgery or pregnancy. The LHP procedure was performed under subarachnoid block. For each hemorrhoid, a 2-3 mm micro-incision was created outside the anal verge. The 1470 nm laser fiber probe was then carefully threaded through the submucosal tissue to the hemorrhoid base under direct tactile guidance to prevent perforation. The laser was pulsed at 8W for 3 seconds (≈24 J per pulse). Depending on the size and severity of the hemorrhoid, 10-12 such pulses were typically delivered in a fan-shaped pattern along the longitudinal anal axis until the hemorrhoidal vasculature contracted. All procedures were performed by a single senior surgeon. Postoperative follow-up was conducted at designated intervals. VAS pain scores were recorded on days 1, 7, and 14, while bleeding was assessed dynamically on days 1, 7, 14, and 30, as well as at the 6th and 12th months. The length of stay, time to return to work, complications, patient satisfaction, recurrence rate (symptom score ≥ 6 or need for further intervention) and re-operation rate were also recorded within 12 months. All statistical analyses were performed using SPSS 26.0 for descriptive statistics.

Results/Outcomes: Twenty patients (11 male; median age 43y, range 26-64) completed the 12-month follow-up (8 grade II, 12 grade III). Mean hospital stay was 2.0 ± 0.7 d (range 1-3); all patients were discharged within 3 days. Median time to return to work was 4.4 ± 1.5 d (range 2-8). VAS pain scores peaked at 1.9 ± 0.8 on postoperative day 1, declined to 1.1 ± 0.6 on day 7 and 0.6 ± 1.0 on day 14; no patient required opioid analgesia. No bleeding was observed within 24 h; two patients (10%) reported minor blood on toilet paper at day 7, and one developed moderate bleeding secondary to a superficial infection at day 14. Only one adverse event (5 %)-a localized perianal infection-was documented, the symptoms resolved following a 3-day course of oral antibiotic therapy; no patient experienced anal stenosis, urinary retention or defecatory dysfunction. Satisfaction (very satisfied/satisfied) was 95 % at 30 days and remained 95 % at 12 months. During the one-year follow-up period, both the recurrence rate and the re-operation rate were 0%.

Conclusion/Discussion: This study establishes LHP as a safe and effective treatment for grades II-III hemorrhoids, characterized by minimal pain, scant bleeding, and prompt recovery. Nevertheless, further verification via large-sample, multicenter randomized controlled trials and long-term follow-up studies is necessary to corroborate these findings.

Table 1. Demographics of the participants (n = 20）; 2.Twelve-Month dynamic follow-up metrics after LHP (n = 20）.
Cases Presentation
Figure 1. Case 1 (Grade III hemorrhoids): a female patient presenting with hemorrhoidal prolapse after bowel movement, necessitating manual reduction. A. Preoperatively; B. Laser fiber inserted via a perianal incision to the base of the internal hemorrhoid (the white arrow points to the micro-incision outside the anal verge); C. Immediate postoperative view after LHP procedure; D. Postoperative day 30.

Figure 2. Case 2 (Grade II hemorrhoids): a young woman presenting with recurrent hematochezia and prolapsed internal hemorrhoids after defecation. A. Preoperatively; B. Immediate postoperative view after LHP procedure (the white arrow points to micro-incision outside the anal verge); C. Postoperative day 7.