A Healing Through Light: A Prospective Study About Laser Haemorrhoidoplasty

INTRODUCTION

Haemorrhoids are vascular structures in the anal canal that contribute to continence. When swollen or inflamed—often due to constipation, prolonged straining, or increased intra-abdominal pressure—they become symptomatic, presenting with bleeding, pain, itching, and prolapse. These symptoms can significantly impair a patient’s quality of life.^[1]

Management of haemorrhoids ranges from conservative approaches, such as dietary changes, laxatives, and topical treatments, to surgical interventions like conventional haemorrhoidectomy. While effective, traditional surgery is often associated with considerable postoperative pain, longer hospital stays, and delayed return to normal activities.^[2]

In response to the demand for less invasive alternatives, laser haemorrhoidoplasty has emerged as a promising technique. This minimally invasive procedure uses diode laser energy— typically at a wavelength of 1470 nm—which is selectively absorbed by haemoglobin. The laser coagulates blood vessels within the haemorrhoidal tissue, causing shrinkage without excision. This technique minimises damage to surrounding tissues and results in less postoperative pain and quicker recovery.^[3]

Given its safety profile and positive outcomes, diode laser haemorrhoidoplasty represents an effective alternative in the treatment of symptomatic haemorrhoids and merits further clinical evaluation.

MATERIAL AND METHODS

A prospective, hospital-based study was conducted at K.S. Hospital over a period of one year, from November 2023 to November 2024. A total of 20 patients with symptomatic haemorrhoids were enrolled after obtaining informed consent. All patients underwent clinical and proctoscopic evaluation, with grading of haemorrhoids according to Goligher’s classification.^[4]

Inclusion Criteria:

• Age >18 years

• Grade II, III, or IV haemorrhoids

Exclusion Criteria:

• Acutely inflamed or thrombosed haemorrhoids

• Presence of anal fistulas

Surgical procedure

All procedures were performed under spinal anaesthesia using a 1470 nm diode laser system (Lasotronix) [Figure 1]. Equipment included a laser device, bare fibre, eye protective gear, ice cubes, and beak proctoscopes [Figure 2].

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Figure 1: 1470 nm diode laser system (Lasotronix).

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Figure 2: Beak proctoscopes

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Laser energy was applied in a calculated and standardised manner at the pedicle and at the intersphincteric plane: 8W for 9 seconds.^[5]

Following laser application, ice cubes were applied locally, and an anal pack was placed.

RESULTS

A total of 20 patients who met the inclusion criteria were enrolled in the study. The cohort comprised 9 males and 11 females [Figure 3], with a mean age of 39 years (range: 26–62 years).

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Figure 3: Gender wise distribution

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The most common presenting symptoms were shown in Table 1 and Figure 4.

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Figure 4: Percentage of presenting symptoms. PR: Per rectum

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Proctoscopic examination confirmed the diagnosis and allowed for grading based on Goligher’s classification:

• Grade II: 3 cases (15%)

• Grade III: 12 cases (60%)

• Grade IV: 5 cases (25%)

Additionally, associated anal fissures were identified in 7 patients (35%).

Regarding the surgical technique:

• Mucopexy (Suture Bite taken involving only mucosa and submucosal layer) with laser coagulation was performed in 11 patients.

• Laser coagulation alone was performed in 9 patients.

Postoperatively, the majority of patients had an uneventful recovery [Figure 5]. However, two patients experienced persistent mild pain and minimal bleeding per rectum during the early postoperative period. These symptoms were self-limiting and resolved within a few weeks with conservative management.

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Figure 5: Post op events (recovery)

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Throughout the follow-up period—weekly for one month and telephonically up to one year—no recurrence of haemorrhoidal disease was reported in any of the patients.

DISCUSSION

LASER stands for Light Amplification by Stimulated Emission of Radiation. Laser light possesses unique properties such as coherence, monochromaticity, and collimation, which make it ideal for precise medical applications. In laser haemorrhoidoplasty, a diode laser with a wavelength typically around 1470 nm is used. This specific wavelength is selectively absorbed by haemoglobin, allowing for targeted thermal coagulation of haemorrhoidal vessels while minimising damage to surrounding tissues.^[5-7]

The procedure involves controlled delivery of energy—up to a maximum of 350 Joules per pedicle—which induces vascular sealing and promotes progressive shrinkage of haemorrhoidal tissue. Laser energy is deposited within the haemorrhoidal pedicle and the intersphincteric plane, leading to fibrosis and volume reduction of the haemorrhoidal mass from within.^[6]

Recovery is typically fast, with minimal postoperative pain, reduced need for analgesia, and early return to daily activities. Most patients can be discharged on the same day. Over 2–6 weeks, the haemorrhoidal mass continues to shrink, with occasional mild bleeding or discomfort being the only transient complaints.^[8]

CONCLUSION

Diode laser haemorrhoidoplasty is a safe, minimally invasive, and effective procedure for the treatment of Grade II to IV haemorrhoids. It offers several advantages over traditional surgical methods, including less postoperative pain, minimal complications, and faster recovery. The technique’s ability to selectively target haemorrhoidal vasculature ensures tissue preservation and patient comfort. In this study, no recurrence was observed over a one-year follow-up, highlighting its promising potential as a first-line surgical intervention in appropriately selected cases.