Hemorrhoidal laser procedure: short- and long-term results from a prospective study

Published:January 17, 2014DOI:



      We report the results of 2-year regular use of the hemorrhoidal laser procedure (HeLP) in 97 patients with symptomatic second- to third-grade hemorrhoids with minimal or moderate internal mucosal prolapse.


      Data on duration of the procedure, perioperative complications, postoperative pain, downgrading of hemorrhoids, resolution or persistency, and recurrence of hemorrhoidal disease (HD) were prospectively collected.


      No significant intraoperative complications occurred. The median follow-up was 15 months. Postoperative pain was null in most patients. There were no cases of rectal tenesmus or alteration of defecation habits. Symptoms and HD downgrading reached a “plateau” at 3 to 6 months after the HeLP. At this evaluation, frequency of bleeding, pain, itching, and hemorrhoidal acute syndrome decreased by 76% to 79%. HD grade showed a significant reduction. HD recurrence rate was 5% at 2 years.


      Our study demonstrates that the HeLP is a safe, effective, and painless technique for the treatment of symptomatic second- to third-grade hemorrhoids with minimal or moderate mucosal prolapse, ideally suitable as ambulatory treatment.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Riss S.
        • Weiser F.A.
        • Schwameis K.
        • et al.
        The prevalence of hemorrhoids in adults.
        Int J Colorectal Dis. 2012; 27: 215-220
        • Violán C.
        • Foguet-Boreu Q.
        • Hermosilla-Pérez E.
        • et al.
        Comparison of the information provided by electronic health records data and a population health survey to estimate prevalence of selected health conditions and multimorbidity.
        BMC Public Health. 2013; 13: 251
        • Loder P.B.
        • Kamm M.A.
        • Nicholls R.J.
        • et al.
        Haemorrhoids: pathology, pathophysiology and aetiology.
        Br J Surg. 1994; 81: 946-954
        • Lohsiriwat V.
        Hemorrhoids: from basic pathophysiology to clinical management.
        World J Gastroenterol. 2012; 18: 2009-2017
        • Gazet J.C.
        • Redding W.
        • Rickett J.W.
        The prevalence of haemorrhoids. A preliminary survey.
        Proc R Soc Med. 1970; : 78-80
        • Milligan E.T.C.
        • Morgan C.N.
        • Jones L.E.
        • et al.
        Surgical anatomy of the anal canal and the operative treatment of hemorrhoids.
        Lancet. 1937; : 1119-1123
        • Ferguson J.A.
        • Heaton J.R.
        Closed hemorroidectomy.
        Dis Colon Rectum. 1959; 2: 176-179
        • Gerbershagen H.J.
        • Aduckathil S.
        • van Wijck A.J.
        • et al.
        Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures.
        Anesthesiology. 2013; 118: 934-944
        • Morinaga K.
        • Hasuda K.
        • Ikeda T.
        A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter.
        Am J Gastroenterol. 1995; 90: 610-613
        • Sohn N.
        • Aronoff J.S.
        • Cohen F.S.
        • et al.
        Transanal hemorrhoidal dearterialization: nonexcisional surgery for the treatment of hemorrhoidal disease.
        Am J Surg. 2001; 182: 515-519
        • Giamundo P.
        • Cecchetti W.
        • Esercizio L.
        • et al.
        Doppler-guided hemorrhoidal laser procedure for the treatment of symptomatic hemorrhoids: experimental background and short-term clinical results of a new mini-invasive treatment.
        Surg Endosc. 2011; 25: 1369-1375
        • Giamundo P.
        • Salfi R.
        • Geraci M.
        • et al.
        The hemorrhoid laser procedure technique vs rubber band ligation: a randomized trial comparing 2 mini-invasive treatments for second- and third-degree hemorrhoids.
        Dis Colon Rectum. 2011; 54: 693-698
        • Jorge J.M.
        • Wexner S.D.
        Etiology and management of fecal incontinence.
        Dis Colon Rectum. 1993; 36: 77-97
        • Osterberg A.
        • Graf W.
        • Karlbom U.
        • et al.
        Evaluation of a questionnaire in the assessment of patients with faecal incontinence and constipation.
        Scand J Gastroenterol. 1996; 31: 575-580
      1. American Gastroenterological Association medical position statement: diagnosis and treatment of hemorrhoids.
        Gastroenterology. 2004; 126: 1461-1462
        • Chew S.S.
        • Marshall L.
        • Kalish L.
        • et al.
        Short-term and long-term results of combined sclerotherapy and rubber band ligation of hemorrhoids and mucosal prolapse.
        Dis Colon Rectum. 2003; 46: 1232-1237
        • Dal Monte P.P.
        • Tagariello C.
        • Sarago M.
        • et al.
        Transanal haemorrhoidal dearterialisation: nonexcisional surgery for the treatment of haemorrhoidal disease.
        Tech Coloproctol. 2007; 11: 333-338
        • Gaj F.
        • Trecca A.
        PATE 2000 Sorrento: a modern, effective instrument for defining haemorrhoids. A multicentre observational study conducted in 930 symptomatic patients.
        Chir Ital. 2004; 56: 509-515
        • Aigner F.
        • Bodner G.
        • Conrad F.
        • et al.
        The superior rectal artery and its branching pattern with regard to its clinical influence on ligation techniques for internal hemorrhoids.
        Am J Surg. 2004; 187: 102-108
        • Aigner F.
        • Bodner G.
        • Gruber H.
        • et al.
        The vascular nature of hemorrhoids.
        J Gastrointest Surg. 2006; 10: 1044-1050
        • Schuurman J.P.
        • Go P.M.
        • Bleys R.L.
        Anatomical branches of the superior rectal artery in the distal rectum.
        Colorectal Dis. 2009; 11: 967-971
        • Ratto C.
        • Donisi L.
        • Parello A.
        • et al.
        Evaluation of transanal hemorrhoidal dearterialization as a minimally invasive therapeutic approach to hemorrhoids.
        Dis Colon Rectum. 2010; 53: 803-811
        • Giordano P.
        • Overton J.
        • Madeddu F.
        • et al.
        Transanal hemorrhoidal dearterialization: a systematic review.
        Dis Colon Rectum. 2009; 52: 1665-1671
        • Karahaliloglu A.F.
        First results after laser obliteration of first and second degree hemorrhoids.
        Coloproctology. 2007; 29: 329-336
        • Plaper H.
        • Hage R.
        • Duarte J.
        • et al.
        A new method for hemorrhoid surgery: intrahemorrhoidal diode laser, does it work?.
        Photomed Laser Surg. 2009; 25: 819