Is laser treatment effective for hemorrhoids?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: November 10, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Laser Treatment for Hemorrhoids

Laser hemorrhoid procedures (HeLP) are effective for grade II-III hemorrhoids with minimal prolapse, offering superior pain control and symptom resolution compared to rubber band ligation, though they are not included in current major guidelines as a standard treatment option. 1, 2

Evidence Quality and Guideline Position

The American Gastroenterological Association and World Journal of Emergency Surgery guidelines do not mention laser therapy as a recommended treatment option, instead focusing on rubber band ligation as the preferred office-based procedure for grade I-III hemorrhoids (70.5-89% success rates). 1 However, multiple research studies from 2011-2022 demonstrate that laser procedures may offer advantages over traditional approaches. 2, 3, 4, 5

Mechanism and Technique

Laser hemorrhoid procedures work through Doppler-guided dearterialization using a diode laser (typically 1470nm) to close terminal branches of the superior rectal artery 2-3cm above the dentate line. 2, 6 The procedure:

  • Uses a 20MHz Doppler probe to identify arterial branches that would otherwise be missed 6
  • Delivers 5 pulsed laser shots to each identified artery through a dedicated proctoscope 2
  • Confirms successful arterial coagulation by absence of Doppler signal after treatment 2
  • Can be combined with suture mucopexy (HeLPexx) when significant mucosal prolapse is present 6

Clinical Efficacy Data

The strongest evidence comes from a 2011 randomized controlled trial comparing laser procedure to rubber band ligation in 60 patients with grade II-III hemorrhoids. 2 Results showed:

  • Significantly lower postoperative pain: median 1.1 (range 0-2) vs 2.9 (range 1-5) with rubber band ligation (P<0.001) 2
  • Superior symptom resolution at 6 months: 90% vs 53% with rubber band ligation (P<0.001) 2
  • Better hemorrhoid downgrading: 80% vs 40% with rubber band ligation (P<0.001) 2
  • Significantly improved quality of life (P=0.002) 2

A 2022 multicenter trial with 2-year follow-up of 276 patients demonstrated 89.9% overall symptom resolution, with recurrence rates of 4.35% for pain, 3.6% for bleeding, and 2.2% for prolapse. 3 Only 11 of 28 patients with persistent symptoms required additional surgery. 3

Postoperative Outcomes

Laser procedures demonstrate remarkably low morbidity:

  • Postoperative pain scores averaging 2 on visual analog scale at 12-24 hours 4
  • 100% return to daily activities within 2 days in one 50-patient series 4
  • No anesthesia required in most cases 2, 6
  • No significant postoperative bleeding or rectal tenesmus 4, 5

Optimal Patient Selection

Laser therapy is most effective for:

  • Grade II-III hemorrhoids with minimal to mild mucosal prolapse 2, 6, 5
  • Patients with bleeding, pain, and recurrent acute symptoms where conservative treatment failed 3
  • Patients with high-grade preoperative pain at evacuation (better outcomes) 3

Predictors of failure include:

  • Constipation (statistically significant higher failure rate, P=0.046) 3
  • Grade III-IV hemorrhoids (P=0.012) 3
  • Severe mucosal prolapse without concurrent mucopexy 6

Clinical Algorithm

For grade II-III hemorrhoids after conservative management fails:

  1. If minimal prolapse with bleeding/pain: Consider laser procedure as alternative to rubber band ligation, offering lower pain and faster recovery 2, 3
  2. If significant mucosal prolapse: Combine laser with mucopexy (HeLPexx) 6
  3. If grade IV or mixed internal/external hemorrhoids: Proceed to conventional hemorrhoidectomy per guidelines (2-10% recurrence rate) 1

Important Caveats

  • Laser procedures are not mentioned in current American Gastroenterological Association or World Journal of Emergency Surgery guidelines, which recommend rubber band ligation as first-line office procedure 1
  • Higher cost compared to rubber band ligation 2
  • Limited long-term data beyond 2 years 3
  • Requires specialized equipment and Doppler guidance 2, 6
  • Most studies have median follow-up of 6-9 months, with longest at 2 years 2, 3, 5

The absence of laser therapy from major guidelines suggests it should be considered an emerging rather than standard treatment, despite favorable research outcomes. 1, 6

References

1
Guideline

Management of Hemorrhoids

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Related Questions

What is HelPexx (Hemorrhoidal Laser Procedure with Mucopexy)?
What degree are hemorrhoids (hemorrhoids) that protrude at the 3, 7, and 11 o'clock positions during a proctoscope examination?
What degree of hemorrhoids (internal or external piles) are indicated by protrusion at the 3, 7, and 11 o'clock positions during a proctoscope examination?
What are the recommended laser energy settings in Joules for treating grade 1-4 hemorrhoids using 980 nm vs 1740 nm lasers?
Is septoplasty and inferior turbinate reduction medically necessary for a patient with a deviated nasal septum, hypertrophy of nasal turbinates, and nasal tip ptosis, who has failed conservative treatment with Flonase (fluticasone propionate) and oral antihistamines, such as Zyrtec (cetirizine)?
What is the most commonly used methylphenidate (MPH) long-acting formulation with the best results for attention deficit hyperactivity disorder (ADHD)?
What is the equivalent dose of Concerta (methylphenidate) for a patient currently taking 60 mg of Vyvanse (lisdexamfetamine)?
How to manage a patient with hypocalcemia on peritoneal dialysis?
Is pudendal cryoneurolysis medically indicated for a 42-year-old female with chronic pudendal neuralgia/perineal pain who has tried multiple therapies, including Cymbalta (duloxetine), nerve blocks, and pelvic floor therapy, and experienced significant relief from the initial procedure?
What is the treatment for acute pancreatitis?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question