Laser Energy Settings for Hemorrhoid Treatment by Grade
For grade 2-3 hemorrhoids, use 980 nm diode laser with total energy of 850 Joules (range 450-1242 J), while grade 4 hemorrhoids should NOT be treated with laser therapy due to significantly higher bleeding and complication rates.
Recommended Energy Settings by Wavelength
980 nm Diode Laser (Standard Approach)
- Total energy delivered: 850 Joules median (range 450-1242 J) across all hemorrhoidal columns 1
- Power setting: 5 Watts with frequency of 5 Hz 2
- Energy density: 19 J/cm² per application 2
- Individual pile treatment: 4-10 Joules per hemorrhoidal pile 2
- The 980 nm wavelength is the most commonly used, representing 90.34% of laser hemorrhoid procedures in the literature 3
1740 nm Laser
No clinical data exists in the provided evidence for 1740 nm wavelength laser treatment of hemorrhoids. The literature exclusively describes 980 nm and 810 nm diode lasers 3, 2.
Treatment Algorithm by Hemorrhoid Grade
Grade 1 Hemorrhoids
- Laser therapy is NOT recommended as first-line treatment 4
- Conservative management with fiber, fluids, and lifestyle modifications should be attempted first 4
- If office procedures are needed, infrared photocoagulation or sclerotherapy are preferred over laser 5
Grade 2 Hemorrhoids
- 980 nm diode laser is appropriate with 850 J total energy 1
- Success rate: 82.7% complete symptom remission 1
- Complication rate: 6.7% (primarily minor bleeding) 1
- Median operative time: 18 minutes 1
- Alternative: Rubber band ligation remains first-line office procedure with 70-89% success 4
Grade 3 Hemorrhoids
- 980 nm diode laser with 850 J total energy is effective 1
- Complication rate: 6.5% 1
- Laser shows superior outcomes compared to rubber band ligation: 90% symptom resolution vs 53% with ligation at 6 months 6
- Significantly lower postoperative pain (VAS 1.1 vs 2.9) compared to rubber band ligation 6
Grade 4 Hemorrhoids
- Laser therapy is NOT recommended due to unacceptably high complication rates 1
- Post-operative bleeding rate: 31.6% (vs 6.5% for grade 3) 1
- Readmission rate: 26.3% (vs 5.4% for grade 3) 1
- Reoperation rate: 21.1% (vs 2.2% for grade 3) 1
- Multivariate analysis shows 6.98-fold increased risk of bleeding, 5.82-fold increased readmission risk, and 11.4-fold increased recurrence risk 1
- Conventional excisional hemorrhoidectomy is the gold standard with only 2-10% recurrence 4
Technical Considerations
Doppler-Guided Technique
- Doppler guidance was used in 29.89% of procedures to localize hemorrhoidal arteries 3
- Five pulsed laser shots delivered to each identified artery approximately 3 cm above dentate line 6
- Absence of Doppler signal after treatment confirms arterial coagulation 6
Pain Outcomes
- Mean postoperative pain (VAS): 0.84 ± 1.13 with laser vs 1.78 ± 0.68 with open hemorrhoidectomy (p = 0.018) 2
- Significantly lower pain compared to open techniques across all studies 3
- Minimal need for analgesia during hospital stay and at home 7
Critical Pitfalls to Avoid
- Never use laser therapy for grade 4 hemorrhoids - the bleeding and reoperation rates are prohibitively high 1
- Avoid excessive energy delivery - burn lesions occurred in 26.7% when technique was not optimized 2
- Do not treat large hemorrhoidal piles with laser - technique is not suitable for bulky disease 2
- Ensure proper fiber placement - residual skin tags (plicoma) occurred in 33% with suboptimal technique 2
- Screen for immunocompromised status - these patients have increased infection risk with any hemorrhoid procedure 4