Laser Hemorrhoidoplasty versus Excisional Hemorrhoidectomy: The Recovery-Durability Tradeoff in Hemorrhoid Surgery-A Systematic Review of Randomized Trials.

In 30 seconds

This systematic review and meta-analysis included 15 randomized controlled trials involving 1099 patients and compared diode laser hemorrhoidoplasty with conventional excisional hemorrhoidectomy. Laser treatment was associated with less postoperative pain, shorter analgesic use and hospital stay, and earlier return to daily activities. The largest reported recovery difference was an earlier return to daily activities (MD -10.78 days). Laser hemorrhoidoplasty was also associated with lower rates of several postoperative complications, but limited follow-up and low to very low certainty leave its long-term durability uncertain.

Key findings

• Postoperative pain was lower with laser hemorrhoidoplasty on day 1 (MD -2.02; 95% CI -2.83 to -1.20) and day 7 (MD -2.13; 95% CI -3.06 to -1.20).
• Return to daily activities was earlier after laser hemorrhoidoplasty (MD -10.78 days); hospital stay was shorter (MD -0.63 days).
• Laser hemorrhoidoplasty was associated with lower postoperative bleeding (RR 0.35), urinary retention (RR 0.29), and anal stenosis (RR 0.12).
• The review found long-term durability uncertain; several outcomes were underpowered and follow-up was limited.

Why it matters

The findings highlight a potential tradeoff in hemorrhoid surgery: laser hemorrhoidoplasty may offer faster short-term recovery, while evidence about longer-term durability remains uncertain. This distinction is relevant when weighing procedural outcomes, since early pain and return to activity do not establish equivalent long-term control. The review’s low to very low certainty also calls for caution in interpreting pooled estimates.

What to keep in mind

The authors report low to very low certainty of evidence, limited follow-up, and several underpowered outcomes, restricting conclusions about long-term durability.