Hemorrhoidal disease is one of the most prevalent anorectal conditions in the world, with an estimated prevalence of 4–5% in the general population and a significantly higher prevalence in adults aged 45–65 years.[1] It is caused by the abnormal enlargement and distal displacement of the normal anal vascular cushions, with clinical symptoms including prolapse, pain, bleeding, pruritus and discomfort, which have a marked impact on quality of life.[2] Grade IV hemorrhoids are the farthest advanced stage of the disease, and are permanently prolapsed so that it cannot be pushed back in manually and may need surgery.[3] Although the gold standard for treatment of advanced hemorrhoids is conventional excisional hemorrhoidectomy, this procedure is often painful, the wound healing process takes a long time, patients are unable to return to their normal activities, and satisfaction rates are low.[4, 5] There has been growing interest in minimally invasive surgical techniques that can deliver similar clinical outcomes with reduced post-surgical morbidity.[6]

laser hemorrhoidoplastyis a novel minimally invasive technique that has become available for the management of advanced hemorrhoidal disease.[7] This method involves controlled laser energy to coagulate and shrink the hemorrhoidal tissue without harming the surrounding anoderm and sphincter complex.[8] Laser treatment has been reported to have less tissue trauma, less bleeding in the operating room, less operating time, less post-operative pain, and faster healing when compared to conventional excisional surgery.[9] Hemorrhoidal disease is considered a major reason for millions of outpatient consultations and surgical procedures worldwide every year.[10] Nearly 10–20% of symptomatic hemorrhoid sufferers require surgical interventions, especially among those with Grades III and IV.[11] In recent years, there has been growing evidence that laser-assisted procedures may allow for earlier mobilization and shorter hospital stays, as well as a quicker return to daily activities, which is why they are an appealing choice for both surgeons and patients who seek improved recovery after surgery.[12]

With the growing use of laser surgery for advanced hemorrhoidal disease, it is important to have a thorough evaluation of postoperative outcomes to assess the clinical efficacy and patient-centered benefits of this procedure. Comparative evaluation of pain intensity, recovery profile, and satisfaction level can offer evidence to inform the choice of surgery and the best possible treatment options for Grade IV hemorrhoids. Moreover, there is limited local data that support these outcomes in patients undergoing laser surgery, and more studies are needed to confirm these findings. Thus, the present study is designed to comparatively evaluate postoperative pain, recovery and satisfaction following laser surgery in grade IV hemorrhoids and to provide evidence that can help improve clinical practice and patient outcomes.

A cross-sectional comparative study was performed in the Department of General Surgery, MTI, GOMAL Medical College, D.I.Khan from November 2025-April 2026. The number of patients was calculated by software (OpenEpi version 3.01) for comparing two means based on previous study which reported the expected difference in mean postoperative pain scores of about 1.5 units with a pooled standard deviation of 2.5 units, a 95% confidence level, 80% study power, and equal allocation between groups, a minimum sample size of 90 participants (45 per group) was determined.[13] The sample size was increased by about 5% to compensate for the possibility of incomplete follow-up and missing data, giving a final sample size of 95 patients. Non-probability consecutive sampling technique was used to recruit patients. The study included patients ages 18–70 years of either gender with clinically confirmed Grade IV hemorrhoids undergoing laser hemorrhoid surgery and who signed an informed consent form.[14] Patients with recurrent hemorrhoids after previous surgery, patients with thrombosis of external hemorrhoids who required emergency surgery, patients who had inflammatory bowel disease or have colorectal malignancy, patients who had an anal fissure or fistula, or patients who were pregnant, had a bleeding disorder, uncontrolled diabetes mellitus, severe systemic illness ‘ASA class IV or above’, or incomplete follow-up data were excluded from the study. Written informed consent was obtained before entry into the study, after Institutional Ethical Review Committee approval. Demographic and clinical data such as age, gender, BMI, duration of symptoms, presenting complaints, and associated comorbidities were obtained using a structured proforma. The surgical procedures were carried out by the experienced colorectal surgeons involved in this study, under spinal or general anesthesia, following the institutional protocol, and using a standardized laser hemorrhoid oplasty technique. Visual Analogue Scale (VAS), ranging from 0 to 10, was used to evaluate the postoperative pain at 24 hours, 3 days after surgery, and 7 days after surgery. Evaluation of recovery was done through length of hospital stay, time to recover to normal daily functioning, postoperative complications, and the outcome of wound healing during follow-up. A five-point Likert satisfaction scale (very dissatisfied to very satisfied) was used to assess patient satisfaction for the first month post-surgery.[15] The principal investigator recorded all information to make it uniform and to reduce the observer bias. The privacy of the participants was respected during this study. IBM SPSS Statistics version 26.0 was used to enter and analyze the data. Continuous variables such as age, BMI, postoperative pain scores, hospital stay and recovery time were reported as mean ± standard deviation. Qualitative data such as gender, presenting symptoms, postoperative complications and patient satisfaction categories were presented in frequencies and percentages. To test the normality of the continuous variables, the Shapiro–Wilk test was used. Comparisons between continuous variables were done by ‘an independent sample t-test’, and for categorical variables, the chi-square test and Fisher's exact test were used. Results with a p-value of ≤ 0.05 were regarded as statistically significant.

This study consisted of 95 patients who underwent laser hemorrhoid surgery for Grade IV hemorrhoids. The study population consisted of adult female and male patients with similar demographic and clinical data points at the start of the cohort. Most patients were presenting with bleeding per rectum, pain on defecation and prolapse, and almost half of the patients did not have associated comorbidities. The study population was representative of the patients who are typically treated surgically for advanced hemorrhoidal disease. (Table 1)

The outcomes of the operative surgery and early postoperative period were favorable in laser hemorrhoid surgery. Most patients had an uncomplicated recovery period, while there were some minor complications in a small number of patients. The procedure was minimally invasive as most participants had a short hospital stay, rapid recovery and satisfactory wound healing. (Table 2)

The pain score improved over time in the postoperative period, and there was significant reduction in pain during follow-up. The results of statistical analysis showed there to be a significant decrease in pain with time, indicating successful postoperative recovery following laser surgery. (Table 3)

The overall satisfaction levels were high, with the majority of patients having positive perceptions about the surgical outcome one month after surgery, with a few patients reporting dissatisfaction. (Table 4)

There was no gender difference in any postoperative pain or complication rate seen in the comparative analysis. Patients with diabetes, however, spent significantly longer in hospital and those who went on to develop postoperative complications spent longer to get back to normal daily activities. Furthermore, patient satisfaction was significantly associated with postoperative complications. (Table 5)

Table 1. Baseline demographic and clinical characteristics of study participants (n = 95)

Table 2. Operative characteristics, postoperative recovery and complications (n = 95)

Table 3. Postoperative pain assessment using Visual Analogue Scale (VAS) (n = 95)

Table 4. Patient satisfaction one month after laser surgery (n = 95)

Table 5. Association of postoperative outcomes with selected patient characteristics

The current study showed the positive short-term results after laser treatment for Grade IV hemorrhoids, which included a progressive decrease in postoperative pain, quick healing, a low complication rate, a short hospital stay, and high patient satisfaction. These results are in line with the increasing number of studies proving the effectiveness of laser hemorrhoidoplasty as a minimally invasive procedure for severe hemorrhoid disease. The dramatic reduction in Visual Analogue Scale (VAS) pain scores between postoperative day 1 and day 7 seen in the present study is consistent with the tissue-preserving mechanism of laser surgery, which is associated with a minimum of thermal destruction and postoperative inflammation.

The results of our study are consistent with the results of the randomized controlled trial conducted by Tuba Mert (2023) to compare laser hemorrhoidoplasty with Ferguson hemorrhoidectomy in patients having Grade III to Grade IV hemorrhoids. The authors found that significantly lower VAS pain scores and faster symptom resolution were achieved with laser surgery vs. traditional hemorrhoidectomy (p<0.001), and that laser surgery resulted in fewer postoperative complications, suggesting better postoperative pain than traditional hemorrhoidectomy. These results are very similar to our study, where we found a marked decrease in pain after surgery.[16]

In the same way, the systematic review and meta-analysis from 2023 showed that the laser hemorrhoidoplasty yielded significantly lower postoperative pain on postoperative day 1 and day 7, fewer analgesic uses, shorter operation time and earlier return to everyday activity when compared with the traditional hemorrhoidectomy. According to the review, laser surgery provides significant clinical benefits in the short term with an acceptable level of safety.[17] The results of the present study in pain reduction and faster healing time are consistent with these combined results.

The prospective non-randomized study published in 2024, which compared laser hemorrhoidoplasty, LigaSure hemorrhoidectomy, and diathermy hemorrhoidectomy, also corroborates our findings of quick postoperative recovery and short hospital stay. The investigators found that the laser hemorrhoidoplasty technique showed significantly shorter surgery times, quicker return to work, lower postoperative pain scores, higher quality-of-life scores, and better recovery. The patient satisfaction level was similar across treatment groups, but there were clear benefits for laser surgery in early postoperative recovery, as in the current study.[18]

The prospective study about postoperative results and predictive factors after laser hemorrhoidoplasty further confirms the favorable recovery profile that we observed in our patients. That study found that there was little post-operative pain, low complication rates, and that patients were able to recover quickly, with quality of life being significantly improved after undergoing laser treatment. Additionally, the severity of the disease (based on grade) was found to be an independent predictor of pain and longer recovery among patients; this indicated the significance of the grade of the disease in postoperative outcome. However, with advanced hemorrhoids, our research also showed excellent recovery results from laser surgery.[19]

The low number of postoperative complications in our study aligns with the results of the retrospective study published in Scientific Reports in 2025 that showed low postoperative complications following ‘laser hemorrhoidoplasty and excisional hemorrhoidectomy’ for Grade IV hemorrhoids. The authors noted less postoperative pain, less urinary retention, satisfactory patient-reported outcomes and acceptable complication rates when compared to LigaSure hemorrhoidectomy. As expected, their findings validate the safety of laser surgery for severe hemorrhoid cases.[20]

The high satisfaction level that was found in the present study also backs up the 2026 retrospective cohort study that looked at the 2-year outcomes of laser hemorrhoidoplasty. Patients were highly satisfied, postoperative pain was mild, hospital stay was generally one day and most patients were able to return to their normal activities within the first week after their operation. Our follow-up period was shorter, but our results show that patients were similarly satisfied following laser surgery.[21]

In conclusion, the results of the present study were similar to the current evidence revealing that laser surgery for Grade IV hemorrhoids results in significantly less postoperative pain, faster healing, lower complication rates, shorter hospital stays, and higher patient satisfaction. The results of the study provide further support for the growing use of laser hemorrhoidoplasty as a less radical surgical procedure when compared with traditional hemorrhoidectomy and the need for larger multicenter studies with longer follow-up to determine the long-term recurrence and durability of the procedure.

There were a number of limitations to this study. First, it was carried out in one institution, with a small sample of just 39 patients, which can make it difficult to generalize the results. Second, this follow-up period was brief, and the follow-up data were mostly early postoperative results, leaving out the possibility of determining the rate of recurrence or how satisfied patients were with the results in the long run. Third, there was no control group with a traditional hemorrhoidectomy available to compare the relative effectiveness of laser surgery. Lastly, patient satisfaction and pain assessment focused on subjective reporting and may have resulted in a response bias despite the use of validated assessment tools.

The early postoperative results of laser surgery for Grade IV hemorrhoids showed improved and progressive decrease in pain, rapid recovery, short hospital stay, low complications and high patient satisfaction. The results showed that laser hemorrhoidoplasty is a safe and effective minimally invasive procedure for the treatment of advanced hemorrhoidal disease. The results of this study should be confirmed with larger multicenter studies with longer follow-up to determine long-term recurrence and functional results.

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