Short term outcomes of Laser Pile Ablation (LPA) to treat II-III degree symptomatic hemorrhoidal disease.

Document Type : Research/Original Article


1 Proctology Unit, Private Hospital of Forlì, Forlì, Italy

2 Proctology and Pelvic Floor Clinical Centre, Cisanello University Hospital, Pisa, Italy



The aim of this study is to assess the outcomes of Laser Pile Ablation (LPA) in patients affected by II-III degree symptomatic hemorrhoidal disease.

Material and Methods
Consecutive patients suffering of II-III degree symptomatic HD were enrolled to undergo LPA. The primary study endpoint was to assess the post-operative pain using NRS scale (0-10) and the use of painkiller. Secondary endpoints were: intraoperative, postoperative complications and recurrence rate (including bleeding and prolapse). Patients satisfaction was assessed at 6- and 12-months using VAS scale (0-10) and also through the questions “Would you undergo this surgery again?” and “Would you recommend this procedure to a relative or friend?”.

Twenty-five patients (7F–18M) were enrolled in the study. All the procedures were performed under spinal anesthesia and the mean amount of energy delivered was 472.6±50.7 J. The mean follow-up was 9 months (range 6-12). Mean postoperative pain, assessed through NRS scale, was 4.7±1.5 at 12 h, 4.4±1.3 at 24 h and 2.2±1.0 at day 10. The pain was managed with paracetamol 1 gr only 30.7 % required NSAIDs in addition for 3 days. Recurrence rate was 7.7% at 3 and 6 months after the procedure referring persistent bleeding. The mean time interval to return to work is 2.7±2.1 days. All the patients were extremely satisfied of the procedure VAS 9.

LPA resulted to be a safe, effective and minimally invasive procedure to treat II-III degree HD with optimal management of post-operative pain and excellent patient satisfaction.


[1]         W. H. F. Thomson, “The nature of haemorrhoids,” Br. J. Surg., vol. 62, no. 7, pp. 542–552, 1975.
[2]         G. Gallo, R. Sacco, and G. Sammarco, “Epidemiology of hemorrhoidal disease,” Coloproctology, vol. 2, pp. 3–7, 2018.
[3]         L. Abramowitz, M. Benabderrahmane, D. Pospait, J. Philip, and C. Laouénan, “The prevalence of proctological symptoms amongst patients who see general practitioners in France,” Eur. J. Gen. Pract., vol. 20, no. 4, pp. 301–306, 2014.
[4]         A. Sturiale, B. Fabiani, C. Menconi, D. Cafaro, F. C. Porzio, and G. Naldini, “Stapled Surgery for Hemorrhoidal Prolapse: From the Beginning to the Modern Times,” Rev. Recent Clin. Trials, vol. 15, Mar. 2020.
[5]         G. Gallo et al., “Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of hemorrhoidal disease,” vol. 24, pp. 145–164, 2020.
[6]         G. Cocorullo et al., “The non-surgical management for hemorrhoidal disease. A systematic review,” G. di Chir., vol. 38, no. 1, pp. 5–14, 2017.
[7]         Karahaliloglu A. Laser hemorrhoidoplasty - a new surgical procedure for the treatment of advanced hemorrhoidal illness. Coloproctology 2010;32:116-123.
[8]         J. M. N. Jorge and S. D. Wexner, “Etiology and management of fecal incontinence,” Dis. Colon Rectum, vol. 36, no. 1, pp. 77–97, Jan. 1993.
[9]         A. Medina-Gallardo, Y. Curbelo-Peña, X. De Castro, P. Roura-Poch, J. Roca-Closa, and E. De Caralt-Mestres, “Is the severe pain after Milligan-Morgan hemorrhoidectomy still currently remaining a major postoperative problem despite being one of the oldest surgical techniques described? A case series of 117 consecutive patients,” Int. J. Surg. Case Rep., vol. 30, pp. 73–75, 2017.
[10]      A. Sturiale et al., “Long-term results after stapled hemorrhoidopexy: a survey study with mean follow-up of 12 years,” Tech. Coloproctol., vol. 22, no. 9, pp. 689–696, Sep. 2018.
[11]      C. Ratto, P. Campennì, F. Papeo, L. Donisi, F. Litta, and A. Parello, “Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: a single-center study on 1000 consecutive cases and a review of the literature,” Tech. Coloproctol., vol. 21, no. 12, pp. 953–962, 2017.
[12]      G. Naldini and A. Sturiale, “Stapled hemorrhoidopexy and THD/HAL-RAR: false myths of the third millennium,” Tech. Coloproctol., vol. 24, no. 9, pp. 985–986, 2020.
[13]      L. Brusciano et al., “Postoperative discomfort and pain in the management of hemorrhoidal disease: laser hemorrhoidoplasty, a minimal invasive treatment of symptomatic hemorrhoids,” Updates Surg., vol. 72, no. 3, pp. 851–857, 2020.
[14]      M. Naderan, S. Shoar, M. Nazari, A. Elsayed, H. Mahmoodzadeh, and Z. Khorgami, “A Randomized Controlled Trial Comparing Laser Intra-Hemorrhoidal Coagulation and Milligan–Morgan Hemorrhoidectomy,” J. Investig. Surg., vol. 30, no. 5, pp. 325–331, 2017.
[15]      H. Maloku, Z. Gashi, R. Lazovic, H. Islami, and A. Juniku-Shkololli, “Laser hemorrhoidoplasty procedure vs open surgical hemorrhoidectomy: A trial comparing 2 treatments for hemorrhoids of third and fourth degree,” Acta Inform. Medica, vol. 22, no. 6, pp. 365–367, 2014.
[16]      A. Jahanshahi, E. Mashhadizadeh, and M. H. Sarmast, “Diode laser for treatment of symptomatic hemorrhoid: A short term clinical result of a mini invasive treatment, and one year follow up,” Pol. Prz. Chir. Polish J. Surg., vol. 84, no. 7, pp. 329–332, 2012.
[17]      G. Naldini et al., “Improvement in Hemorrhoidal Disease Surgery Outcomes Using a New Anatomical/Clinical–Therapeutic Classification (A/CTC),” Surg. J., vol. 06, no. 03, pp. e145–e152, 2020.