Hemorrhoidectomy vs Laser Ablation: How to Make the Right Choice

Hemorrhoidectomy vs Laser Ablation: How to Make the Right Choice

Hemorrhoidal disease affects millions of individuals worldwide, leading to pain, discomfort, and decreased quality of life. As patients seek lasting relief, colorectal surgeons are often tasked with selecting the most appropriate intervention.

Two commonly discussed options—hemorrhoidectomy vs laser ablation—offer distinct benefits and limitations. Making the right choice requires a thorough understanding of the procedures, outcomes, patient considerations, and long-term expectations.

Whether you're a practicing colorectal specialist or a patient exploring treatment options, this article provides valuable insights into selecting the best approach.

Understanding the Procedures

What Is a Hemorrhoidectomy?

A hemorrhoidectomy is the surgical removal of internal or external hemorrhoids. It is typically reserved for advanced cases, such as Grade III or IV hemorrhoids that do not respond to conservative treatments. There are several surgical techniques:

  • Open hemorrhoidectomy (Milligan-Morgan): The wound is left open to heal by secondary intention.

  • Closed hemorrhoidectomy (Ferguson technique): The wound is sutured closed, reducing healing time but increasing risk of infection.

  • Stapled hemorrhoidopexy (PPH): Often used for internal prolapsing hemorrhoids, this technique repositions the hemorrhoidal tissue and cuts off its blood supply.

Most hemorrhoidectomy procedures are performed under general or spinal anesthesia in a hospital or outpatient surgical setting.

What Is Laser Ablation for Hemorrhoids?

Laser ablation is a minimally invasive technique using focused energy—typically from diode or Nd:YAG lasers—to coagulate hemorrhoidal tissue and reduce symptoms. The most commonly performed techniques include:

  • Laser Hemorrhoidoplasty (LHP): A fiber is inserted into the hemorrhoidal node to deliver energy internally.

  • External laser coagulation: Targets external hemorrhoids or residual external skin tags.

Depending on the approach, laser ablation can be performed under local or general anesthesia and often in an outpatient setting.

Indications for Each Procedure

When Hemorrhoidectomy Is Indicated

Hemorrhoidectomy is typically the treatment of choice when:

  • The patient presents with Grade III or IV hemorrhoids with significant prolapse.

  • There is persistent bleeding or thrombosis.

  • Minimally invasive therapies, such as rubber band ligation or infrared coagulation, have failed.

  • There are recurrent hemorrhoids after prior treatment.

When Laser Ablation Is Suitable

Laser ablation may be preferred when:

  • The patient has Grade II or III hemorrhoids without significant prolapse.

  • There's a desire for minimal postoperative pain and faster recovery.

  • Patients have comorbidities that make general anesthesia or extended recovery periods undesirable.

  • There's access to laser technology and trained personnel.

Comparing Outcomes: Hemorrhoidectomy vs Laser Ablation

Pain and Postoperative Recovery

One of the most significant differences between hemorrhoidectomy vs laser ablation lies in postoperative pain.

  • Hemorrhoidectomy is associated with considerable pain, especially in the first 7–10 days. Recovery may take 2–4 weeks, often requiring analgesics and frequent sitz baths.

  • Laser ablation, by contrast, causes minimal tissue disruption and results in significantly less postoperative pain. Most patients return to normal activity within 3–5 days.

Bleeding and Complication Rates

  • Hemorrhoidectomy carries a moderate risk of bleeding, typically 1–5%, and can result in complications such as urinary retention, anal stenosis, or incontinence in rare cases.

  • Laser ablation typically results in minimal bleeding due to intraoperative coagulation. Infection and secondary complications are rare, especially when proper technique and postoperative care are followed.

Efficacy and Long-Term Outcomes

  • Hemorrhoidectomy remains the most effective long-term solution for severe cases, with recurrence rates below 5%.

  • Laser ablation, while highly effective in early-stage disease, has slightly higher recurrence rates (10–15%) and may require repeat treatment for optimal results.

Cost and Facility Considerations

Procedure Setting and Equipment

  • Hemorrhoidectomy often requires an operating room, general anesthesia, and a team of surgical staff—adding to the logistical complexity and cost.

  • Laser ablation can often be done in an ambulatory surgical center or even an office-based setting, provided proper equipment and safety protocols are in place.

Cost Analysis

  • Direct costs for hemorrhoidectomy may be higher due to facility fees, anesthesia, and longer post-op care.

  • Laser ablation requires upfront investment in laser systems, but can reduce overall healthcare costs by shortening recovery time and minimizing complications.

  • Indirect costs to the patient, such as time off work and need for postoperative care, are typically lower with laser treatment.

Patient-Centered Decision-Making

Factors to Consider When Choosing the Right Procedure

When comparing hemorrhoidectomy vs laser ablation, decision-making should consider:

  • Grade and severity of hemorrhoids

  • Pain tolerance and expectations

  • Willingness for downtime post-procedure

  • Existing medical conditions

  • Accessibility to surgical or laser facilities

Surgeon’s Role in Guiding the Decision

Surgeons play a critical role in:

  • Conducting a thorough clinical exam and endoscopic evaluation

  • Educating the patient on risks, benefits, and expectations

  • Ensuring the patient’s preferences and priorities are central to the decision

  • Providing clear follow-up protocols regardless of the chosen procedure

Conclusion

There is no universal solution when it comes to treating hemorrhoids. Understanding the key differences between hemorrhoidectomy vs laser ablation allows both surgeons and patients to tailor care to individual needs.

Hemorrhoidectomy remains the preferred option for severe or recurrent cases, while laser ablation offers a modern, low-pain alternative for early-stage disease. As technology and patient preferences evolve, the focus should remain on safe, effective, and patient-centered care.

Learn how our neoLaser is being used for laser treatment of hemorrhoids and related conditions.

Brian Chandler