Laser Hemorrhoidoplasty for Grade III Hemorrhoidal Disease: Safety and Efficacy in a Brazilian Multicenter Retrospective Cohort Study

Abstract

Background:

Laser hemorrhoidoplasty (LHP) has emerged as a minimally invasive alternative to excisional hemorrhoidectomy, but data remain heterogeneous, particularly regarding energy settings and safety outcomes.

Methods:

This multicenter retrospective cohort included 100 patients with symptomatic grade III hemorrhoids treated with LHP across six Brazilian centers between January 2021 and August 2023. Primary outcomes were postoperative pain (Visual Analog Scale—VAS), proctological symptoms (Proctological Symptoms Scale—PSS), and complications. Associations between total laser energy and complications were analyzed using multivariable logistic regression.

Results:

Median VAS peaked at 3.0 on day 7 and declined to near-complete remission by day 14, remaining minimal up to 1 year. PSS scores improved in parallel, reaching zero from day 30. The 30-day complication rate averaged 19.7%, peaking at 27% on day 14, with a cumulative per-patient rate of 44%. Most complications were mild (edema, skin tags), and only four patients required reintervention. Higher total energy was associated with increased complications from day 14 onwards, although the clinical effect was modest. Adjunctive CO₂ laser excision of skin tags (n = 49) did not increase morbidity.

Conclusions:

LHP proved safe and effective for grade III hemorrhoids, ensuring early pain relief and symptom resolution with high satisfaction. Energy standardization may help minimize risks, and adjunctive CO₂ skin-tag excision appears feasible without added morbidity.