Comparison of Postoperative Bleeding Incidence in Laser Haemorrhoidoplasty with and without Hemorrhoidal Artery Ligation: A Prospective Observational Study

Background: Laser Haemorrhoidoplasty (LHP) is a minimally invasive technique for treating symptomatic haemorrhoids. Hemorrhoidal Artery Ligation (HAL) targets vascular supply to reduce bleeding. This study compared postoperative bleeding incidence in patients undergoing LHP alone versus LHP combined with HAL.

Materials and Methods: This prospective observational study was conducted at SMS Medical College, Jaipur from 2024-2025. One hundred ten patients with Grade II-III haemorrhoids were randomized into two groups: Group A (LHP alone, n=55) and Group B (LHP+HAL, n=55). LHP was performed using 1470 nm diode laser with radial fiber delivery. In Group B, additional digital-guided HAL was performed using absorbable sutures. Postoperative bleeding was assessed using Verbal Rating Score (VRS) on Days 1, 3, 7, and 14. Secondary outcomes included pain (VAS), perianal swelling, hospital stay, and patient satisfaction.

Results: Both groups showed low postoperative bleeding rates with no significant difference. On Day 1, 94.5% (LHP) and 90.9% (LHP+HAL) had no bleeding (p=0.463). By Day 14, bleeding had nearly resolved in both groups (p=0.558). Mean pain scores were comparable (Day 1: 1.67±0.77 vs 1.96±0.88, p=0.068). Hospital stay averaged 1.04 days in both groups. Complete recovery at 6 weeks was 96.4% (LHP) and 100% (LHP+HAL). Patient satisfaction was high (4.53 vs 4.58 out of 5, p=0.690).

Conclusion: Both LHP alone and LHP with HAL are effective and well-tolerated for Grade II-III haemorrhoids. Adding HAL did not significantly reduce postoperative bleeding, suggesting LHP alone may be sufficient for most patients