Laser Hemorrhoidoplasty: Postoperative Outcomes and Predictive Factors for Pain, Bleeding, and Recovery.

Background: Laser hemorrhoidoplasty (LHP) is a minimally invasive alternative to excisional hemorrhoidectomy, with promising short-term outcomes. However, predictors of postoperative pain, bleeding, and recovery remain insufficiently characterized. Methods: We conducted a prospective study including 140 patients with Goligher grade I-IV hemorrhoidal disease (January 2020-December 2024) at Independența Vita Plus Hospital, Craiova. All patients received preoperative diosmin and topical ointments. Procedures were performed under spinal anesthesia using a standardized 1470 nm diode laser technique. Outcomes included postoperative pain (VAS), bleeding, early and late complications, recovery time, HDSS change, and quality of life assessed with a simple 0-10 numerical scale used in routine clinical practice (not a validated QoL instrument). Results: Mean operative time was 17.9 ± 4.8 min, with minimal blood loss. Postoperative bleeding occurred in 28.6% and was mild. Early complications increased with disease stage: 10% (II), 53% (III), 68% (IV) (p < 0.001). VAS pain decreased from 2.1 on day 1 to 0.3 on day 7 (p < 0.0001). Median recovery time was 3 days, longer in advanced stages. HDSS improved from 10.3 ± 2.5 preoperatively to 1.7 ± 1.1 at 3 months (p < 0.0001). QoL numerical scores also improved significantly at 3 months. Goligher grade independently predicted late bleeding (OR 70.2), high pain (OR 4.9), and prolonged recovery (OR 8.6). No recurrences were observed at 12 months. Conclusions: LHP provides low postoperative pain, minimal bleeding, rapid recovery, and significant symptom and QoL improvement. Disease severity strongly predicts outcomes and should guide perioperative planning.