Nonsurgical treatment of thrombosed external hemorrhoids using non-ablative Er:YAG and Nd:YAG laser

Nonsurgical treatment of thrombosed external hemorrhoids using non-ablative Er:YAG and Nd:YAG laser | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Nonsurgical treatment of thrombosed external hemorrhoids using non-ablative Er:YAG and Nd:YAG laser Olga Pustotina, Anna Lopatina, Zdenko Visintin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6305528/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background In recent years, non-ablative lasers, such as neodymium and erbium lasers generated by yttrium aluminum garnet (Nd:YAG and Er:YAG), have been used for treating various female pelvic floor disorders. Objective To evaluate the effectiveness of nonsurgical treatment of thrombosed external hemorrhoids using a non-ablative erbium and neodymium laser. Methods This was a retrospective study that analyzed data from charts of fourteen female patients with thrombosed external hemorrhoids associated with severe pain syndrome, which underwent a single procedure of perianal area irradiation with a non-ablative erbium and neodymium laser in PIANO mode. Results The assessment of pain using a visual analog scale directly after the 15-minute procedure decreased from 8 (7;10) to 1 (0;2) points (р<0.0001). The severity of defecation pain was reduced over a week from 8 (7;10) to 0 (0;2) points (p < 0.0001). One week after treatment, pain syndrome was completely absent, and half of the women having none remaining of hemorrhoids. No complications or symptom deterioration were observed. No patients were with recurrence of hemorrhoids for six months follow up. Conclusion A single procedure of combined exposure to a non-ablative erbium and neodymium laser on the perianal area in patients with thrombosed external hemorrhoids seems to effectively alleviates pain syndrome and promotes rapid symptoms regression. Larger-scale, long-term, and well-controlled studies are needed to confirm the results of this small pilot study. thrombosed external hemorrhoids non-ablative erbium laser neodymium laser in PIANO mode Figures Figure 1 Figure 2 Figure 3 Introduction Thrombosed external hemorrhoid is one of the severe complications of the hemorrhoidal disease. Patients present with an acutely painful formation in the perianal area and develop severe pain syndrome. The pathological enlargement of hemorrhoids is caused by circulatory disorders in the cavernous formations, along with dystrophic changes in the general longitudinal muscle of the submucosal layer of the rectum and the Parks ligament, which hold the cavernous bodies in the anal canal. Acute circulatory disturbances cause blood clots of the hemorrhoids, accompanied by severe pain in the perianal area. Within three days after symptom onset, a thrombosed hemorrhoid may evacuate spontaneously, leaving a small ulcer with residual clot at the anal opening. This is typically resolved on its own over a few weeks, leaving only a skin tag. Patients with severe pain unresponsive to conservative therapy have a high risk for infection and necrotic complications and require surgical intervention [ 1 , 2 ]. The primary methods for pain relief and preventing possible complications include excision of the thrombosed hemorrhoid (hemorrhoidectomy) or incision with evacuation of the clot (enucleation), which is usually performed using a surgical scalpel or laser. Surgical methods require anesthesia, a high duration of hospital stay and a long postoperative care, which can take up to 40 days. In the initial days after hemorrhoid surgery, patients often experience considerable pain, a sensation of “tightness”, constipation, swelling, and wounds discharge. Supportive care typically involves wound care, warm sitz baths, stool softeners, and pain management with oral analgesics and, in some cases, narcotic medications [ 1 ]. The complications following hemorrhoid surgery are not very often but can be very severe. They include urinary retention, urinary tract infection, fecal impaction and fecal incontinence, bleeding, perianal abscess/fistula, and deep space infection [ 3 , 4 ]. The recurrence rate of thrombosis after hemorrhoid surgery can reach 30% [ 1 ]. Surgical removal of hemorrhoids using ablative lasers, including neodymium-doped yttrium aluminum garnet (Nd:YAG), diode, or CO2 lasers, has been described [ 5 , 6 , 7 ]. Laser hemorrhoidectomy, compared to traditional surgery, decreases operative time, reduces the duration of hospital stay, causes less postoperative pain, and results in faster wound healing. However, laser-assisted surgery is associated with a higher incidence of infectious complications, pelvic organ dysfunction, and has the same high recurrence rates around 30% [ 8 , 9 ]. In recent years, non-ablative lasers, such as Nd:YAG and erbium lasers generated by yttrium aluminum garnet (Er:YAG) (Fotona, Slovenia), have been used for treating pelvic floor dysfunction. Long-term experience demonstrates the high effectiveness of vaginal non-ablative erbium laser (VEL) therapy in treating vulvovaginal atrophy, stress urinary incontinence, pelvic organ prolapses, vaginal relaxation syndrome [ 10 , 11 ]. We previously reported about endometrial recovery [ 12 ] and improving of anorectal dysfunction in patients treated by Er:YAG laser [ 13 ]. The Nd:YAG laser, with a wavelength of 1064 nm in PIANO mode, is also widely used in gynecology for treatment vulvodynia, superficial dyspareunia, and lichen sclerosus [ 10 , 14 , 15 ]. Combined VEL and Nd:YAG laser therapy, as shown in Gambacciani and Fidecicchi study [ 16 ], was significantly more effective for improving vulvar pain and superficial dyspareunia than VEL alone. Okui N. et al. [ 17 ] reported resolving symptoms in a patient with refractory interstitial cystitis, bladder pain syndrome and vulvodynia treated with combined laser therapy. Non-ablative dual Nd:YAG/Er:YAG laser therapy was safe and significantly improved clinical outcome and subjective symptoms in patients with lichen sclerosus similarly as the topical corticosteroids [ 18 ]. The aim of this study was to evaluate the effectiveness of combined erbium and neodymium laser therapy in non-ablative mode for treatment women with thrombosed external hemorrhoids. Methods Study design and patients This study was a retrospective analysis of data recorded from patient charts at Dr. Pustotina’s Private Clinic in Moscow, Russia from February 2023 to September 2024 and was conducted in accordance with the Helsinki Declaration and approved by the Ethic Committee of Private Educational Institution of Supplementary Education “Academy of Medical Education named F.I. Inosemtsev” (protocol №2-2025, 25.03.2025). After signing informed consent, we collected data of 14 women aged 20–35 years (7 of whom were in the early postpartum period) with a verified diagnosis of thrombosed external hemorrhoids who were treated with Erbium/Neodymium Laser combination. Laser treatment Nonsurgical treatment of thrombosed external hemorrhoids was conducted at an outpatient clinic and involved a single irradiation of the perianal area with a non-ablative laser radiation, consisting of two steps. In the 1st step, the perianal area was irradiated with an Nd:YAG laser (Fotona SP Dynamis, PIANO mode), an R33 non-contact handpiece with a spot size of 9 mm, PIANO pulse mode (5 s), and fluence of 120 J/cm 2 . 6–8 passes were conducted in the brushing mode until the skin surface temperature reached 39–40°C. In the 2nd step, the area was irradiated with an Er:YAG laser at a wavelength of 2940 nm in SMOOTH mode. The PS03 handpiece with a 7-mm spot size, frequency 2.5 Hz, and pulse fluence 7.0 J/cm 2 , was used to perform four passes in the brushing mode over the perianal area. Before laser exposure, a thin layer of water-soluble colorless gel, typically used for ultrasound scanning, was applied to the skin of the perianal area to ensure a painless and comfortable procedure. No other anesthesia was used. Methods All patients with thrombosed external hemorrhoids present an acutely painful blue mass in the perianal area and severe pain syndrome, occurring within three days after symptoms onset. Patients with malignant diseases of the perianal region and rectum, systemic inflammatory infections, Crohn’s disease, complications of hemorrhoids (abscess, necrosis, wound infection, bleeding) were excluded from the study. All patients underwent pain assessment using the Visual Analog Scale (VAS) before, directly after the procedure and one week after laser therapy. Dynamic of thrombosed external hemorrhoids, rectal function, defecation, and complications assessed for one-week post-treatment. A comprehensive evaluation of adverse events was conducted during the procedure and the subsequent week after. Treatment satisfaction was assessed on a 4-point scale: 0 points – unsatisfactory, 1 point – satisfactory, 2 points – good, 3 points – excellent. Recurrent rate was assessed after 6 months via phone call. Statistical analysis Statistical analysis was performed using Statistica 12 software (StatSoft. Inc., USA). For normally distributed indicators, the results are presented as median and interquartile range Me (Q 25 ; Q 75 ). Quantitative indicators were compared using Student’s t-test for normally distributed values, otherwise the Mann-Whitney test was applied. The criterion of statistical significance of differences was accepted as p < 0.05. Results The total duration of the laser procedure was 15 minutes and did not cause additional pain or discomfort in any patient, despite all of them initially reporting severe anal pain (Table 1 ). Table 1 Characteristics of treatment patients (n = 14) Patients Age, years BMI, kg/m 3 Early postpartum Anal pain (VAS) Defecation pain (VAS) Patient satisfactions (Scores) Before Directly after 1 week after Before 1 week after 1 20 23 yes 10 0 0 10 0 3 2 28 20 No 10 1 0 10 1 3 3 35 27 No 10 3 0 10 2 3 4 30 19 No 8 2 0 8 2 3 5 29 30 Yes 5 3 0 5 1 3 6 24 23 yes 7 0 0 7 0 3 7 27 24 No 7 2 0 7 0 3 8 32 18 No 6 0 0 6 0 3 9 33 28 No 3 1 0 4 0 3 10 27 22 No 9 1 0 10 1 3 11 35 24 No 8 0 0 8 0 3 12 32 26 Yes 10 2 0 10 0 3 13 28 20 Yes 9 2 0 10 1 3 14 24 27 Yes 7 0 0 7 0 3 Me (Q 25 ; Q 75 ) 28,5 (23;32) 23,6 (20;27) yes – 7/14 (50%) no – 7/14 (50%) 8 (7;10) 1 (0;2) 0 (0; 0) 8 (7;10) 0 (0;2) 3 (3;3) p value, Wilcoxon’s t-criterion with group before - p < 0,001 p < 0,001 - p < 0,001 - Twelve patients (85.7%) described the pain as severe (6–10 points) and two (14.3%) as moderate (3 and 5 points). Directly after the procedure, pain was completely relieved in 35.7% of patients, while others reported a pain level of 1–3 points. The mean pain score before and immediately after the treatment was 8 (7;10) and 1 (0;2) points, respectively (p < 0.0001) (Fig. 1 ). At one week follow up there were no patients with pain (VAS = 0). All patients also reported pain during defecation, with 85.7% rating it as severe (6–10 points) and two as moderate (4–5 points). One week after treatment, 57.1% of women experienced completely painless defecation, while others reported pain levels of 1–2 points. The average pain during defecation score before treatment was 8 (7;10) points, which decreased to 0 (0;2) points after one week (p < 0.0001) (Fig. 2 ). After the laser procedure, patients were advised to hydrate and soften the mucosa of the anal canal before each bowel movement using a moisturizing intimate gel. All of them reported easier and more comfortable bowel emptying compared to when not using it. No complications or worsening of symptoms were observed during the follow-up period. There were no patients with pain syndrome, painful hemorrhoids, and infection complications. The hemorrhoids had significantly reduced in size, and in half of the women, they had disappeared entirely. All patients rated their treatment satisfaction as high (3 points). At six months follow up there were no patients with recurrence of hemorrhoids. Figure 3 demonstrates dynamic of thrombosed external hemorrhoid during one week after treatment in postpartum patient 32 y.o. Discussion The traditional method for treating thrombosed external hemorrhoids, accompanied by severe pain syndrome, is surgical intervention. This involves either excision of the hemorrhoids or removal of the thrombus through an incision. The main disadvantages of surgical treatment include invasiveness, the need for anesthesia, prolonged postoperative care (up to 40 days), as well as risks of postoperative complications and disease recurrence. A recent study [ 19 ] demonstrated that perianal thrombosis and thrombosed external hemorrhoids can heal well without surgery. Five hundred four patients with perianal thrombosis and 115 patients with thrombosed hemorrhoids which were treated conservatively, with sitz baths and oral pain medication, stated that their pain had largely resolved after 5 days and completely disappeared after 10 days. But most of patients in this study evaluated their pain before the treatment as mild or moderate. Mean pain on a numerical rating scale (0–10) was 3.8 for perianal thrombosis and 5.2 for thrombosed hemorrhoids. Recurrence rate after thrombosis was 6.3%. In our study, for the first time, the possibility of a non-surgical approach to reducing very severe pain syndrome in female patients with thrombosed external hemorrhoids was demonstrated. The mean pain score was 8 (7;10) on the VAS. Combined exposure of the perianal area to a non-ablative Nd:YAG laser in PIANO mode and an Er:YAG laser in SMOOTH mode reduced anal pain severity from 5–10 to 0–3 points on the VAS within only 15 minutes, with 35.7% of patients achieving complete pain relief during the procedure. No complications and recurrence were observed for 6 months follow up. Non-ablative erbium laser with a wavelength of 2940 nm in SMOOTH mode induces stepwise tissue heating via a rapid sequence of pulse packets lasting 250msec (equivalent to 0.25 sec) with 400-msec intervals. This controlled thermal diffusion triggers immune cell responses, epithelial regeneration, fibroblast activation, and extracellular matrix component production, promoting vascular restoration and neoangiogenesis, thereby enhancing oxygenation and nutrient supply to the treated area. The discrete pulse packet delivery technology allows tissue heating up to 60–63°C, optimal for collagen restoration and neoangiogenesis, without exceeding the surface ablation threshold or causing irreversible collagen denaturation [ 11 , 20 ]. The Nd:YAG laser, with a wavelength of 1064 nm in PIANO mode, generates ultra-long laser pulses lasting several seconds, which far exceed the thermal relaxation time of tissues (such as epidermis, hair follicles, and blood vessels), preventing an initial temperature spike and epithelial destruction while evenly distributing thermal energy to the submucosa, dermis, and subcutaneous fat, stimulating neocollagenesis, neoangiogenesis, and tissue elasticity restoration. Additionally, Nd:YAG in PIANO mode has vasodilatory and anti-inflammatory effects [ 14 , 21 ]. Based on the obtained clinical effect, we can conclude that laser treatment facilitates the release of vascular-muscular spasm and the restoration of blood circulation in the tissues of the hemorrhoids. Improved blood circulation is accompanied by clot resorption and a reduction in inflammation and edema in the perianal area. Additionally, the rapid reduction in the size of hemorrhoids is facilitated by the densification of their walls due to the contraction of collagen fibers under the influence of thermal diffusion generated by the non-ablative laser, followed by stimulation of neocollagenesis in the supporting structures of the cavernous formations. An important aspect of preventing disease recurrence is avoiding trauma to the hemorrhoids and excessive compression of the pelvic floor during defecation. Preliminarily moisturizing and softening the mucosa of the anal canal with a hydrating intimate gel protects it from damage during anal sphincter stretching, reduces straining effort, and facilitates easier and more comfortable bowel emptying. This minimally invasive approach, which we propose for managing of patients with thrombosed external hemorrhoids, provides rapid pain relief and may help some patients avoid surgical treatment. Conclusion This pilot study shows that treatment with a combination of Er:YAG + Nd:YAG has a potential to become a non-surgical treatment for thrombosed external hemorrhoids. Rapid pain relief, achieved in a single procedure that does not require anesthesia, incisions, or rehabilitation, could be considered as an emergency treatment method for patients with severe anal pain associated with thrombosed external hemorrhoids. This study has a number of limitations. This is a small pilot study, not related to comparative analysis. Further larger-scale, long-term, and well-controlled studies are needed to explore the use of these two laser wavelengths in order to offer this method for non-surgical treatment of thrombosed external hemorrhoids. Abbreviations Nd:YAG: neodymium-doped yttrium aluminum garnet; Er:YAG: erbium-doped yttrium aluminum garnet; VEL: vaginal non-ablative erbium laser; VAS: Visual Analog Scale. Declarations Ethics approval and consent to participate : The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethic Committee of Private Educational Institution of Supplementary Education “Academy of Medical Education named F.I. Inosemtsev” (protocol № 2-2025, 25.03.2025). Written informed consent was obtained for all participants. Consent for the publication : All the patients had given a written informed voluntary consent to participate in the study and publish their data. Availability of data and materials: The data that support the findings of this study are not publicly available due to privacy reasons but are available from the corresponding author upon reasonable request. Competing Interests: The authors declare no conflict of interest and guarantee that the article is the original work of the authors. Funding: No external source of funding. This research did not receive any specific grant from funding agencies in the public, commercial, or non-for-profit sectors. Authors’ contributions: Pustotina O.: collection of clinical data and creation of an electronic database for the results, analysis of the results of statistical processing of the clinical material and their interpretation, writing, correcting, and editing of the article before the publication. Lopatina A. and Vizintin Z.: writing, correcting, and editing of the article before the publication. All authors read and approved the final manuscript. Acknowledgements: not applicable References Hawkins AT, Davis BR, Bhama AR, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids. Dis Colon Rectum. 2024;67(5):614–23. Aigner F, Gruber H, Conrad F, et al. Revised morphology and hemodynamics of the anorectal vascular plexus: impact on the course of hemorrhoidal disease. Int J Colorectal Dis. 2009;24(1):105–13. Greenspon J, Williams SB, Young HA, Orkin BA. Thrombosed external hemorrhoids: outcome after conservative or surgical management. Dis Colon Rectum 2004;;47(9):1493–1498;. Jongen J, Bach S, Stübinger SH, Bock JU. Excision of thrombosed external hemorrhoid under local anesthesia: a retrospective evaluation of 340 patients. Dis Colon Rectum. 2003;46(9):1226–31. Senagore A, Mazier WP, Luchtefeld MA, et al. Treatment of advanced hemorrhoidal disease: a prospective, randomized comparison of cold scalpel vs. contact Nd:YAG laser. Dis Colon Rectum. 1993;36(11):1042–9. 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Short-term effects of an erbium/ neodymium laser combination in superficial dyspareunia: a pilot study. Climacteric. 2022;25(2):208–11. 10.1080/13697137.2021.2014809 . Okui N, Okui M, Gambacciani M, November. 08, (2022) Is Erbium/Neodymium Laser Combination Therapy an Effective Treatment Option for Interstitial Cystitis/Bladder Pain Syndrome With Vulvodynia? Cureus 14(11): e31228. 10.7759/cureus.31228 Zivanovic I, Gamper M, Fesslmeier D, Walser C, Regauer S, Viereck V. Nd:YAG/Er:YAG dual laser compared with topical steroid to treat vulvar lichen sclerosus: A randomized controlled trial. BJOG. 2024;131(6):740–9. 10.1111/1471-0528.17737 . Alldinger I, Poschinski Z, Ganzera S, Helmes C. Perianal thrombosis: no need for surgery. Langenbecks Arch Surg. 2022;407(3):1251–6. 10.1007/s00423-021-02415-2 . Lukac M, Zorman A, Lukac N, et al. Characteristics of Non-Ablative Resurfacing of Soft Tissues by Repetitive Er:YAG Laser Pulse Irradiation. Lasers Surg Med. 2021;53(9):1266–78. Marini L, Alexiou A. Photo-Thermal rejuvenation with 1064 nm Nd:YAG PIANO pulse laser. J Laser Health Acad. 2012;1:75–9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6305528","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":452962370,"identity":"5b5aa625-d940-4b5d-beb1-d6682f843925","order_by":0,"name":"Olga Pustotina","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1UlEQVRIiWNgGAWjYPACCQYG9gYgbWBBlHLGBoYEoBaeAyAtEkRrAVmUALWOEDCXSH/+4OMPizz+mc+vbvhRIMHA396dgFeL5Ywcw8YZCRLFErdzym72AB0mcebsBrxaDG7kMDbzJEgkNtzOSbvBA9RiIJFLSEv6Q7CW+TfPpN38Q5yWBEOwlg032I/dJsoWy543hjNnpEkkbjyTw3ZbxkCCh6BfzNnTH3z4YFOXOO/48Wc33/yxkeNv7yXgMASTB8zmwascTQv7A4KqR8EoGAWjYGQCAJ9/SgGgbvhUAAAAAElFTkSuQmCC","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Olga","middleName":"","lastName":"Pustotina","suffix":""},{"id":452962372,"identity":"c27e9d45-3cc5-4dfd-a0d3-8eeeea093bcf","order_by":1,"name":"Anna Lopatina","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Anna","middleName":"","lastName":"Lopatina","suffix":""},{"id":452962374,"identity":"f4724130-0cb1-4b7a-bce3-7ea72f2d7789","order_by":2,"name":"Zdenko Visintin","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Zdenko","middleName":"","lastName":"Visintin","suffix":""}],"badges":[],"createdAt":"2025-03-25 16:08:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6305528/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6305528/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82581708,"identity":"f541ded8-35bc-4e77-ae94-f8edffea21b2","added_by":"auto","created_at":"2025-05-13 06:39:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":22837,"visible":true,"origin":"","legend":"\u003cp\u003eMean anal pain score before, directly after and 1 week after the treatment (VAS)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6305528/v1/5529123083e033d4f333a817.png"},{"id":82580195,"identity":"e56196d9-be5b-437d-9161-5abe2fcc5dde","added_by":"auto","created_at":"2025-05-13 06:31:00","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":20884,"visible":true,"origin":"","legend":"\u003cp\u003eMean defecation pain score before and 1 week after the treatment (VAS)\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6305528/v1/597bc52a73c8a9bb2a8b358a.png"},{"id":82581710,"identity":"d7a6ee35-db26-4078-be2b-26e8621aedb6","added_by":"auto","created_at":"2025-05-13 06:39:00","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":502138,"visible":true,"origin":"","legend":"\u003cp\u003ePatient A., 32 years old. Two months postpartum. She presented with severe anal pain (VAS 10) and a sharply painful, dense formation in the anal region that appeared 1.5 days prior, along with severe pain during defecation (VAS 10). Examination revealed a thrombosed external hemorrhoid measuring 15×10 mm and four swollen external hemorrhoids that were moderately painful upon palpation (Fig. 3a). A single session of perianal treatment was performed using an Nd:YAG laser in PIANO mode and an Er:YAG laser in SMOOTH mode. The treated area measured 8×8 cm, and the procedure duration was 15 minutes. Directly after the procedure, the pain decreased to 2 points. During the follow-up examination one week later, the size of the previously thrombosed hemorrhoid had reduced to 5×5 mm, perianal swelling had significantly decreased (Fig. 3b), and the pain syndrome was absent.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6305528/v1/123adac53a97a4a987da362c.png"},{"id":84834197,"identity":"aacc7730-6663-484c-a843-133416de4507","added_by":"auto","created_at":"2025-06-17 20:46:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1348783,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6305528/v1/3b7a100f-defd-49c6-a7f2-a6d92ba46a05.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eNonsurgical treatment of thrombosed external hemorrhoids using non-ablative Er:YAG and Nd:YAG laser\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThrombosed external hemorrhoid is one of the severe complications of the hemorrhoidal disease. Patients present with an acutely painful formation in the perianal area and develop severe pain syndrome. The pathological enlargement of hemorrhoids is caused by circulatory disorders in the cavernous formations, along with dystrophic changes in the general longitudinal muscle of the submucosal layer of the rectum and the Parks ligament, which hold the cavernous bodies in the anal canal. Acute circulatory disturbances cause blood clots of the hemorrhoids, accompanied by severe pain in the perianal area. Within three days after symptom onset, a thrombosed hemorrhoid may evacuate spontaneously, leaving a small ulcer with residual clot at the anal opening. This is typically resolved on its own over a few weeks, leaving only a skin tag. Patients with severe pain unresponsive to conservative therapy have a high risk for infection and necrotic complications and require surgical intervention [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe primary methods for pain relief and preventing possible complications include excision of the thrombosed hemorrhoid (hemorrhoidectomy) or incision with evacuation of the clot (enucleation), which is usually performed using a surgical scalpel or laser. Surgical methods require anesthesia, a high duration of hospital stay and a long postoperative care, which can take up to 40 days. In the initial days after hemorrhoid surgery, patients often experience considerable pain, a sensation of \u0026ldquo;tightness\u0026rdquo;, constipation, swelling, and wounds discharge. Supportive care typically involves wound care, warm sitz baths, stool softeners, and pain management with oral analgesics and, in some cases, narcotic medications [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe complications following hemorrhoid surgery are not very often but can be very severe. They include urinary retention, urinary tract infection, fecal impaction and fecal incontinence, bleeding, perianal abscess/fistula, and deep space infection [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The recurrence rate of thrombosis after hemorrhoid surgery can reach 30% [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSurgical removal of hemorrhoids using ablative lasers, including neodymium-doped yttrium aluminum garnet (Nd:YAG), diode, or CO2 lasers, has been described [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Laser hemorrhoidectomy, compared to traditional surgery, decreases operative time, reduces the duration of hospital stay, causes less postoperative pain, and results in faster wound healing. However, laser-assisted surgery is associated with a higher incidence of infectious complications, pelvic organ dysfunction, and has the same high recurrence rates around 30% [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn recent years, non-ablative lasers, such as Nd:YAG and erbium lasers generated by yttrium aluminum garnet (Er:YAG) (Fotona, Slovenia), have been used for treating pelvic floor dysfunction. Long-term experience demonstrates the high effectiveness of vaginal non-ablative erbium laser (VEL) therapy in treating vulvovaginal atrophy, stress urinary incontinence, pelvic organ prolapses, vaginal relaxation syndrome [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. We previously reported about endometrial recovery [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and improving of anorectal dysfunction in patients treated by Er:YAG laser [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The Nd:YAG laser, with a wavelength of 1064 nm in PIANO mode, is also widely used in gynecology for treatment vulvodynia, superficial dyspareunia, and lichen sclerosus [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Combined VEL and Nd:YAG laser therapy, as shown in Gambacciani and Fidecicchi study [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], was significantly more effective for improving vulvar pain and superficial dyspareunia than VEL alone. Okui N. et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] reported resolving symptoms in a patient with refractory interstitial cystitis, bladder pain syndrome and vulvodynia treated with combined laser therapy. Non-ablative dual Nd:YAG/Er:YAG laser therapy was safe and significantly improved clinical outcome and subjective symptoms in patients with lichen sclerosus similarly as the topical corticosteroids [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe aim of this study was to evaluate the effectiveness of combined erbium and neodymium laser therapy in non-ablative mode for treatment women with thrombosed external hemorrhoids.\u003c/p\u003e "},{"header":"Methods","content":"\u003ch3\u003eStudy design and patients\u003c/h3\u003e\n\u003cp\u003e This study was a retrospective analysis of data recorded from patient charts at Dr. Pustotina\u0026rsquo;s Private Clinic in Moscow, Russia from February 2023 to September 2024 and was conducted in accordance with the Helsinki Declaration and approved by the Ethic Committee of Private Educational Institution of Supplementary Education \u0026ldquo;Academy of Medical Education named F.I. Inosemtsev\u0026rdquo; (protocol №2-2025, 25.03.2025). After signing informed consent, we collected data of 14 women aged 20\u0026ndash;35 years (7 of whom were in the early postpartum period) with a verified diagnosis of thrombosed external hemorrhoids who were treated with Erbium/Neodymium Laser combination.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eLaser treatment\u003c/h2\u003e \u003cp\u003eNonsurgical treatment of thrombosed external hemorrhoids was conducted at an outpatient clinic and involved a single irradiation of the perianal area with a non-ablative laser radiation, consisting of two steps. In the 1st step, the perianal area was irradiated with an Nd:YAG laser (Fotona SP Dynamis, PIANO mode), an R33 non-contact handpiece with a spot size of 9 mm, PIANO pulse mode (5 s), and fluence of 120 J/cm\u003csup\u003e2\u003c/sup\u003e. 6\u0026ndash;8 passes were conducted in the brushing mode until the skin surface temperature reached 39\u0026ndash;40\u0026deg;C. In the 2nd step, the area was irradiated with an Er:YAG laser at a wavelength of 2940 nm in SMOOTH mode. The PS03 handpiece with a 7-mm spot size, frequency 2.5 Hz, and pulse fluence 7.0 J/cm\u003csup\u003e2\u003c/sup\u003e, was used to perform four passes in the brushing mode over the perianal area. Before laser exposure, a thin layer of water-soluble colorless gel, typically used for ultrasound scanning, was applied to the skin of the perianal area to ensure a painless and comfortable procedure. No other anesthesia was used.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMethods\u003c/h3\u003e\n\u003cp\u003eAll patients with thrombosed external hemorrhoids present an acutely painful blue mass in the perianal area and severe pain syndrome, occurring within three days after symptoms onset. Patients with malignant diseases of the perianal region and rectum, systemic inflammatory infections, Crohn\u0026rsquo;s disease, complications of hemorrhoids (abscess, necrosis, wound infection, bleeding) were excluded from the study.\u003c/p\u003e \u003cp\u003eAll patients underwent pain assessment using the Visual Analog Scale (VAS) before, directly after the procedure and one week after laser therapy. Dynamic of thrombosed external hemorrhoids, rectal function, defecation, and complications assessed for one-week post-treatment. A comprehensive evaluation of adverse events was conducted during the procedure and the subsequent week after. Treatment satisfaction was assessed on a 4-point scale: 0 points \u0026ndash; unsatisfactory, 1 point \u0026ndash; satisfactory, 2 points \u0026ndash; good, 3 points \u0026ndash; excellent. Recurrent rate was assessed after 6 months via phone call.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed using Statistica 12 software (StatSoft. Inc., USA). For normally distributed indicators, the results are presented as median and interquartile range Me (Q\u003csub\u003e25\u003c/sub\u003e; Q\u003csub\u003e75\u003c/sub\u003e). Quantitative indicators were compared using Student\u0026rsquo;s t-test for normally distributed values, otherwise the Mann-Whitney test was applied. The criterion of statistical significance of differences was accepted as p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe total duration of the laser procedure was 15 minutes and did not cause additional pain or discomfort in any patient, despite all of them initially reporting severe anal pain (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of treatment patients (n\u0026thinsp;=\u0026thinsp;14)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePatients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c3\" namest=\"c2\" rowspan=\"2\"\u003e \u003cp\u003eAge, years\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBMI,\u003c/p\u003e \u003cp\u003ekg/m\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEarly postpartum\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eAnal pain (VAS)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003eDefecation pain (VAS)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePatient satisfactions (Scores)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBefore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDirectly after\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 week after\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eBefore\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1 week after\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMe (Q\u003csub\u003e25\u003c/sub\u003e; Q\u003csub\u003e75\u003c/sub\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e28,5 (23;32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23,6 (20;27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eyes \u0026ndash; 7/14 (50%)\u003c/p\u003e \u003cp\u003eno \u0026ndash; 7/14 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8 (7;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (0;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0 (0; 0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8 (7;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0 (0;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3 (3;3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003ep value, Wilcoxon\u0026rsquo;s t-criterion with group before\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0,001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0,001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0,001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTwelve patients (85.7%) described the pain as severe (6\u0026ndash;10 points) and two (14.3%) as moderate (3 and 5 points). Directly after the procedure, pain was completely relieved in 35.7% of patients, while others reported a pain level of 1\u0026ndash;3 points. The mean pain score before and immediately after the treatment was 8 (7;10) and 1 (0;2) points, respectively (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). At one week follow up there were no patients with pain (VAS\u0026thinsp;=\u0026thinsp;0). All patients also reported pain during defecation, with 85.7% rating it as severe (6\u0026ndash;10 points) and two as moderate (4\u0026ndash;5 points). One week after treatment, 57.1% of women experienced completely painless defecation, while others reported pain levels of 1\u0026ndash;2 points. The average pain during defecation score before treatment was 8 (7;10) points, which decreased to 0 (0;2) points after one week (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAfter the laser procedure, patients were advised to hydrate and soften the mucosa of the anal canal before each bowel movement using a moisturizing intimate gel. All of them reported easier and more comfortable bowel emptying compared to when not using it. No complications or worsening of symptoms were observed during the follow-up period. There were no patients with pain syndrome, painful hemorrhoids, and infection complications. The hemorrhoids had significantly reduced in size, and in half of the women, they had disappeared entirely. All patients rated their treatment satisfaction as high (3 points). At six months follow up there were no patients with recurrence of hemorrhoids. Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e demonstrates dynamic of thrombosed external hemorrhoid during one week after treatment in postpartum patient 32 y.o.\u003c/p\u003e "},{"header":"Discussion","content":"\u003cp\u003eThe traditional method for treating thrombosed external hemorrhoids, accompanied by severe pain syndrome, is surgical intervention. This involves either excision of the hemorrhoids or removal of the thrombus through an incision. The main disadvantages of surgical treatment include invasiveness, the need for anesthesia, prolonged postoperative care (up to 40 days), as well as risks of postoperative complications and disease recurrence. A recent study [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] demonstrated that perianal thrombosis and thrombosed external hemorrhoids can heal well without surgery. Five hundred four patients with perianal thrombosis and 115 patients with thrombosed hemorrhoids which were treated conservatively, with sitz baths and oral pain medication, stated that their pain had largely resolved after 5 days and completely disappeared after 10 days. But most of patients in this study evaluated their pain before the treatment as mild or moderate. Mean pain on a numerical rating scale (0\u0026ndash;10) was 3.8 for perianal thrombosis and 5.2 for thrombosed hemorrhoids. Recurrence rate after thrombosis was 6.3%.\u003c/p\u003e \u003cp\u003eIn our study, for the first time, the possibility of a non-surgical approach to reducing very severe pain syndrome in female patients with thrombosed external hemorrhoids was demonstrated. The mean pain score was 8 (7;10) on the VAS. Combined exposure of the perianal area to a non-ablative Nd:YAG laser in PIANO mode and an Er:YAG laser in SMOOTH mode reduced anal pain severity from 5\u0026ndash;10 to 0\u0026ndash;3 points on the VAS within only 15 minutes, with 35.7% of patients achieving complete pain relief during the procedure. No complications and recurrence were observed for 6 months follow up.\u003c/p\u003e \u003cp\u003eNon-ablative erbium laser with a wavelength of 2940 nm in SMOOTH mode induces stepwise tissue heating via a rapid sequence of pulse packets lasting 250msec (equivalent to 0.25 sec) with 400-msec intervals. This controlled thermal diffusion triggers immune cell responses, epithelial regeneration, fibroblast activation, and extracellular matrix component production, promoting vascular restoration and neoangiogenesis, thereby enhancing oxygenation and nutrient supply to the treated area. The discrete pulse packet delivery technology allows tissue heating up to 60\u0026ndash;63\u0026deg;C, optimal for collagen restoration and neoangiogenesis, without exceeding the surface ablation threshold or causing irreversible collagen denaturation [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Nd:YAG laser, with a wavelength of 1064 nm in PIANO mode, generates ultra-long laser pulses lasting several seconds, which far exceed the thermal relaxation time of tissues (such as epidermis, hair follicles, and blood vessels), preventing an initial temperature spike and epithelial destruction while evenly distributing thermal energy to the submucosa, dermis, and subcutaneous fat, stimulating neocollagenesis, neoangiogenesis, and tissue elasticity restoration. Additionally, Nd:YAG in PIANO mode has vasodilatory and anti-inflammatory effects [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBased on the obtained clinical effect, we can conclude that laser treatment facilitates the release of vascular-muscular spasm and the restoration of blood circulation in the tissues of the hemorrhoids. Improved blood circulation is accompanied by clot resorption and a reduction in inflammation and edema in the perianal area. Additionally, the rapid reduction in the size of hemorrhoids is facilitated by the densification of their walls due to the contraction of collagen fibers under the influence of thermal diffusion generated by the non-ablative laser, followed by stimulation of neocollagenesis in the supporting structures of the cavernous formations.\u003c/p\u003e \u003cp\u003eAn important aspect of preventing disease recurrence is avoiding trauma to the hemorrhoids and excessive compression of the pelvic floor during defecation. Preliminarily moisturizing and softening the mucosa of the anal canal with a hydrating intimate gel protects it from damage during anal sphincter stretching, reduces straining effort, and facilitates easier and more comfortable bowel emptying.\u003c/p\u003e \u003cp\u003eThis minimally invasive approach, which we propose for managing of patients with thrombosed external hemorrhoids, provides rapid pain relief and may help some patients avoid surgical treatment.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis pilot study shows that treatment with a combination of Er:YAG\u0026thinsp;+\u0026thinsp;Nd:YAG has a potential to become a non-surgical treatment for thrombosed external hemorrhoids. Rapid pain relief, achieved in a single procedure that does not require anesthesia, incisions, or rehabilitation, could be considered as an emergency treatment method for patients with severe anal pain associated with thrombosed external hemorrhoids.\u003c/p\u003e \u003cp\u003eThis study has a number of limitations. This is a small pilot study, not related to comparative analysis. Further larger-scale, long-term, and well-controlled studies are needed to explore the use of these two laser wavelengths in order to offer this method for non-surgical treatment of thrombosed external hemorrhoids.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eNd:YAG: neodymium-doped yttrium aluminum garnet; Er:YAG: erbium-doped yttrium aluminum garnet; VEL: vaginal non-ablative erbium laser; VAS: Visual Analog Scale.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e: The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethic Committee of Private Educational Institution of Supplementary Education \u0026ldquo;Academy of Medical Education named F.I. Inosemtsev\u0026rdquo; (protocol № 2-2025, 25.03.2025). Written informed consent was obtained for all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for the publication\u003c/strong\u003e: All the patients had given a written informed voluntary consent to participate in the study and publish their data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003edata that support the findings of this study are not publicly available due to privacy reasons but are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e The authors declare no conflict of interest and guarantee that the article is the original work of the authors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e No external source of funding. This research did not receive any specific grant from funding agencies in the public, commercial, or non-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u003c/strong\u003e Pustotina O.: collection of clinical data and creation of an electronic database for the results, analysis of the results of statistical processing of the clinical material and their interpretation, writing, correcting, and editing of the article before the publication. Lopatina A. and Vizintin Z.: writing, correcting, and editing of the article before the publication. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003enot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHawkins AT, Davis BR, Bhama AR, et al. 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Characteristics of Non-Ablative Resurfacing of Soft Tissues by Repetitive Er:YAG Laser Pulse Irradiation. Lasers Surg Med. 2021;53(9):1266\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarini L, Alexiou A. Photo-Thermal rejuvenation with 1064 nm Nd:YAG PIANO pulse laser. J Laser Health Acad. 2012;1:75\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"thrombosed external hemorrhoids, non-ablative erbium laser, neodymium laser in PIANO mode","lastPublishedDoi":"10.21203/rs.3.rs-6305528/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6305528/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eIn recent years, non-ablative lasers, such as neodymium and erbium lasers generated by yttrium aluminum garnet (Nd:YAG and Er:YAG), have been used for treating various female pelvic floor disorders.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo evaluate the effectiveness of nonsurgical treatment of thrombosed external hemorrhoids using a non-ablative erbium and neodymium laser.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis was a retrospective study that analyzed data from charts of fourteen female patients with thrombosed external hemorrhoids associated with severe pain syndrome, which underwent a single procedure of perianal area irradiation with a non-ablative erbium and neodymium laser in PIANO mode.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe assessment of pain using a visual analog scale directly after the 15-minute procedure decreased from 8 (7;10) to 1 (0;2) points (р\u0026lt;0.0001). The severity of defecation pain was reduced over a week from 8 (7;10) to 0 (0;2) points (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). One week after treatment, pain syndrome was completely absent, and half of the women having none remaining of hemorrhoids. No complications or symptom deterioration were observed. No patients were with recurrence of hemorrhoids for six months follow up.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eA single procedure of combined exposure to a non-ablative erbium and neodymium laser on the perianal area in patients with thrombosed external hemorrhoids seems to effectively alleviates pain syndrome and promotes rapid symptoms regression. Larger-scale, long-term, and well-controlled studies are needed to confirm the results of this small pilot study.\u003c/p\u003e","manuscriptTitle":"Nonsurgical treatment of thrombosed external hemorrhoids using non-ablative Er:YAG and Nd:YAG laser","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-13 06:30:55","doi":"10.21203/rs.3.rs-6305528/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0c314cea-f9ad-4c0a-85b5-13a84291416e","owner":[],"postedDate":"May 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-17T20:38:14+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-13 06:30:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6305528","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6305528","identity":"rs-6305528","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}