Which technique is preferable for grade 2-3 hemorrhoidal disease: Laser vs. rubber band ligation?

Which technique is preferable for grade 2-3 hemorrhoidal disease: Laser vs. rubber band ligation? | 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 Which technique is preferable for grade 2-3 hemorrhoidal disease: Laser vs. rubber band ligation? Ahmet Cihangir EMRAL, Merter GULEN, Bahadır EGE This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5387370/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract BACKGROUND The aim of this study is to compare the short and long-term results (postoperative pain, complications, return to daily life, recurrence) between patients who underwent hemorrhoids laser procedure (HeLP) and rubber band ligation (RBL) due to grade 2–3 hemorrhoidal disease. METHODS The results of patients who underwent HeLP and RBL between June 2020 and June 2023 for grade 2–3 hemorrhoidal disease were evaluated retrospectively. The patient information was examined in terms of operation time, postoperative 1st, 7th and 14th day visual analog scale (VAS) values, the amount of analgesic used in the first 7 postoperative days, return to normal life (days), recurrence within 1 year and other complications (postoperative bleeding, thrombosis, urinary retention, infection/abscess, anal stenosis, deterioration in continence). RESULTS A total of 260 patients were included in the study, 166 of whom underwent RBL and 94 HeLP. Operation time, hospital stay (hours), VAS values, postoperative 7-day analgesic use (mg), worsening of incontinence, time to return to normal life (days), complications and recurrence within 1 year evaluated. HeLP has statistically significant lower postoperative 1st day pain and less analgesic use (mg) than RBL (p < 0.001). CONCLUSIONS The reduced pain and fewer analgesic use provided by HeLP, especially on the first postoperative day, improves patients' satisfaction. Hemorrhoids Laser Rubber band ligation Pain Figures Figure 1 Figure 2 Introduction Hemorrhoidal disease is a benign anorectal disease frequently encountered in the clinics of surgeons interested in proctology. Laser application has recently begun to be used, especially in benign anorectal diseases such as perianal fistula, pilonidal sinus and hemorrhoidal disease [ 1 , 2 ]. In early stage (grade 1–2) hemorrhoidal disease, 4%-7% of patients are symptomatic and the first line treatment in these patients is conservative management including lifestyle changes, diet and medical therapy. However, surgical treatment is indicated for hemorrhoidal disease in patients who do not respond to conservative treatment [ 3 – 4 ]. Milligan-Morgan hemorrhoidectomy, one of the most commonly used techniques today, was first described in 1937. Excisional hemorrhoidectomy is the most effective method with a low recurrence rate compared to other techniques in hemorrhoidal disease. Due to complications such as bleeding, infection/abscess, anal stenosis, incontinance, fissure and postoperative pain following excisional hemorrhoidectomy, non-excisional, minimally invasive treatments such as rubber band ligation (RBL) and hemorrhoids laser procedure (HeLP) have been developed [ 4 – 6 ]. The use of laser was first described in 1998 in an animal study conducted by Barr et al. [ 7 ]. In this treatment, a laser fiber is inserted through a skin incision at the hemorrhoidal base and the hemorrhoidal cushions are coagulated [ 8 ]. Laser is used especially in grade 2–3 hemorrhoidal disease and has been shown in studies to have acceptable recurrence rates despite shorter operative time, earlier return to daily life and less postoperative pain compared to excisional methods [ 9 – 10 ]. Rubber band ligation (RBL) in hemorrhoidal disease was described by Blaisdell and modified by Barron until today [ 11 – 12 ]. The most important complications of RBL are rectal discomfort, pain and bleeding [ 4 , 13 ]. The aim of this study is to compare the short and long-term results (postoperative pain, complications, return to daily life, recurrence) between patients who underwent hemorrhoids laser procedure (HeLP) and rubber band ligation (RBL) due to grade 2–3 hemorrhoidal disease. Materials and methods Ethics committee approval number ‘46’ dated 18.12.2023 was received from Atılım University Medicana Hospital for this study. The results of patients who underwent HeLP and RBL between June 2020 and June 2023 for grade 2–3 hemorrhoidal disease were evaluated retrospectively. The patient information was examined from the prospectively completed standardized daily follow-up records in terms of postoperative 1st, 7th and 14th day visual analog scale (VAS) values, the amount of analgesic used in the first 7 postoperative days, return to normal life (days), recurrence within 1 year and other complications (postoperative bleeding, thrombosis, urinary retention, infection/abscess, anal stenosis, deterioration in continence). Patients with grade 1 and 4 hemorrhoidal disease, thrombosed hemorrhoidal disease, inflammatory bowel disease (crohn’s disease/ulcerative colitis), autoimmune disease, pregnancy, other anorectal disease (such as fissure, fistula, abscess), malignancy, previous anorectal surgery history, chemotherapy or radiotherapy history, active infectious disease (such as tuberculosis, viral diseases), diabetes, use of blood thinners, immunosuppressed patients, patients who had not previously received medical treatment for hemorrhoidal disease, and patients aged 60 were excluded from the study. Patients who did not respond to conservative treatment, those with grade 2 or 3 hemorrhoidal disease, those aged 18–60 years, patients who underwent 2-quadrant RBL or 2-quadrant HeLP, and all patients who met the study criteria were included in the study. No patient underwent bowel preparation before the surgical procedure. All surgical procedures were performed in the jack-knife position under local anesthesia (bupivacaine) combined with sedation. Before anesthesia induction, all patients were given 1 gr ceftriaxone and 500 mg metronidazole intravenously. Oral intake was started for all patients at the 1st hour postoperatively. All patients were discharged when they felt well after sedation. Postoperative information of the patients was recorded on standardized forms after 1st day, 7th day, 14th day, 1st month, 3rd month and 1st year controls. The patients were prescribed 5-day ciprofloxacin 2x500mg and metronidazole 3x500mg oral tablets and 1-month calcium dobesilate 2x1000mg oral tablets. If they had pain, dexketoprofen 25mg was prescribed and the dose (mg) they received for 7 postoperative days was noted. The patients were advised to have a high-fiber diet, avoid hot/spicy foods, and apply hot water 3 times a day for 5 minutes during the postoperative period. The patients' 1st, 7th and 14th day VAS values, analgesic use (mg), time to return to normal life, complications and recurrence during 1-year follow-up were examined. VAS (0 = no pain to 10 = severe pain) was used for postoperative pain. Incontinence evaluation was performed at the 3rd postoperative month using the Cleveland Clinic Incontinence Score (CCIS, 0 = perfect continence and 20 = complete incontinence) and patients with worsening continence were noted. Surgical procedure: HeLP A laser probe was advanced to the root of the diseased internal hemorrhoidal bundle at the level of the dentate line between the mucosa and the internal sphincter through a skin incision of approximately 2 mm from the anal verge. Diode laser generator (LEONARDO® DUAL 45 Biolitec, Jena, Germany) 8W 1470 nm was set. 6 shots of 3 seconds each were made from proximal to distal for each diseased hemorrhoidal cushion (Fig. 1 ). Then, cold application was made to the treated bundle with sterile ice cubes for 2 minutes. Anal blockage was performed with a total of 0.5mg/kg bupivacaine injection equally into four quadrants. No suture was used. RBL After aspiration was applied approximately 1–2 cm proximal to the dentate line with a disposable anoscope and McGown applicator, with the vacuum chamber pressure of the band ligator being between − 1 bar=-0.1 MPa, including the mucosa and submucosa, rubber band ligation was applied to the root of the aspirated diseased hemorrhoidal cushion (Fig. 2 ). Anal blockage was performed with a total of 0.5mg/kg bupivacaine injection equally into four quadrants. No suture was used. Statistical analysis: Analysis was carried out with SPSS v23 (IBM-SPSS, Chicago, IL, USA). Continuous descriptive data was expressed as the mean ± std. deviation, and categorical descriptive data were presented as numbers and percentages. The distribution is checked by looking at Skewness and Kurtosis. Independent sample t-test was used to the relationship between 2 continuous independent variables with a normal distribution. The relationship between categorical variables was examined using the Chi-Square test. A p value of less than 0.05 was considered to be statistically significant. Results A total of 260 patients were included in the study, with 166 undergoing Rubber Band Ligation (RBL) (63.8%) and 94 receiving HeLP (36.2%). The overview of patient demographics and hemorrhoid grades is presented in Table 1. Table1. The overview of patient demographics and hemorrhoid grades Hemorrhoids laser procedure Rubber Band Ligation p Age 41.2±7.5 41.3±5.7 0.89 Gender Male Female 29 (30.9%) 65 (69.1%) 68 (41%) 98 (59%) 0.1 Preop. hemorrhoid grade Grade 2 Grade 3 52 (55.3%) 42 (44.7%) 87 (52.4%) 79 (47.6%) 0.65 No statistically significant difference was observed between the preoperative hemorrhoidal disease grades of the patients. The postoperative outcomes of patients within 1 year, including VAS values (1 st , 7 th , and 14 th day), postoperative analgesic use (mg) over 7 days, worsening of incontinence, time to return to normal life (days), complications, and recurrence, are summarized in Table 2. All patients were treated for 2-quadrant hemorrhoidal diseases. No deterioration in continence was observed according to CCIS with either method. There was no statistically significant difference between the two groups in terms of VAS values on the 7 th and 14 th postoperative days, return to normal life, complications and recurrence. HeLP has statistically significant lower postoperative 1 st day pain and less analgesic use (mg) than RBL (p<0.001). Table 2. Postoperative outcomes of patients Hemorrhoids laser procedure Rubber Band Ligation p Visual Analog Scale Postoperative day 1 Postoperative day 7 Postoperative day 14 1.5±0.5 0.2±0.5 0±0 2.3±1.6 0.2±0.6 0±0 <0.001 0.3 - Analgesic use (mg) 64.9±27.5 78.2±31 <0.001 Worsening of continence 0 0 - Return to normal life (days) 2.3±0.6 2.3±0.8 0.4 Recurrence (in 1 year) 14 (14.9%) 26 (15.7%) 0.87 Complications Bleeding Thrombosis Urinary retention Infection Anal stenosis 3 (3.2%) 3 (3.2%) 0 0 0 0 11 (6.6%) 10 (6%) 0 1 (0.6%) 0 0 0.24 0.38 - 1 - - Discussion Laser treatment causes intrahemorrhoidal coagulation and tissue contraction macroscopically, and submucosal protein denaturation and fibrosis microscopically. In this way, the area where laser treatment is applied adheres to the underlying tissues and prevents prolapse [ 14 , 15 ]. RBL causes fibrosis, retraction and fixation of the hemorrhoidal cushions [ 16 ]. Both treatments are minimally invasive and generally do not cause internal sphincter damage. Therefore, worsening incontinence or anal stenosis is generally not expected with either method. In this study, both methods were compared and it was seen that there was no worsening in incontinence according to CCIS values ​​and no patient developed anal stenosis. Due to hemorrhoidal disease, Iyer et al. found RBL complication rates as 8.7% severe pain, 2.8% bleeding, 1.5% external pack thrombosis, and 0.09% pelvic sepsis [ 17 ]. Nakeeb et al. reported complication rates after RBL as 4.1% pain, 4.1% minor bleeding, 1.3% vasovagal symptoms, 0.13% infection, 0.13% perianal fistula, and 0.4% perianal fissure in their studies [ 18 ]. In their study, Jin et al. found a bleeding rate of 2.9% following the use of laser for hemorrhoidal disease and reported no cases of infection, urinary retention, or deterioration in incontinence among the patients [ 19 ]. It has been demonstrated that both laser treatment and RBL for hemorrhoidal disease do not harm muscle and nerve fibers and result in less postoperative pain compared to conventional hemorrhoidectomy [ 20 ]. In this study, when the two methods were compared in terms of postoperative complications, we observed no significant difference and low complication rates. In a prospective comparison study of rubber band ligation and laser treatment for hemorrhoidal disease, it was found that laser treatment was statistically superior in reducing postoperative pain [ 19 ]. In this study, it was seen that HeLP caused less pain than RBL, especially on the first postoperative day. However, it was seen that these two minimally invasive methods, which were not expected to cause much postoperative pain, were no longer superior to each other in terms of pain in the following days. Laser beam does not damage mucosa, muscle and nerve fibers and only a 1–2 mm incision is used. [ 15 , 20 ]. Severe perineal pain up to 8.7% has been described in the literature following RBL [ 17 , 21 ]. Although RBL is applied above the dentate line, the pain is thougth to be due to anal discomfort (feeling of anal fullness) or damage that may develop in muscular or nerve fibers due to excessive aspiration or progression towards the dentate line. Another statistically significant result in this study was seen in postoperative analgesic use. As a reflection of the superiority of HeLP over RBL in postoperative pain, we see that postoperative analgesic use is also less in HeLP. In addition, although HeLP causes less pain on the first postoperative day compared to RBL, both methods are minimally invasive methods and postoperative analgesic use is low in both methods. We were not surprised by the lack of a statistically significant difference in this study in terms of early return to normal life due to the low analgesic use and pain in both methods in the postoperative period. In the context of laser treatment for hemorrhoidal disease, Weyand et al. reported a recurrence rate of 8.8%, while Faes et al. reported a recurrence rate of 34%. It has been described in the literature that recurrence after RBL is between 6.6% and 18% [ 21 , 22 ]. In this study, in the 1-year follow-up of patients who received both minimally invasive treatments, it was seen that HeLP had a recurrence rate of 14.9% and RBL had a recurrence rate of 15.7%, and that these treatments had no statistical superiority over each other. Conclusions In early stage (grade 2–3) hemorrhoidal disease, HeLP and RBL are minimally invasive non-excisional methods that can be preferred in terms of acceptable recurrence rates, low postoperative pain, complication rates and early return to work. HeLP and RBL can be preferred in early stage hemorrhoidal disease because it is easy to perform, almost painless after the procedure, and has low complication rates. The reduced pain and fewer analgesic use provided by HeLP, especially on the first postoperative day, may improves patients' satisfaction. Declarations Funding The author(s) received no financial support for the research, authorship, and/or publication of this article. Conflict of interest (COI) The author/s declare/s no conflict of interest. Author Contribution Conceptualization, M.G. and A.C.E.; methodology, M.G. and B.E.; formal analysis, M.G. and A.C.E.; investigation, A.C.E., M.G.; data curation: A.C.E., M.G.; writing—original draft preparation, M.G., B.E.; writing—review and editing, B.E.; visualization, M.G.; supervision, B.E. All authors have read and agreed to the published version of the manuscript. Acknowledgement The authors would like to thank all the hospital staff who contributed to the publication of this article. References Osborn NK, King KH, Adeniji OA, Parikh SR, LeVine MS, Quinn D, et al. 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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-5387370","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":381901903,"identity":"ea7c3e88-3a29-4aff-a545-790a7f4b311b","order_by":0,"name":"Ahmet Cihangir EMRAL","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAklEQVRIiWNgGAWjYDACZh4QKQHhPKg4AKYPPCBaS8KZAwwg/oEEvNbwILET2yBaGPBp4W/nPfi54JdFPr/Y2YcfEufdkbMXO/wQaIudnG4Ddi0Sh/mSpWf2SVjOnJ1uLJG47Zkxj3SaAVBLsrHZAexaDJh5DKR5eyQMDG6nMQC1HE7skU4AaTmQuA23FuPfIC32t9OYfyTOAWlJ/0BIi5k0zw+gLdJpbBKJDSAtOfhtkTjMY2bN2yBhIHE7jc0i4dhhY57bOQUHEgxw+4W//4zxbZ4/dQb8s9OYb3yoOSzHPjt984cPFXZyuLSAAWMbpoPxKAeDP4QUjIJRMApGwYgGAF1oW0aaLjpMAAAAAElFTkSuQmCC","orcid":"","institution":"Atilim University","correspondingAuthor":true,"prefix":"","firstName":"Ahmet","middleName":"Cihangir","lastName":"EMRAL","suffix":""},{"id":381901904,"identity":"77972fa5-bacc-4380-abea-0900c696eb57","order_by":1,"name":"Merter GULEN","email":"","orcid":"","institution":"Atilim University","correspondingAuthor":false,"prefix":"","firstName":"Merter","middleName":"","lastName":"GULEN","suffix":""},{"id":381901905,"identity":"6027e586-95f5-42eb-b93e-6ebdcd2febf5","order_by":2,"name":"Bahadır EGE","email":"","orcid":"","institution":"Atilim University","correspondingAuthor":false,"prefix":"","firstName":"Bahadır","middleName":"","lastName":"EGE","suffix":""}],"badges":[],"createdAt":"2024-11-04 10:53:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5387370/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5387370/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":71623311,"identity":"a6da8fff-ef66-41a8-a57b-54079d8a94f8","added_by":"auto","created_at":"2024-12-17 08:35:39","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":53560,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eHemorrhoids laser procedure (HeLP) application\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure1.HemorrhoidslaserprocedureHeLPapplication.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5387370/v1/cd03a67c2d0bad909aace0b8.jpg"},{"id":71623309,"identity":"5d8ed679-05a8-4f9a-8403-9f8099ac16e4","added_by":"auto","created_at":"2024-12-17 08:35:39","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":84206,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eColonoscopic view following Rubber Band Ligation\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure2.ColonoscopicviewfollowingRubberBandLigation.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5387370/v1/8e35311d37768b7dcac09758.jpg"},{"id":71625042,"identity":"238748a2-3eef-4fcc-ac72-2441516296fa","added_by":"auto","created_at":"2024-12-17 08:43:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":496905,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5387370/v1/616b3090-8ef2-4354-9a60-5a91095ff357.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Which technique is preferable for grade 2-3 hemorrhoidal disease: Laser vs. rubber band ligation?","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHemorrhoidal disease is a benign anorectal disease frequently encountered in the clinics of surgeons interested in proctology. Laser application has recently begun to be used, especially in benign anorectal diseases such as perianal fistula, pilonidal sinus and hemorrhoidal disease [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In early stage (grade 1\u0026ndash;2) hemorrhoidal disease, 4%-7% of patients are symptomatic and the first line treatment in these patients is conservative management including lifestyle changes, diet and medical therapy. However, surgical treatment is indicated for hemorrhoidal disease in patients who do not respond to conservative treatment [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMilligan-Morgan hemorrhoidectomy, one of the most commonly used techniques today, was first described in 1937. Excisional hemorrhoidectomy is the most effective method with a low recurrence rate compared to other techniques in hemorrhoidal disease. Due to complications such as bleeding, infection/abscess, anal stenosis, incontinance, fissure and postoperative pain following excisional hemorrhoidectomy, non-excisional, minimally invasive treatments such as rubber band ligation (RBL) and hemorrhoids laser procedure (HeLP) have been developed [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe use of laser was first described in 1998 in an animal study conducted by Barr et al. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In this treatment, a laser fiber is inserted through a skin incision at the hemorrhoidal base and the hemorrhoidal cushions are coagulated [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Laser is used especially in grade 2\u0026ndash;3 hemorrhoidal disease and has been shown in studies to have acceptable recurrence rates despite shorter operative time, earlier return to daily life and less postoperative pain compared to excisional methods [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRubber band ligation (RBL) in hemorrhoidal disease was described by Blaisdell and modified by Barron until today [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The most important complications of RBL are rectal discomfort, pain and bleeding [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe aim of this study is to compare the short and long-term results (postoperative pain, complications, return to daily life, recurrence) between patients who underwent hemorrhoids laser procedure (HeLP) and rubber band ligation (RBL) due to grade 2\u0026ndash;3 hemorrhoidal disease.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e Ethics committee approval number \u0026lsquo;46\u0026rsquo; dated 18.12.2023 was received from Atılım University Medicana Hospital for this study. The results of patients who underwent HeLP and RBL between June 2020 and June 2023 for grade 2\u0026ndash;3 hemorrhoidal disease were evaluated retrospectively. The patient information was examined from the prospectively completed standardized daily follow-up records in terms of postoperative 1st, 7th and 14th day visual analog scale (VAS) values, the amount of analgesic used in the first 7 postoperative days, return to normal life (days), recurrence within 1 year and other complications (postoperative bleeding, thrombosis, urinary retention, infection/abscess, anal stenosis, deterioration in continence).\u003c/p\u003e \u003cp\u003ePatients with grade 1 and 4 hemorrhoidal disease, thrombosed hemorrhoidal disease, inflammatory bowel disease (crohn\u0026rsquo;s disease/ulcerative colitis), autoimmune disease, pregnancy, other anorectal disease (such as fissure, fistula, abscess), malignancy, previous anorectal surgery history, chemotherapy or radiotherapy history, active infectious disease (such as tuberculosis, viral diseases), diabetes, use of blood thinners, immunosuppressed patients, patients who had not previously received medical treatment for hemorrhoidal disease, and patients aged\u0026thinsp;\u0026lt;\u0026thinsp;18 to \u0026gt;\u0026thinsp;60 were excluded from the study.\u003c/p\u003e \u003cp\u003ePatients who did not respond to conservative treatment, those with grade 2 or 3 hemorrhoidal disease, those aged 18\u0026ndash;60 years, patients who underwent 2-quadrant RBL or 2-quadrant HeLP, and all patients who met the study criteria were included in the study.\u003c/p\u003e \u003cp\u003eNo patient underwent bowel preparation before the surgical procedure. All surgical procedures were performed in the jack-knife position under local anesthesia (bupivacaine) combined with sedation. Before anesthesia induction, all patients were given 1 gr ceftriaxone and 500 mg metronidazole intravenously. Oral intake was started for all patients at the 1st hour postoperatively. All patients were discharged when they felt well after sedation. Postoperative information of the patients was recorded on standardized forms after 1st day, 7th day, 14th day, 1st month, 3rd month and 1st year controls. The patients were prescribed 5-day ciprofloxacin 2x500mg and metronidazole 3x500mg oral tablets and 1-month calcium dobesilate 2x1000mg oral tablets. If they had pain, dexketoprofen 25mg was prescribed and the dose (mg) they received for 7 postoperative days was noted. The patients were advised to have a high-fiber diet, avoid hot/spicy foods, and apply hot water 3 times a day for 5 minutes during the postoperative period.\u003c/p\u003e \u003cp\u003eThe patients' 1st, 7th and 14th day VAS values, analgesic use (mg), time to return to normal life, complications and recurrence during 1-year follow-up were examined. VAS (0\u0026thinsp;=\u0026thinsp;no pain to 10\u0026thinsp;=\u0026thinsp;severe pain) was used for postoperative pain. Incontinence evaluation was performed at the 3rd postoperative month using the Cleveland Clinic Incontinence Score (CCIS, 0\u0026thinsp;=\u0026thinsp;perfect continence and 20\u0026thinsp;=\u0026thinsp;complete incontinence) and patients with worsening continence were noted.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSurgical procedure:\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eHeLP\u003c/strong\u003e \u003cp\u003eA laser probe was advanced to the root of the diseased internal hemorrhoidal bundle at the level of the dentate line between the mucosa and the internal sphincter through a skin incision of approximately 2 mm from the anal verge. Diode laser generator (LEONARDO\u0026reg; DUAL 45 Biolitec, Jena, Germany) 8W 1470 nm was set. 6 shots of 3 seconds each were made from proximal to distal for each diseased hemorrhoidal cushion (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Then, cold application was made to the treated bundle with sterile ice cubes for 2 minutes. Anal blockage was performed with a total of 0.5mg/kg bupivacaine injection equally into four quadrants. No suture was used.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eRBL\u003c/strong\u003e \u003cp\u003eAfter aspiration was applied approximately 1\u0026ndash;2 cm proximal to the dentate line with a disposable anoscope and McGown applicator, with the vacuum chamber pressure of the band ligator being between \u0026minus;\u0026thinsp;1 bar=-0.1 MPa, including the mucosa and submucosa, rubber band ligation was applied to the root of the aspirated diseased hemorrhoidal cushion (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Anal blockage was performed with a total of 0.5mg/kg bupivacaine injection equally into four quadrants. No suture was used.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis:\u003c/h2\u003e \u003cp\u003eAnalysis was carried out with SPSS v23 (IBM-SPSS, Chicago, IL, USA). Continuous descriptive data was expressed as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;std. deviation, and categorical descriptive data were presented as numbers and percentages. The distribution is checked by looking at Skewness and Kurtosis. Independent sample t-test was used to the relationship between 2 continuous independent variables with a normal distribution. The relationship between categorical variables was examined using the Chi-Square test. A p value of less than 0.05 was considered to be statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 260 patients were included in the study, with 166 undergoing Rubber Band Ligation (RBL) (63.8%) and 94 receiving HeLP (36.2%). The overview of patient demographics and hemorrhoid grades is presented in Table 1. \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable1. The overview of patient demographics and hemorrhoid grades\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.7815%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.1457%;\"\u003e\n \u003cp\u003eHemorrhoids laser procedure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003eRubber Band Ligation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0728%;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.7815%;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.1457%;\"\u003e\n \u003cp\u003e41.2\u0026plusmn;7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e41.3\u0026plusmn;5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0728%;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.7815%;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.1457%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e29 (30.9%)\u003c/p\u003e\n \u003cp\u003e65 (69.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e68 (41%)\u003c/p\u003e\n \u003cp\u003e98 (59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0728%;\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.7815%;\"\u003e\n \u003cp\u003ePreop. hemorrhoid grade\u003c/p\u003e\n \u003cp\u003eGrade 2\u003c/p\u003e\n \u003cp\u003eGrade 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.1457%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e52 (55.3%)\u003c/p\u003e\n \u003cp\u003e42 (44.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e87 (52.4%)\u003c/p\u003e\n \u003cp\u003e79 (47.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.0728%;\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eNo statistically significant difference was observed between the preoperative hemorrhoidal disease grades of the patients.\u003c/p\u003e\n\u003cp\u003eThe postoperative outcomes of patients within 1 year, including VAS values (1\u003csup\u003est\u003c/sup\u003e, 7\u003csup\u003eth\u003c/sup\u003e, and 14\u003csup\u003eth\u003c/sup\u003e day), postoperative analgesic use (mg) over 7 days, worsening of incontinence, time to return to normal life (days), complications, and recurrence, are summarized in Table 2.\u003c/p\u003e\n\u003cp\u003eAll patients were treated for 2-quadrant hemorrhoidal diseases. No deterioration in continence was observed according to CCIS with either method. There was no statistically significant difference between the two groups in terms of VAS values on the 7\u003csup\u003eth\u003c/sup\u003e and 14\u003csup\u003eth\u003c/sup\u003e postoperative days, return to normal life, complications and recurrence. HeLP has statistically significant lower postoperative 1\u003csup\u003est\u003c/sup\u003e day pain and less analgesic use (mg) than RBL (p\u0026lt;0.001).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Postoperative outcomes of patients\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.3802%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.0992%;\"\u003e\n \u003cp\u003eHemorrhoids laser procedure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4628%;\"\u003e\n \u003cp\u003eRubber Band Ligation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.0579%;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.3802%;\"\u003e\n \u003cp\u003eVisual Analog Scale\u003c/p\u003e\n \u003cp\u003ePostoperative day 1\u003c/p\u003e\n \u003cp\u003ePostoperative day 7\u003c/p\u003e\n \u003cp\u003ePostoperative day 14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.0992%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.5\u0026plusmn;0.5\u003c/p\u003e\n \u003cp\u003e0.2\u0026plusmn;0.5\u003c/p\u003e\n \u003cp\u003e0\u0026plusmn;0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4628%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.3\u0026plusmn;1.6\u003c/p\u003e\n \u003cp\u003e0.2\u0026plusmn;0.6\u003c/p\u003e\n \u003cp\u003e0\u0026plusmn;0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.0579%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.3802%;\"\u003e\n \u003cp\u003eAnalgesic use (mg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.0992%;\"\u003e\n \u003cp\u003e64.9\u0026plusmn;27.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4628%;\"\u003e\n \u003cp\u003e78.2\u0026plusmn;31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.0579%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.3802%;\"\u003e\n \u003cp\u003eWorsening of continence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.0992%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4628%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.0579%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.3802%;\"\u003e\n \u003cp\u003eReturn to normal life (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.0992%;\"\u003e\n \u003cp\u003e2.3\u0026plusmn;0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4628%;\"\u003e\n \u003cp\u003e2.3\u0026plusmn;0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.0579%;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.3802%;\"\u003e\n \u003cp\u003eRecurrence (in 1 year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.0992%;\"\u003e\n \u003cp\u003e14 (14.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4628%;\"\u003e\n \u003cp\u003e26 (15.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.0579%;\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.3802%;\"\u003e\n \u003cp\u003eComplications\u003c/p\u003e\n \u003cp\u003eBleeding\u003c/p\u003e\n \u003cp\u003eThrombosis\u003c/p\u003e\n \u003cp\u003eUrinary retention\u003c/p\u003e\n \u003cp\u003eInfection\u003c/p\u003e\n \u003cp\u003eAnal stenosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.0992%;\"\u003e\n \u003cp\u003e3 (3.2%)\u003c/p\u003e\n \u003cp\u003e3 (3.2%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.4628%;\"\u003e\n \u003cp\u003e11 (6.6%)\u003c/p\u003e\n \u003cp\u003e10 (6%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e1 (0.6%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.0579%;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eLaser treatment causes intrahemorrhoidal coagulation and tissue contraction macroscopically, and submucosal protein denaturation and fibrosis microscopically. In this way, the area where laser treatment is applied adheres to the underlying tissues and prevents prolapse [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. RBL causes fibrosis, retraction and fixation of the hemorrhoidal cushions [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Both treatments are minimally invasive and generally do not cause internal sphincter damage. Therefore, worsening incontinence or anal stenosis is generally not expected with either method. In this study, both methods were compared and it was seen that there was no worsening in incontinence according to CCIS values ​​and no patient developed anal stenosis.\u003c/p\u003e \u003cp\u003eDue to hemorrhoidal disease, Iyer et al. found RBL complication rates as 8.7% severe pain, 2.8% bleeding, 1.5% external pack thrombosis, and 0.09% pelvic sepsis [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Nakeeb et al. reported complication rates after RBL as 4.1% pain, 4.1% minor bleeding, 1.3% vasovagal symptoms, 0.13% infection, 0.13% perianal fistula, and 0.4% perianal fissure in their studies [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In their study, Jin et al. found a bleeding rate of 2.9% following the use of laser for hemorrhoidal disease and reported no cases of infection, urinary retention, or deterioration in incontinence among the patients [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. It has been demonstrated that both laser treatment and RBL for hemorrhoidal disease do not harm muscle and nerve fibers and result in less postoperative pain compared to conventional hemorrhoidectomy [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In this study, when the two methods were compared in terms of postoperative complications, we observed no significant difference and low complication rates.\u003c/p\u003e \u003cp\u003eIn a prospective comparison study of rubber band ligation and laser treatment for hemorrhoidal disease, it was found that laser treatment was statistically superior in reducing postoperative pain [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In this study, it was seen that HeLP caused less pain than RBL, especially on the first postoperative day. However, it was seen that these two minimally invasive methods, which were not expected to cause much postoperative pain, were no longer superior to each other in terms of pain in the following days. Laser beam does not damage mucosa, muscle and nerve fibers and only a 1\u0026ndash;2 mm incision is used. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Severe perineal pain up to 8.7% has been described in the literature following RBL [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Although RBL is applied above the dentate line, the pain is thougth to be due to anal discomfort (feeling of anal fullness) or damage that may develop in muscular or nerve fibers due to excessive aspiration or progression towards the dentate line.\u003c/p\u003e \u003cp\u003eAnother statistically significant result in this study was seen in postoperative analgesic use. As a reflection of the superiority of HeLP over RBL in postoperative pain, we see that postoperative analgesic use is also less in HeLP. In addition, although HeLP causes less pain on the first postoperative day compared to RBL, both methods are minimally invasive methods and postoperative analgesic use is low in both methods. We were not surprised by the lack of a statistically significant difference in this study in terms of early return to normal life due to the low analgesic use and pain in both methods in the postoperative period.\u003c/p\u003e \u003cp\u003eIn the context of laser treatment for hemorrhoidal disease, Weyand et al. reported a recurrence rate of 8.8%, while Faes et al. reported a recurrence rate of 34%. It has been described in the literature that recurrence after RBL is between 6.6% and 18% [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In this study, in the 1-year follow-up of patients who received both minimally invasive treatments, it was seen that HeLP had a recurrence rate of 14.9% and RBL had a recurrence rate of 15.7%, and that these treatments had no statistical superiority over each other.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn early stage (grade 2\u0026ndash;3) hemorrhoidal disease, HeLP and RBL are minimally invasive non-excisional methods that can be preferred in terms of acceptable recurrence rates, low postoperative pain, complication rates and early return to work. HeLP and RBL can be preferred in early stage hemorrhoidal disease because it is easy to perform, almost painless after the procedure, and has low complication rates. The reduced pain and fewer analgesic use provided by HeLP, especially on the first postoperative day, may improves patients' satisfaction.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThe author(s) received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003ch2\u003eConflict of interest (COI)\u003c/h2\u003e\n\u003cp\u003eThe author/s declare/s no conflict of interest.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eConceptualization, M.G. and A.C.E.; methodology, M.G. and B.E.; formal analysis, M.G. and A.C.E.; investigation, A.C.E., M.G.; data curation: A.C.E., M.G.; writing\u0026mdash;original draft preparation, M.G., B.E.; writing\u0026mdash;review and editing, B.E.; visualization, M.G.; supervision, B.E. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eThe authors would like to thank all the hospital staff who contributed to the publication of this article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOsborn NK, King KH, Adeniji OA, Parikh SR, LeVine MS, Quinn D, et al. Hemorrhoid Treatment in the Outpatient Gastroenterology Practice Using the O\u0026rsquo;Regan Disposable Hemorrhoid Banding System is Safe and Effective. J Med 2009; 2: 248\u0026ndash;256.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCemil A, Ugur K, Salih GM, Merve K, Guray DM, Emine BS. Comparison of Laser Hemorrhoidoplasty and Milligan-Morgan Hemorrhoidectomy Techniques in the Treatment of Grade 2 and 3 Hemorrhoidal Disease. Am Surg. 2024;90(4):662\u0026ndash;671. doi: 10.1177/00031348231207301. Epub 2023 Oct 17. 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Laser hemorrhoidoplasty for hemorrhoidal disease: a systematic review and meta-analysis. Lasers Med Sci. 2022;37(9):3621\u0026ndash;3630. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10103-022-03643-8\u003c/span\u003e\u003cspan address=\"10.1007/s10103-022-03643-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2022 Sep 12. PMID: 36094598.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlbuquerque A. Rubber band ligation of hemorrhoids: A guide for complications. World J Gastrointest Surg. 2016;8(9):614\u0026ndash;620. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4240/wjgs.v8.i9.614\u003c/span\u003e\u003cspan address=\"10.4240/wjgs.v8.i9.614\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 27721924; PMCID: PMC5037334.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDurgun C, Yiğit E. Laser Hemorrhoidoplasty Versus Ligasure Hemorrhoidectomy: A Comparative Analysis. Cureus. 2023;15(8):e43119. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.43119\u003c/span\u003e\u003cspan address=\"10.7759/cureus.43119\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 37692631; PMCID: PMC10483433.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bratislava-medical-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Bratislava Medical Journal](https://link.springer.com/journal/44411)","snPcode":"44411","submissionUrl":"https://submission.springernature.com/new-submission/44411/3","title":"Bratislava Medical Journal","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Hemorrhoids, Laser, Rubber band ligation, Pain","lastPublishedDoi":"10.21203/rs.3.rs-5387370/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5387370/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBACKGROUND\u003c/h2\u003e \u003cp\u003eThe aim of this study is to compare the short and long-term results (postoperative pain, complications, return to daily life, recurrence) between patients who underwent hemorrhoids laser procedure (HeLP) and rubber band ligation (RBL) due to grade 2\u0026ndash;3 hemorrhoidal disease.\u003c/p\u003e\u003ch2\u003eMETHODS\u003c/h2\u003e \u003cp\u003eThe results of patients who underwent HeLP and RBL between June 2020 and June 2023 for grade 2\u0026ndash;3 hemorrhoidal disease were evaluated retrospectively. The patient information was examined in terms of operation time, postoperative 1st, 7th and 14th day visual analog scale (VAS) values, the amount of analgesic used in the first 7 postoperative days, return to normal life (days), recurrence within 1 year and other complications (postoperative bleeding, thrombosis, urinary retention, infection/abscess, anal stenosis, deterioration in continence).\u003c/p\u003e\u003ch2\u003eRESULTS\u003c/h2\u003e \u003cp\u003eA total of 260 patients were included in the study, 166 of whom underwent RBL and 94 HeLP. Operation time, hospital stay (hours), VAS values, postoperative 7-day analgesic use (mg), worsening of incontinence, time to return to normal life (days), complications and recurrence within 1 year evaluated. HeLP has statistically significant lower postoperative 1st day pain and less analgesic use (mg) than RBL (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eCONCLUSIONS\u003c/h2\u003e \u003cp\u003eThe reduced pain and fewer analgesic use provided by HeLP, especially on the first postoperative day, improves patients' satisfaction.\u003c/p\u003e","manuscriptTitle":"Which technique is preferable for grade 2-3 hemorrhoidal disease: Laser vs. rubber band ligation?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-17 08:35:34","doi":"10.21203/rs.3.rs-5387370/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-12-18T13:48:29+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-12-14T16:15:20+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-12-13T06:38:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-12-05T12:10:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"163704958702806145804853501699046509564","date":"2024-11-27T04:23:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"97499297743058777070347892643692349179","date":"2024-11-24T12:07:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"69453025370526557586947608996456048329","date":"2024-11-22T04:16:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-21T20:49:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-08T12:58:04+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-08T12:56:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"Bratislava Medical Journal","date":"2024-11-04T10:47:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bratislava-medical-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Bratislava Medical Journal](https://link.springer.com/journal/44411)","snPcode":"44411","submissionUrl":"https://submission.springernature.com/new-submission/44411/3","title":"Bratislava Medical Journal","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"4407b4b6-4c2e-4d05-a0cf-5e096eae5f04","owner":[],"postedDate":"December 17th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-01-04T07:53:32+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-17 08:35:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5387370","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5387370","identity":"rs-5387370","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}