Since Thomson proposed the concept of “Anal Cushion” [11], people have realized that hemorrhoids in humans are caused by the alteration of anorectal anatomic structures. To protect normal structures, more and more minimally invasive procedures have emerged. These procedures improve symptoms of hemorrhoids by blocking the blood supply while protecting the anal cushion structure. Such as Rubber Band Ligation (RBL)、Doppler-guided hemorrhoidal artery ligation(DGHAL)、Stapled Hemorrhoidopexy(SH) and Laser Hemorrhoidoplasty (LHP). DGHAL can relieve bleeding of grade II or III hemorrhoids effectively instead of improving prolapsing.SH is reserved for circumferential prolapsing hemorrhoids. It has less complications as well as higher degree of patient satisfaction. However, in the longer term, SH was associated with a higher rate of prolapse [12].RBL has been generally recognized as a safe and effective mini-invasive office technique for the treatment of symptomatic early hemorrhoids [13]. Short-term recurrence rates reported in the literature for this procedure range from 12–18% [14]. With the development of instruments, the way of ligation has changed accordingly. But there are some problems, such as sudden shedding bleeding, which is a common problem in resection surgery. Karahaliloglu first used LHP to treat hemorrhoids in 2007.As an emerging non-excisional treatment, a systematic review and meta-analysis has shown that LHP has favorable short-term clinical outcomes in treating grade II/III hemorrhoids compared to traditional surgery, reducing pain and allowing for earlier resumption of work or daily activities [15]. And compared to RBL, LHP has been reported lower postoperative pain than RBL, and recurrence rate was reported to range between 0 and 11.3% after LHP [16].

Our research showed that postoperative pains scores on the VAS were significantly lower after LHP than after RBL during one week after surgery. The result might be attributed to two reasons. On one hand, multiple band ligations (in 3 positions or more) were made in RBL group, which was also mentioned by Giamundo [13].Although the rubber band should be as far away as possible from the dentate line, as a foreign body, which will cause the patient to feel swelling until it sloughs off. It might be responsible for the mild urinary retention reported by 6 cases and anal distention significantly after RBL. On the other hand, that was due to the preservation of mucosal integrity in LHP group. The laser releases energy under the mucosa, it did not destroy the integrity of the mucosa at all. The only damage was a small microincision in the skin of the anal margin for the laser fiber to enter and exit, so the pain after laser surgery was significantly lower than that after RBL.

We were pleased to find that the probability of bleeding after LHP was significantly lower than RBL. Due to the delay bleeding when the banded tissue sloughs off, the proportion of patients with blood stool within one week after RBL was higher than after LHP group, and there was a significant difference between the two groups.

Regarding resolution of symptoms, both methods were satisfactory. On account of light pain and less complications, the patients after LHP could return to normal activities faster than after RBL. After one year of follow-up, the 5.9% recurrence rate in the LHP group is consistent with the results reported by others [4, 9, 17, 18]. Although there was no difference in the recurrence rate between the two groups, it could be seen that LHP was superior to RBL in resolving bleeding and inferior to RBL in improving the symptoms of hemorrhoids prolapse.

A systematic review [16] of seven LHP studies mentioned that resolution of grade II and III hemorrhoids symptoms ranged between 70% and 100% after LHP. It showed lower postoperative pain, but the most commonly reported postoperative complication was bleeding (range 0–64%). In severe cases, sutures were needed to stop bleeding. These research used different wavelengths of lasers, and due to the novelty of technology, the proficiency of surgeons in the use of lasers varies, which can greatly affect postoperative complications. So in the future, LHP will be better and more widely used by surgeons, and its therapeutic effects will continue to improve.

Most of these studies used either 980–1470 nm lasers. Lasers with a wavelength of 980 nm are chosen in most studies. This kind of short-wavelength laser is mainly absorbed by hemoglobin; it damages blood vessel walls through heat release and has a good hemostatic effect. However, its absorption efficiency is low, and the required working energy is high (12–18 W), so damage to the surrounding tissue and postoperative pain are inevitable, and tissue carbonization is obvious. Plapler et al. [16] mentioned that scars were formed because of burn lesions in four patients. They concluded that on the one hand, this is related to the doctor’s experience, and on the other hand, the more energy is applied for too long or too close to the mucosa, the greater is the chance of tissue damage.

The 1470 nm laser is mainly absorbed by water and has relatively little effect on hemoglobin. The heat can be concentrated in a small volume of tissue, causing the necrotic tissue to rapidly decompose and vaporize, which is beneficial to reduce skin paresthesia and local pain [17, 18]. The 1470 nm laser exhibits a high tissue absorption rate, has a low penetration depth and requires only 6–8 W, and hence it can effectively control the tissue damage range and avoid damage to normal tissue. Based on the above reasons, we chose 980 and 1470 nm double-wave treatment, which can not only achieve a good hemostatic effect, less postoperative bleeding, but also requires only 8 W for effective treatment, so damage to normal tissue is avoided.

The following is a summary of our experience with this minimally invasive technology: (1) The path is fan-shaped during laser delivery to ensure that all blood vessels in the hemorrhoids are destroyed. (2) When firing the laser, the laser fiber and the mucosa must not be too close; otherwise the mucosa may be burned. (3) When laser treatment is performed on the area of obvious internal hemorrhoids, it is recommended to treat the external hemorrhoids together to avoid edema after surgery.

The limitations of study was a single-center study and lack of long-term follow-up. Larger samples will provide more reliable data to support clinicians’ surgical decision. We also suggest that for different types of hemorrhoids, LHP can not only be used alone, but also can be combined with other technologies. How to reduce postoperative pain and complications while improving efficiency and bringing more benefits to patients is what we need to think about in the future.