Laser Hemorrhoidoplasty versus Excisional Hemorrhoidectomy: The Recovery-Durability Tradeoff in Hemorrhoid Surgery—A Systematic Review of Randomized Trials

Background Excisional hemorrhoidectomy remains the standard for advanced disease, while the applicability of laser hemorrhoidoplasty remains uncertain. This study evaluates the tradeoff between short-term recovery and long-term durability to inform patient-centered decision-making. Methods A systematic search of PubMed, Web of Science, Scopus, and CENTRAL was conducted through September 2025. Randomized controlled trials (RCTs) comparing diode laser hemorrhoidoplasty with conventional hemorrhoidectomy were included. Pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals were estimated using random-effects models. Heterogeneity was assessed with the I 2 statistic, and trial sequential analysis (TSA) was performed to explore the robustness of selected outcomes. Results Fifteen RCTs involving 1099 patients were included. Laser hemorrhoidoplasty was associated with reduced postoperative pain on day 1 (MD −2.02; 95% CI −2.83 to −1.20) and day 7 (MD −2.13; 95% CI −3.06 to −1.20), shorter duration of analgesic use (MD −2.72 days), operative time (MD −12.49 min), intraoperative blood loss (MD −21.63 mL), hospital stay (MD −0.63 days), and earlier return to daily activities (MD −10.78 days). It was also associated with lower rates of postoperative bleeding (RR 0.35), urinary retention (RR 0.29), and anal stenosis (RR 0.12). TSA suggested that some short-term findings may be robust; however, several outcomes remained underpowered, and limited follow-up restricts the interpretation of long-term outcomes. Conclusion Laser hemorrhoidoplasty offers improved short-term recovery but with uncertain long-term durability. Given the low to very low certainty of the evidence and limited follow-up, these findings support a preference-sensitive approach rather than replacing excisional hemorrhoidectomy.