Laser & Stapler Piles Surgery

Medically reviewed by Dr Murlidhar Boob, MS, FAIS, DLS, FMAS - Laparoscopic Surgeon & Surgical Gastroenterologist

What it is

Haemorrhoids, or piles, are swollen cushions of blood vessels inside the anal canal. Everyone has these cushions - they help seal the canal and keep us continent. They become a problem when years of straining, constipation, long hours seated, pregnancy or heavy lifting cause them to enlarge, slip downward and bleed.

Laser haemorrhoidoplasty (LHP) and stapled haemorrhoidopexy (usually called stapler piles surgery, or MIPH) are two modern ways of treating that problem without cutting away large amounts of tissue from the sensitive skin around the anus.

In laser surgery, a fine fibre is passed into each pile and laser energy is delivered inside it. The energy shrinks the swollen vessels and causes the tissue to scar down and stick back to the muscle wall underneath. The skin outside is left almost untouched.

In stapler surgery, a circular stapling device removes a ring of tissue from higher up in the rectum - above the level where you feel pain - and simultaneously staples the edges together. This lifts the prolapsed piles back into their normal position and cuts off much of their blood supply. Nothing is cut in the sensitive area at all.

Both are day-care procedures. Both exist for one reason: the old operation worked, but it hurt.

Who needs it

• Grade 3 piles that come out during a bowel movement and have to be pushed back with a finger.
• Grade 4 piles that stay out permanently and cannot be pushed back.
• Grade 2 piles that keep bleeding despite diet, medicines and one or two sessions of rubber band ligation.
• Bleeding heavy enough to cause anaemia - low haemoglobin, tiredness, breathlessness on climbing stairs.
• Piles combined with a fissure or a skin tag that make hygiene and daily life difficult.
• Recurrent piles after a previous banding, injection or surgery.
• Circumferential prolapse, where the whole ring of tissue slips down - this is where the stapler comes into its own.

“My father had this operation twenty years ago and still talks about it. Is it the same thing?” No, and I hear this often enough that it is worth answering properly. What your father had was almost certainly an open haemorrhoidectomy - the piles cut away, leaving three raw wounds that healed over several weeks. That operation still has a place, but for most patients today we can use laser or stapler techniques, where there is no open wound in the sensitive skin. The recovery is a different experience altogether.

How it is done

Before you go in. You are fasted from midnight, given a small enema or a rectal wash to empty the lower bowel, and a single dose of antibiotic. Blood tests, an ECG if you are over forty, and a proctoscopy or colonoscopy where indicated are done beforehand.

Positioning and anaesthesia. You are positioned on the table and anaesthetised - most often a spinal anaesthetic, sometimes a short general anaesthetic.

Examination under anaesthesia. With the muscles fully relaxed, the surgeon examines the anal canal properly. This is the point at which a hidden fissure, fistula or polyp is often found, and the plan may be adjusted.

Laser method. A small opening is made at the base of each pile. The laser fibre is passed inside the swollen cushion, and energy is delivered in short pulses while the fibre is slowly withdrawn. The pile shrinks visibly. Each one takes a few minutes. There is very little bleeding and usually no stitching.

Stapler method. A circular anal dilator is placed, a purse-string suture is taken in the rectal lining about four centimetres above the pile-bearing area, and the stapler is introduced, closed and fired. It excises a doughnut of tissue and staples the join in one action. The staple line is checked carefully for bleeding and any bleeding point is stitched.

Finishing. A soft dressing is placed, sometimes with a small pack that is removed the same day. You are moved to the recovery area and encouraged to sit up and take fluids within a couple of hours.

Which method suits you depends on the grade, whether the prolapse is one area or the whole circumference, and what else is going on in the anal canal. We decide that with you before the day, not on the table.

Anaesthesia, duration and hospital stay

Most piles procedures are done under a spinal anaesthetic - awake but numb from the waist down, with sedation if you would rather not be aware of the theatre. Short general anaesthesia is used in some patients.

A laser procedure takes about twenty to thirty minutes. A stapler procedure takes about thirty to forty-five minutes. Combined procedures - piles plus a fissure or a small fistula - take a little longer.

Both are planned as day-care: admission in the morning, home the same evening once you have passed urine and are comfortable. Some patients stay one night, particularly after a stapler procedure or if they live at a distance.

You can eat normally the same evening. There is no special diet beyond plenty of fibre and water.

Recovery

Day 1. Expect a dull ache and a feeling of fullness or of needing to pass stool - that sensation is the surgery, not your bowel. Paracetamol and a mild anti-inflammatory usually cover it. A warm sitz bath two or three times a day is genuinely soothing. Start your stool softener the same evening.

The first week. The first bowel movement is the moment everyone dreads. It is almost always less bad than expected, particularly after laser. A little bleeding or spotting for a few days is normal. Keep the softener going so that nothing is hard. Most desk workers are back at work by day three to five.

Weeks 2 to 4. Discomfort settles steadily. Some patients get intermittent spasm or a sharp twinge with a bowel movement in the second or third week as the tissue contracts - unpleasant, not dangerous. Avoid heavy lifting, long two-wheeler rides and cycling. Sitting for long stretches on a hard chair is best broken up with a short walk.

By six weeks. Healing is complete for the large majority. Bleeding should have stopped entirely. If you are still bleeding, still in significant pain or feel a lump, come back and be examined rather than waiting it out.

The long-term result depends heavily on what happens after the surgery. Fibre, water, a fixed toilet time, and getting off the toilet in three minutes rather than fifteen - these are not throwaway advice, they are the difference between one operation and two.

Why laser or stapler rather than the conventional open operation

The open haemorrhoidectomy remains a sound, definitive operation, and for grade 4 piles with large external components it is sometimes still the best choice. But where a modern technique is suitable, the case for it is strong.

• Considerably less pain, because the incisions are either tiny (laser) or placed above the pain-sensitive line (stapler).
• No large open wound to dress, soak or worry about.
• Day-care surgery instead of two or three days in hospital.
• Return to work in days rather than two to three weeks.
• Less bleeding during and after the procedure.
• Lower risk of anal stenosis - narrowing from scarring - which is a real, if uncommon, problem after extensive open excision.

The honest trade-off: recurrence rates after stapler surgery are somewhat higher over the long term than after the open operation, and laser works best for internal piles rather than large external tags. When an open operation is the right answer for your particular anatomy, we will say so.

Risks and complications

• Pain and spasm for the first few days - expected, and treatable.
• Bleeding, usually minor spotting; occasionally significant bleeding from the staple line needing a return to theatre. This is uncommon but real.
• Difficulty passing urine in the first few hours, particularly after a spinal anaesthetic, sometimes needing a temporary catheter.
• Recurrence of piles, especially if straining and constipation continue.
• Infection, uncommon, treated with antibiotics.
• Anal fissure or a residual skin tag that may need a small further procedure.
• Persistent urge to pass stool after stapler surgery, usually settling over weeks.
• Narrowing of the anal canal, rare with these techniques.
• Incontinence to flatus, uncommon and usually temporary, more likely where the sphincter was already weak.
• Anaesthetic risks, higher with heart or lung disease.

Alternatives

Diet and habit change alone. For grade 1 and many grade 2 piles this is the whole treatment and it works: 25 to 30 grams of fibre a day, two to three litres of water, no phones in the toilet, and no straining.

Medicines. Stool softeners, fibre supplements, and short courses of local ointments help symptoms but do not shrink established piles.

Rubber band ligation. An outpatient procedure - a small band is applied to the base of the pile, which drops off in about a week. No anaesthesia, no time off. Excellent for grade 1 to 2 and some grade 3 piles, and often the right first step.

Sclerotherapy and infrared coagulation. Other office-based options for early piles.

Open haemorrhoidectomy. The traditional operation. More painful, longer recovery, and still the most definitive answer for advanced disease with large external components.

Treating something else entirely. If bleeding turns out to be from a fissure, a polyp or inflammatory bowel disease, treating that is the correct alternative to piles surgery. If you are not sure which you have, read this first, then come and be examined. You can also see all the procedures we perform or read more about our general surgery and gastroenterology work.

What it costs

We have not published a fixed range for piles surgery, because the figure varies more than for most operations and we would rather quote you accurately than approximately. What the cost depends on:

• Which technique is used - laser, stapler, conventional excision, or a combination.
• How many piles are treated, and whether the prolapse is one segment or the full circumference.
• Whether anything else is done at the same time - a fissure, a fistula, or a skin tag.
• The type of anaesthesia and how long you are in theatre.
• Consumables - the stapler device in particular is a significant single cost.
• Room category and length of stay, if you stay overnight rather than going home the same evening.
• Investigations done before surgery, including a colonoscopy where it is indicated.
• Insurance or TPA cover, which changes what you actually pay out of pocket.

Please call us on +91-8668954915 and we will give you a written estimate for your own case, with the technique named, before you commit to anything.

Preparing for your surgery

• Get the diagnosis confirmed first. Do not assume bleeding is piles. Ask for a proper examination and, if you are over forty or have any warning sign, a colonoscopy.
• Bring your medicine list. Blood thinners such as aspirin, clopidogrel or warfarin usually need to be adjusted several days beforehand - never stop them yourself without asking.
• Tell us about diabetes, heart or lung disease, and any previous anal surgery.
• Start on fibre and water a week early. Soft stool before surgery makes the first week after it considerably easier.
• Fast from midnight and take only the medicines we tell you to take with a sip of water.
• Follow the enema or wash instructions given to you the evening before.
• Arrange a companion to bring you home; you should not drive yourself after a spinal anaesthetic.
• Stock up at home - fibre supplement, stool softener, a small tub for sitz baths, soft tissue or a bidet spray.
• Plan a light three or four days. Not bed rest - walking is good - just nothing heavy.

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If piles have been quietly making your day harder for months, you have put up with it long enough. The surgical team at Shubham Hi-Tech Hospital and Test Tube Baby Centre, Amravati, will examine you properly, tell you which grade you actually have, and explain honestly whether you need an operation or whether banding and a change in habits will do. Call +91-8668954915 or get in touch here.

Disclaimer: This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor for guidance specific to your situation.