SURGICAL MANAGEMENT OF HEMORRHOIDS: CURRENT APPROACHES AND ADVANCEMENTS

ISSN: 2582-4686 SJIF 2021-3.261, 2022-2.889, 20235.384, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-10 438 UDC: 616.355-007.274-089 SURGICAL MANAGEMENT OF HEMORRHOIDS: CURRENT APPROACHES AND ADVANCEMENTS Teshayev Oktyabr Ruxullayevich1, Murodov Alijon Salimovich 2, Shermamatova Azima Ulug‘bekovna3 Teshayev Oktyabr Ruxullayevich - Professor of the Department of Surgical Diseases in Family Medicine, Tashkent State Medical University (TSMU), Tashkent, Uzbekistan. Murodov Alijon Salimovich - Doctor of Medical Sciences of the Department of Surgical Diseases in Family Medicine, Tashkent State Medical University (TSMU), Tashkent, Uzbekistan. Shermamatova Azima Ulug‘bekovna2nd Year Student of the Department of Surgical Diseases in Family Medicine, Tashkent State Medical University (TSMU), Tashkent, Uzbekistan. ABSTRACT Hemorrhoidal disease, a common vascular pathology of the anorectal region, presents variably from asymptomatic cushions to severe prolapse and bleeding, affecting 4.4-36.4% of adults worldwide, with higher rates in Western populations due to low-fiber diets, inactivity, and rising obesity. When conservative measures—such as ≥30 g/day fiber intake, phlebotonics (e.g., diosmin), and office procedures like rubber band ligation (RBL) or infrared coagulation (IRC)—fail, especially for Goligher grades III-IV with persistent prolapse, surgery is indicated to relieve symptoms, restore anatomy, and improve health-related quality of life (HRQoL). This systematic review, based on peer-reviewed studies from 2023 to mid-2025, highlights the shift from traditional excisional hemorrhoidectomy to minimally invasive options, aiming to reduce postoperative pain, recovery time, and complications like stenosis or incontinence. Key techniques include Milligan-Morgan/Ferguson excisions, stapled hemorrhoidopexy (SH/PPH), transanal hemorrhoidal dearterialization (THD) with Doppler-guided ligation and mucopexy, laser hemorrhoidoplasty (LHP) using 980-1470 nm lasers, radiofrequency ablation (RFA), and ALTA sclerotherapy hybrids with selective excision. Meta-analyses and RCTs from PubMed Central and Cochrane confirm excisional methods offer superior longevity with 1-5% recurrence at 36-60 months (95% CI: 0.8-4.2%), but at costs of high VAS pain (6.5-8.5) and 21-35 day recovery. Minimally invasive approaches like THD and LHP lower VAS to 1.5-4.0, enable 3-12 day reintegration, and keep complications <5% (e.g., urinary retention OR 0.45, 95% CI 0.32-0.64), though recurrence rises to 8-18%. Adjuncts such as LigaSure, harmonic scalpels, robotics, and AI planning cut bleeding by 40-60% and procedure time by 15-25%. Challenges include inconsistent reporting, limited long-term data (>24 months) for hybrids, and costs (e.g., $1,500-3,500 for THD) hindering access in low-resource areas. The review recommends patient-specific algorithms incorporating comorbidities, grading, and expertise to maximize benefits and minimize risks. Future directions involve bioengineered agents, microbiomebased prevention, and large RCTs to strengthen guidelines, potentially easing the >$1.2 billion annual U.S. economic burden. Keywords: hemorrhoidal pathology; Anorectal vascular anomalies; Excisional hemorrhoidectomy; Minimally invasive proctological interventions; Stapled hemorrhoidopexy ISSN: 2582-4686 SJIF 2021-3.261, 2022-2.889, 20235.384, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-10 439 (SH/PPH); Transanal hemorrhoidal dearterialization (THD); Doppler-guided hemorrhoidal artery ligation (DGHAL/HAL); Laser hemorrhoidoplasty (LHP/HeLP); Radiofrequency ablation (RFA); Aluminum potassium sulfate tannic acid (ALTA) sclerotherapy. INTRODUCTION Hemorrhoidal disease constitutes a multifaceted vascular disorder originating from the hypervascular submucosal cushions of the anal canal, which physiologically contribute to fecal continence by facilitating canal occlusion; however, pathological distension precipitates symptomatic manifestations including pruritus, hematochezia, thrombotic pain, and mucosal prolapse, profoundly impinging upon psychosocial well-being and occupational productivity. Epidemiological inquiries delineate a prevalence spectrum of 4.4% in screening cohorts to 36.4% in symptomatic consultations, with predisposing etiologies encompassing chronic straining secondary to constipation, gravid venous stasis, hepatic portal hypertension, connective tissue laxity syndromes, and adiposity-driven intra-abdominal pressure elevations—factors exacerbated by contemporary demographic shifts toward geriatric populations (projected 1.6 billion ≥65 years by 2050) and obesity pandemics (global prevalence 15.1% in 2025). Diagnostic stratification adheres to the Goligher schema: Grade I (engorged cushions sans prolapse), Grade II (prolapse with autoreduction), Grade III (manual reduction requisite), and Grade IV (irreducible, often incarcerated or strangulated), supplemented by adjunctive classifications like the Hemorrhoidal Disease Symptom Score (HDSS) for quantitative symptom appraisal. Initial therapeutic strata prioritize non-invasive modalities: dietary fiber escalation to 25-35 g/day corroborated by meta-analyses evincing 53% symptom amelioration (RR 0.47, 95% CI 0.32-0.68), topical anesthetics/anti-inflammatories (e.g., 2% lidocaine-hydrocortisone), and venotonics yielding 40-70% bleeding cessation in short-term RCTs. Ambulatory interventions, including RBL (efficacy 70-90% for grades I-III, recurrence 10-20% at 12 months), sclerotherapy (e.g., 3% polidocanol, success 75-89%), and IRC (thermal coagulation at 85-100°C, resolution 68-96%), serve as intermediaries, albeit with limitations in advanced prolapse. Surgical imperatives emerge for recalcitrant grade III-IV pathologies, historically anchored in excisional paradigms originating from antiquity (e.g., Hippocratic ligatures circa 460 BCE) and refined in the 20th century via Milligan-Morgan (1937) open excision and Ferguson (1959) closed suturing, which, despite 95-98% curative rates, incur substantial morbidity: VAS pain 7-9 necessitating opioid analgesia, convalescence 4-6 weeks, and sequelae like stenosis (3-5%) or incontinence (1-2%). The temporal arc from 2023 to 2025 has witnessed an inexorable pivot toward minimally invasive ethos, propelled by bioengineering advancements and patient-centric imperatives, as evidenced by ASCRS 2024 guidelines endorsing office-based procedures for grades I-III and selective excision for external/combined variants. Contemporary armamentaria encompass energy-modulated excisions (LigaSure bipolar or harmonic ultrasonic, attenuating thermal dissemination and hemorrhage by 50%), SH/PPH (Longo 1998, circumferential mucosectomy with vascular interruption, VAS 3-5, recovery 7-14 days), THD/DGHAL (selective arterial ligation via Doppler ultrasonography, often with mucopexy, recurrence 5-12%), LHP (intramucosal photocoagulation inducing fibrosis, outpatient viable with VAS 1-3), RFA (controlled radiofrequency at 4 MHz for ablation, analogous outcomes), and ALTA hybrids (sclerosant-induced fixation plus distal excision, prolapse resolution 95-100% in Asian cohorts). Recent meta-analyses substantiate enhanced PROMs: pain diminution by 50-70%, hospitalization truncation to <24 hours, and occupational resumption in 5-10 days, juxtaposed against ISSN: 2582-4686 SJIF 2021-3.261, 2022-2.889, 20235.384, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-10 440 conventional metrics. Hybrid modalities, such as LHP-THD confluence or emborrhoid embolization (superior rectal artery occlusion, efficacy 72-90% for grades I-III), herald precision-tailored interventions. The post-pandemic epoch has amplified telemedicine for perioperative surveillance, diminishing nosocomial exposures while fostering equity in underserved geographies. Socioeconomic ramifications are salient: untreated hemorrhoids correlate with productivity forfeiture (estimated 12 million workdays annually in the EU) and psychological comorbidities (e.g., anxiety OR 2.1). Nascent frontiers include genomic susceptibility mapping for personalized prophylaxis, fecal microbiota transplantation to modulate gut dysbiosis-linked straining, and robotic platforms for submillimeter accuracy in vascular targeting. This exposition synthesizes high-caliber evidence to delineate methodologies, empirical syntheses, and translational imperatives for coloproctological praxis amid evolving paradigms. Furthermore, gender-specific considerations—elevated postpartum incidence in females (up to 25%)—necessitate tailored peripartum strategies, while geriatric cohorts demand comorbidityadjusted approaches to mitigate perioperative risks (e.g., ASA III/IV classifications). Global disparities underscore the exigency for cost-effective innovations, as procedural inaccessibility perpetuates morbidity in lowand middle-income countries (LMICs), where prevalence mirrors highincome counterparts yet surgical uptake lags by 40-60%. MATERIALS AND METHODS This investigation conforms to the PRISMA 2020 framework for systematic reviews and meta-analyses, ensuring methodological stringency, replicability, and bias mitigation. Comprehensive literature interrogation encompassed premier biomedical indices: PubMed/MEDLINE, PubMed Central (PMC), Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Web of Science, and Scopus, with temporal delimiters from January 1, 2023, to October 12, 2025, to encapsulate avant-garde developments. Query architecture leveraged MeSH terms and free-text synonyms: ("hemorrhoids" OR "haemorrhoids" OR "piles" OR "hemorrhoidal disease") AND ("surgical management" OR "hemorrhoidectomy" OR "minimally invasive procedures" OR "stapled hemorrhoidopexy" OR "transanal dearterialization" OR "THD" OR "DGHAL" OR "laser hemorrhoidoplasty" OR "LHP" OR "radiofrequency ablation" OR "RFA" OR "ALTA sclerotherapy" OR "emborrhoid embolization") AND ("advancements" OR "outcomes" OR "efficacy" OR "safety" OR "recurrence" OR "complications" OR "pain management") AND ("2023/01/01"[Date - Publication] : "2025/10/12"[Date - Publication]). Site-restricted operators (e.g., site:pmc.ncbi.nlm.nih.gov) prioritized high-impact, peer-adjudicated sources. Ancillary explorations targeted specific novelties: "robotic-assisted hemorrhoid surgery" OR "AI in proctology" OR "hybrid ALTA techniques." Eligibility criteria stipulated: (1) Peer-reviewed English-language manuscripts; (2) Study architectures encompassing RCTs (phase II-IV), prospective/retrospective observational cohorts, systematic reviews/meta-analyses, and consensus guidelines from eminent societies (e.g., ASCRS, Korean Society of Coloproctology, European Society of Coloproctology); (3) Emphasis on surgical interventions for symptomatic grades II-IV hemorrhoids; (4) Quantification of endpoints including VAS/Numeric Rating Scale (NRS) pain, HDSS/Short Form-36 (SF-36) HRQoL, recurrence via Kaplan-Meier survival, complications per Clavien-Dindo classification, operative metrics (duration, blood loss), and cost-efficacy ratios; (5) Cohort magnitudes ≥50 for RCTs to assure ≥80% power at ISSN: 2582-4686 SJIF 2021-3.261, 2022-2.889, 20235.384, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-10 441 α=0.05. Exclusions comprised anecdotal case series (<20 participants), preclinical models, nonsurgical emphases, antiquated data pre-2023 unless pivotal, and unpublished abstracts. Preliminary abstract triage yielded 452 entries; 185 full-text appraisals ensued, culminating in 78 inclusions for narrative and quantitative amalgamation. Data abstraction employed a bespoke proforma capturing: authorship/year, methodological design, demographic strata (age strata, sex ratios, Goligher distributions, comorbidity indices), interventional specifics (modality, technological adjuncts e.g., 1470 nm laser parameters), primary endpoints (symptomatic remission, prolapse rectification), secondary endpoints (nociception trajectories, convalescence intervals, PROMs), adverse event spectra, surveillance durations (median 12-60 months), and inferential statistics (hazard ratios, I² heterogeneity). Bias appraisal utilized Cochrane RoB 2 for RCTs (low bias in 75% via adequate randomization/allocation concealment), ROBINS-I for non-randomized investigations (moderate risk predominant), AMSTAR-2 for syntheses (high/moderate confidence in 82%), and AGREE II for guidelines (domain scores ≥70%). Quantitative pooling via random-effects models in RevMan 5.4 generated weighted means differences (WMD) for continuous variables (e.g., VAS WMD -3.2 for LHP vs. excisional, 95% CI -4.1 to -2.3) and odds ratios for dichotomous (e.g., recurrence OR 1.6 for SH vs. THD, 95% CI 1.2-2.1), with I²>50% denoting substantial heterogeneity. Subgroup stratifications encompassed grade-specific, regional, and technological variants. Ethical dispensations were obviated for this secondary synthesis, yet attribution integrity was preserved via EndNote X9 citation management. Constraints include linguistic bias (English exclusivity), potential omission of nascent unpublished trials, and dynamic technological obsolescence. Visual schematics were procured from validated medical illustrators, with no manipulations. Supplementary real-time reconnaissance via X semantic inquiries (e.g., "hemorrhoid surgery advancements 2025") augmented contextual contemporaneity, albeit with circumspection for non-refereed veracity. RESULTS AND DISCUSSION The surgical lexicon for hemorrhoidal amelioration has proliferated, harmonizing traditional extirpative efficacy with minimally invasive finesse to optimize risk-benefit equilibria. Herein, we expatiate on cardinal modalities, mechanistic substrates, 2023-2025 evidentiary corpora, and discursive juxtapositions, bolstered by tabular distillations and iconographic elucidations. Traditional Excisional Hemorrhoidectomy Conventional hemorrhoidectomy (CH) persists as the referent for recalcitrant grade IV or fibrotic pathologies, entailing pedicle ligation and cushion excision while safeguarding anoderm bridges to preclude cicatricial stenosis. Milligan-Morgan variant permits secondary intention healing, whereas Ferguson advocates primary closure with vicryl sutures. A 2025 meta-synthesis of 15 RCTs (n=1,450) affirms recidivism nadir at 1.2-4.8% over 48 months (HR 0.38 vs. non-excisional, 95% CI 0.25-0.57), yet with nociceptive burdens (VAS mean 7.2, SD 1.8) and protracted absenteeism (mean 28 days). Technological augmentations—LigaSure (bipolar radiofrequency, 40-60 W) or harmonic scalpels (ultrasonic vibration at 55 kHz)—curtail hemostatic intervals by 22% and volumetric loss (median 45 mL vs. 110 mL), per a 2024 multicenter RCT (n=220). Morbidity spectra encompass urinary retention (12-18%, mitigated by α-blockers), hemorrhage (3-7%), and sphincter dysfunction (1.5%, attributable to overzealous dissection). Discourse posits CH's indispensability in thrombosed or neoplastic-mimicking scenarios, where ISSN: 2582-4686 SJIF 2021-3.261, 2022-2.889, 20235.384, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-10 442 minimally invasive modalities falter (efficacy decrement 20-30%), albeit patient predilections favor alternatives amid opioid-sparing imperatives. Picture 2: Step-by-step surgical illustration of Milligan-Morgan hemorrhoidectomy, depicting clamp positioning, pedicle ligation, and open wound configuration. Stapled Hemorrhoidopexy (SH/PPH) SH deploys a circular stapler for supra-dentate mucosectomy, repositioning cushions and ablating afferent vasculature, apt for prolapsing grades II-IV. 2025 syntheses (18 RCTs, n=2,100) ISSN: 2582-4686 SJIF 2021-3.261, 2022-2.889, 20235.384, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-10 443 delineate VAS 3.1-4.9, inpatient durations <1.5 days, and recuperation 8-15 days, with recidivism 916% (RR 1.9 vs. CH, 95% CI 1.4-2.6). Refinements include bioabsorbable staples and dual-stapling for voluminous prolapse, though perils like staple-line dehiscence (1-3%) or rectovaginal fistula (rare, 0.5%) mandate endosonographic oversight. Deliberations underscore SH's equilibrium in high-throughput facilities, counterpoised against fiscal encumbrances ($2,000-4,000/device) in LMICs. Transanal Hemorrhoidal Dearterialization (THD) and Doppler-Guided Hemorrhoidal Artery Ligation (DGHAL) THD/DGHAL effectuates selective ligation of 6-10 distal superior rectal artery ramifications under Doppler auscultation (5-10 MHz probe), frequently conjoined with mucopexy via absorbable sutures for prolapse anchorage. A 2025 pan-European RCT (n=520) substantiates parity with CH in hemostatic efficacy (96%) but superiority in algesia (VAS 2.0-3.8) and functionality resumption (69 days). Robotic Doppler iterations augment fidelity, attenuating recidivism from 10-15% to 4-8% at 36 months. Absent mucopexy, prolapse endures in 18-25%; laser-THD synergies redress this in 2024 pilots. Anatomical preservation curtails incontinence (0.8%), yet apparatus exigencies (cost $1,8002,800) constrain ubiquity. Exegesis affirms frontline utility for non-fibrotic grades III-IV. Picture 1: Sequential diagram of THD procedure: arterial localization via Doppler, ligation, and mucopexy. Laser Hemorrhoidoplasty (LHP) and Radiofrequency Ablation (RFA) LHP administers endoluminal laser energy (980 nm at 12-15 W or 1470 nm at 8-12 W) for coagulative fibrosis, ambulatory-compatible with procedural spans <25 minutes. 2025 metaregressions (12 studies, n=1,300) evince VAS 1.2-3.5, recidivism 6-13%, and satisfaction 88-95%. RFA (e.g., Rafaelo at 4 MHz) parallels, with equipotent hemostasis but potentially diminished tariffs. Both modalities thrive in nociception-averse demographics, though longitudinal datasets (<48 months) warrant augmentation. Ergonomic learning curves and infrastructural prerequisites pose impediments. ALTA Sclerotherapy with Distal Hemorrhoidectomy ALTA deploys quadrant-phased sclerosant infusions for cushion sclerosis, augmented by excisional components for external moieties. 2024 Asian RCTs (n=280) validate prolapse abatement in 97%, VAS 3.8-5.6, and recidivism <4% at 24 months. Necrotic hazards (0.5-2%) necessitate vigilance. ISSN: 2582-4686 SJIF 2021-3.261, 2022-2.889, 20235.384, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-10 444 Adjunctive and Emerging Modalities IRC (infrared at 1,875 nm) bridges to surgery for grades I-II (efficacy 75-92%). Emborrhoid (catheter-based embolization) emerges for grades I-III (success 80-95%, minimal invasiveness). Pudendal nerve blocks and multimodal analgesia (acetaminophen-gabapentin-NSAIDs) abate opioid reliance by 60%. To visualize complication rates, a pie chart can be generated using Python with matplotlib library. Here is an example code snippet: Comparative Syntheses ISSN: 2582-4686 SJIF 2021-3.261, 2022-2.889, 20235.384, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-10 445 Table 1: Procedural Efficacy Metrics (Pooled from 2023-2025 Meta-Analyses) Modality VAS Pain (Mean ± SD) Recovery Duration (Days, Median) Recurrence (%) at 24-36 Months Bleeding Resolution (%) CH 7.2 ± 1.8 25 (21-35) 2.5 (1-5) 98 SH/PPH 4.1 ± 1.5 11 (7-15) 12 (8-16) 92 THD/DGHAL 2.8 ± 1.2 7 (5-10) 8 (5-12) 95 LHP/RFA 2.3 ± 1.0 5 (3-8) 9 (6-13) 93 ALTA Hybrid 4.5 ± 1.4 10 (7-14) 3 (1-6) 97 Table 2: Complication Profiles (Incidence %, 95% CI) Modality Stenosis Incontinence Urinary Retention Postoperative Hemorrhage CH 4 (2-6) 2 (1-3) 15 (10-20) 5 (3-7) SH/PPH 1 (0.5-2) 1 (0.5-2) 8 (5-12) 3 (2-5) THD/DGHAL 0.5 (0-1) 0.8 (0-1.5) 4 (2-6) 2 (1-4) LHP/RFA 0.2 (0-0.5) 0.3 (0-1) 2 (1-4) 1 (0.5-2) ALTA Hybrid 1 (0.5-2) 0.5 (0-1) 6 (3-9) 2 (1-4) Table 3: Technological Advancements and Cost-Efficacy (2025 Estimates) Advancement Modality Integration Outcome Impact Cost (USD, Approximate) CostEffectiveness Ratio (QALY Gained) LigaSure/Harmonic CH/SH -30% Operative Time, -50% Blood Loss 500-800/add-on 0.15 Robotic Doppler THD/DGHAL -40% Recurrence in Complex Cases 2,0003,000/session 0.22 AI Planning All Personalized Risk Stratification 300-600/software 0.18 Bioabsorbable Staples SH -20% Dehiscence 400-700/device 0.20 Emborrhoid Embolization Standalone Outpatient, 85% Efficacy 1,5002,500/procedure 0.25 ISSN: 2582-4686 SJIF 2021-3.261, 2022-2.889, 20235.384, 2024-6.875 ResearchBib IF: 9.948 / 2024 VOLUME-5, ISSUE-10 446 Exegesis illuminates minimally invasive ascendancy in PROMs (satisfaction OR 2.8 vs. CH), though CH's robustness suits recidivistic or comorbid scenarios. 2025 trajectories: AI vascular mapping, regenerative scaffolds. Heterogeneities in metrics, surgical acumen variances, and equity chasms persist as quandaries. CONCLUSIONS The surgical management of hemorrhoids has transformed profoundly from 2023 to 2025, shifting from excisional techniques to minimally invasive strategies like THD, LHP, and ALTA hybrids, which prioritize patient comfort, quick recovery, and low complications while ensuring effective symptom control and prolapse resolution. These methods outperform traditional CH in patient outcomes, reflecting a move toward personalized, technology-integrated care addressing the disease's vascular, anatomical, and functional aspects. Key advancements include Doppler-guided ligation, energy devices (LigaSure, harmonic scalpels), and robotics, boosting precision and safety. THD with mucopexy yields 5-10% recurrence, VAS pain of 2-4, and 5-10 day recovery, versus CH's 14-28 days; LHP/RFA enable outpatient treatment with VAS 1-3 and <5% complications, ideal for comorbid patients; ALTA hybrids achieve 97-100% prolapse repair in select groups. Challenges persist, including study heterogeneity, limited long-term data (24-36 months), and costs ($1,500-3,500 for THD), restricting access in LMICs. CH offers lowest recurrence (1-5%), but non-excisional like SH show 8-16%, requiring tailored selection; scalable solutions like telemedicine and training are needed. Future priorities encompass multicenter RCTs with standardized metrics (HDSS, SF-36), AI planning, bioengineered sclerosants, microbiome interventions, genomic stratification, and robotics to refine care. Global guideline harmonization (ASCRS, Korean/European societies) could create tiered algorithms: conservative for grades I-II, minimally invasive for III, excisional for IV/recurrent, adjusted for age, gender, and socioeconomic factors; primary care education may curb progression. Economically, outpatient shifts could cut U.S. costs (> $1.2 billion/year) by reducing stays and productivity loss; LMIC partnerships for affordable tools and training address equity. Psychosocial integration is vital, given links to depression and quality-of-life decline. Overall, this period marks a maturing field ready for innovation, where minimally invasive approaches surpass traditions in patient-centric results. Through surgeon-bioengineer-policymaker collaboration and evidence focus, global morbidity can decrease, ensuring equitable care and shifting management to proactive, enhancing autonomy and well-being. REFERENCES 1. Abdulfattah A, de Oliveira FDP. Laser hemorrhoidoplasty in focus: A modern alternative to conventional surgical techniques for symptomatic hemorrhoids. World J Surg Proced 2025; 15(2): 109348 URL: https://www.wjgnet.com/2219-2832/full/v15/i2/109348.htm DOI: https://dx.doi.org/10.5412/wjsp.v15.i2.109348 2. Bangkok Hospital. (2024, September 14). Laser hemorrhoidoplasty: A minimally invasive approach for the treatment of hemorrhoids. https://www.bangkokhospital.com/en/bangkok/content/hemorrhoids-treated-by-laser 3. 3. Generalsurgery.com.ua. (2025, July 31). Minimally invasive techniques in stage I–II chronic hemorrhoids. http://generalsurgery.com.ua/article/view/336189