Single-Session Laser Treatment of Hemorrhoids with a Concurrent Anal Fissure Using a Flexible Fiber

Keywords:Hemorrhoid Fiber  Time:26-08-2026

Introduction

The patient who arrives with both haemorrhoids and a chronic anal fissure is, in my clinic, a scheduling problem disguised as two problems. The conventional reflex is to stage them: treat the fissure, let it heal, then address the haemorrhoids, or vice versa, accepting two anaesthetics and two recovery periods.

I have come to question that reflex. The pathologies share a distal anal canal, and a flexible fiber that can reach the hemorrhoidal columns can, with the same pass, deliver controlled energy to the fissure floor. Medfibers flexible hemorrhoid fiber is, in this combined scenario, less a hemorrhoid tool than a single distal-canal instrument. The question was whether doing both at once compromised either result.

Material and Methods

Thirty patients with grade II–III haemorrhoids and a chronic posterior midline fissure (confirmed on exam under anaesthetic where needed) were treated in one session: circumferential submucosal coagulation of the hemorrhoidal inflow at 12–15 W, followed by low-energy linear coagulation along the fissure base and internal sphincter, sparing the sphincter bulk. Nineteen were done under local anaesthetic in office, eleven in theatre. Follow-up was at two, six, and twelve weeks; fissure healing was confirmed endoscopically or digitally.

Results

Fissure healing occurred in 28 of 30 patients (93%) by twelve weeks, and hemorrhoid symptom control was maintained in 27 of 30 (90%). One patient required a repeat fissure procedure; two reported residual grade I hemorrhoidal symptoms managed conservatively. No patient developed incontinence or worsen of spasm.

Discussion

Doing both in one sitting did not, in this series, dilute either outcome — if anything, treating the fissure's spastic background at the same moment the hemorrhoidal inflow was closed may have helped both heal together. The enabler was reach: a flexible fiber navigates from the columns down to the fissure floor without a second instrument exchange, so the patient is not reopened for the second pathology. The same reach protects the impaired-wound-healing cohort described in the linked diabetic and immunocompromised report, and the same comfort under local anaesthetic is what makes the office-based awake technique, discussed in the linked post, feasible for combined cases. Taken together, these three reports describe one instrument used with one consistent philosophy — less force, more precision.