The surgeon will first insert a tube called a proctoscope inside your anus. This tube contains a Doppler probe to locate the end of the blood vessels that supply the blood to the haemorrhoids (terminal arteries). Your surgeon will rotate the proctoscope clockwise to find the terminal artery.

1. If we imagine the anus as a clock, then piles are present at three, seven, and 11 o’clock (you may not necessarily have piles in all three positions). Laser surgery helps burn the blood vessels in the haemorrhoids present at either location.
2. The lowermost portion of the anus, close to the skin, is pain-sensitive. Hence, your surgeon will not make any cuts in this region.
3. The region which is four cm inside the anal opening is pain-insensitive. Hence, your surgeon will perform surgery in this region. However, you might feel a stretch sensation post-surgery, which can make you uncomfortable.
4. After the surgeon identifies the artery, they will insert a laser fibre into your anus via the same tube. The surgeon will then apply laser shots to destroy these arteries.
5. The surgeon will use a 1470 nm diode laser to remove haemorrhoids.
6. The laser will help shrink the end of the blood vessels that supply the blood to the haemorrhoids. This step ultimately helps shrink the haemorrhoids as the blood supply is completely cut. However, it takes six weeks for the mass to fully shrink to about 60 - 80% of its original size.
7. Laser surgery requires minimal invasion (fewer cuts) and has an operative time of nearly 16 minutes.

What to Plan Before Surgery?

You can expect the following:

1. Pre-operative investigations: Your proctologist will conduct a blood test and the following physical examinations before surgery:
2. Examine the inside of your anal region via anoproctoscopy.
3. Carry out a digital rectal examination in which they will insert their gloved, lubricated finger inside the anus to feel the haemorrhoids.
4. Ensure you meet your anaesthetist before surgery. They will assess your fitness for surgery
5. Dietary changes: 
6. Your proctologist will advise you to eat foods rich in minerals and vitamins like fruits and vegetables a day before surgery. Avoid red meat and such foods that are difficult to digest
7. Do not consume alcohol three to four days before surgery.
8. Medications: 
9. Medications can interfere with the surgical process. Ask your proctologist about the medicines you can use before or on the day of the surgery.
10. If you have to take any prescription medicines, take them with very little water

What to Expect on the Day of Surgery?

Two hours before the surgery, your proctologist or the medical team might give you enemas. Enema is the injection of a liquid into the large intestine via the anus. Enema helps to remove any stools trapped in the intestines.

What to Expect During Surgery?

You can expect the following:

1. The surgeon will administer spinal, local (e.g., lidocaine and prilocaine) or general anaesthesia before the surgery. Spinal and local anaesthetic methods will numb your anal region and keep you conscious throughout the surgery
2. You will be in a lithotomy position for laser surgery.

You can expect the following:

At the Hospital: 

1. The effect of anaesthesia comes off in four to six hours. However, you must maintain spinal anaesthesia care to prevent spinal headaches. Also, once the effect of anaesthesia comes off, you might feel a stretching sensation after piles surgery, making you uncomfortable. 
2. After the surgery, your anal region will be numbed using a local anaesthetic which will help you not feel any pain for six to 12 hours.
3. You may be unable to urinate due to swelling in the muscles around the anus or spasms of the pelvic muscles. Over one-third of patients can experience.
4. urinary retention post-surgery, with males being more prone to it. Your proctologist might recommend catheterisation or medicines to manage this condition.  
5. You may also experience bleeding from the rectum for seven to 10 days post-surgery, which is visible while passing stools.
6. Laser piles surgery is an outpatient procedure, which means you will be discharged on the same day. You will get discharged once the anaesthesia wears off and you have urinated.
7. Wear loose-fitting clothes so that you remain comfortable while going home. Also, someone must drive you home.

Medications/Pain relief

    Pain relief: Laser surgery usually does not cause pain, but there is a chance that you may feel pain for a brief time. To ease the passage of stools, use laxatives (medicines that empty the bowel) or stool softeners. You may also

1. Use herbs like Isabgul husk and Triphala as laxatives
2. Antibiotics: Your proctologist will prescribe you antibiotics to rule out any infection

Practice good bowel habits:

1. Avoid putting too much pressure while passing stools.
2. Do not stay for a longer time in the toilet.
3. Do not hold your poop.

Diet:

1. You should slowly increase fibre intake (by eating fruits, vegetables, and whole grains).
2. Drink liquids and eat bland food (plain rice, bananas, dry toast or crackers, apple sauce) for a few days following surgery. After that, you can return to regular foods and gradually increase your fibre intake.[8]
3. Drink plenty of water (four to five litres) every day

Wound care:

1.      You will likely need some cotton or other absorbent dressing in this area for several days since you will have some bloody drainage. It is easiest to remove dressings when they are wet.

Sitz bath:

1. After your surgery, you should plan on taking sitz baths for a few days. 
2. A sitz bath is simply submerging your bottom in water. Either in the bathtub, shower, or a portable sitz bath (which looks like a plastic hat upside down).
3. You should use plain, warm water (no soaps or salts). The recommended time is 10 to 15 minutes two to three times a day. 
4. You can stop dressing and bathing can when desired.