We typically recommend a hemorrhoidectomy for Grade 4 hemorrhoids, or for Grade 3 hemorrhoids featuring a large external tag. This surgery involves removing the prolapsing internal hemorrhoid and the external tag component. This treatment has a high rate of success; patients generally experience full resolution of symptoms, without relapse. Patients experience discomfort following surgery, because the low rectum and anal canal are very sensitive areas. Depending upon the extensiveness of the surgery, a patient may miss one to two weeks of work. A common question regarding surgical management of hemorrhoids involves laser treatment. Our practice has not used this for many years; our experience and that of others published in the literature show that laser treatment for hemorrhoids actually leads to more post-operative pain and swelling than standard hemorrhoidectomy treatment.