Grade 3 or 4 piles usually dose not give any result with oral medicine.

Can be managed with stapler or laser , i do even grade 4 with laser sometimes..

Based on the details you have provided, sounds like you have tried medications without relief. Piles surgery is a very common procedure performed in many centres. However, classical surgery involves large wounds and pain. Other options such as pile-banding and sclerootherapy are not definitive, but can be tried with medications for small sized piles or in those who don’t want surgery at all costs. Laser piles surgery is a new procedure. In the right hands, it can be done though 2mm punctures that do not require any sutures/ large wounds. This can be a day care procedure. Recovery is quick and you could go home on the same day.