Do hemorrhoids need surgery, or can they be treated without an operation?

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• n Forty-three unique RCTs comprising 3,277 participants were analysed.
• population Randomised controlled trials comparing LigaSure with conventional techniques were included.
• intervention We performed a systematic review and meta-analysis of randomised controlled trials comparing LigaSure with conventional haemorrhoidectomy.
• comparator Conventional excisional haemorrhoidectomy remains the gold standard treatment for grade IV haemorrhoids, although energy-based devices may reduce postoperative pain.
• primaryOutcome LigaSure was associated with lower postoperative pain scores on days 1 and 2 and during the first and second postoperative weeks
• result No statistically significant differences were observed in immediate postoperative pain, pain on postoperative day 3 or week 4, recurrence, length of hospital stay, constipation, pruritus, surgical site infection, incomplete healing, anal fissure, anal stenosis, or faecal incontinence.

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• population 173 patients with mixed hemorrhoids (grade III or IV) who underwent elastic band ligation of internal hemorrhoids
• intervention elastic band ligation of internal hemorrhoids
• comparator GMM analysis identified two pain progression trajectories: a rapid relief group (82 cases, 47.4%) and a poor relief group (91 cases, 52.6%)
• primaryOutcome dynamic trajectory of acute pain after elastic band ligation of internal hemorrhoids
• result age (odds ratio [OR] = 0.90, 95% confidence interval [CI]: 0.85-0.96, p = 0.002), SAS score (OR = 1.05, 95% CI: 1.01-1.10, p = 0.018), SDS score (OR = 1.05, 95% CI: 1.01-1.09, p = 0.009), SSRS total score (OR = 0.72, 95% CI: 0.65-0.81, p < 0.001), and number of ligations (OR = 4.96, 95% CI: 1.25-19.77, p = 0.023) were independent factors influencing the pain trajectory
• n included 173 patients with mixed hemorrhoids

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• n This retrospective study included 61 patients who underwent surgery for symptomatic grade II-III hemorrhoidal disease
• population 61 patients who underwent surgery for symptomatic grade II-III hemorrhoidal disease between January 2022 and December 2023
• intervention monopolar cautery ablation (MPCA)
• comparator excisional hemorrhoidectomy (EH)
• primaryOutcome operative time, postoperative pain scores (at the 12th hour, postoperative days 1, 7, and 14), duration of analgesic use, patient satisfaction, time to return to daily activities, postoperative complications, and recurrence rates
• result Operative time and postoperative analgesic requirements were significantly lower in the MPCA group (both p < 0.001). The time to return to daily activities was significantly shorter in the MPCA group, while patient satisfaction was significantly higher (both p < 0.001).
• result No recurrences were detected in the EH group, whereas three recurrences were observed in the MPCA group (p = 0.102).
• followUp All patients were followed for at least one year.
• limitations These findings should be interpreted cautiously due to the retrospective design and relatively short follow-up period.

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• population reporting continence >6 months after HAL-based procedures
• intervention Haemorrhoidal artery ligation (HALO) and variants including Doppler-guided HAL (DG-HAL), HAL with rectoanal repair (HAL-RAR), and transanal haemorrhoidal dearterialisation (THD)
• comparator Standard HAL showed 0/76 (0%) cases; THD had 1/104 (1.0%); DG-HAL had 7/293 (2.4%).
• primaryOutcome This systematic review assessed prevalence, severity, and patterns of incontinence beyond six months post-procedure across HAL techniques.
• result Seventeen (2.5%) of 671 patients developed postoperative faecal incontinence. Of these, 14 (82%) cases were mild (Wexner 1-4) and transient, resolving within 3-6 months; 3 (18%) were moderate (Wexner 5-8), primarily in HAL-RAR (9/158 [5.7%]).
• n total n=671 patients

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• n on 56 patients who underwent hemorrhoidectomy (2019-2023)
• population 56 patients who underwent hemorrhoidectomy (2019-2023)
• intervention 56 patients who underwent hemorrhoidectomy (2019-2023)
• comparator The factors of sex, age, smoking, constipation, BMI, and time to surgery were analyzed
• primaryOutcome clinical and demographic factors associated with symptom duration in surgically treated patients
• result men having a mean 4.89 more years of disease than women (β = -4.89, 95% CI -9.61 to -0.17)
• result Factors traditionally considered relevant, such as constipation and BMI, showed no significant association
• limitations A retrospective, cross-sectional study was conducted
• limitations with no causal inference or predictive intent

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• n Thirty-seven patients completed follow-up.
• population patients with Goligher grade I-IV HD treated with endoscopic PF sclerotherapy
• intervention endoscopic PF sclerotherapy
• comparator stratified by HD severity (Goligher I-II vs III-IV)
• primaryOutcome Symptoms were evaluated using the PROM-HISS score.
• result patients with lower-grade HD showed a significant reduction in PSV and RI at both 7 and 30 days (p < 0.01), indicating effective modulation of arterial inflow.
• result In contrast, no significant changes in PSV or RI were observed in higher-grade HD, while EDV increased at 30 days (p = 0.012).
• result PROM-HISS scores significantly improved in all patients at 7 days; however, symptom scores increased between 7 and 30 days in higher-grade HD.

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• n A total of 127 patients with mixed hemorrhoids who underwent Milligan-Morgan hemorrhoidectomy
• population patients with mixed hemorrhoids who underwent Milligan-Morgan hemorrhoidectomy
• intervention 48 patients in the preoperative anemia group
• comparator 79 patients in the preoperative non-anemia group
• primaryOutcome Postoperative complications such as postoperative pain, delayed bleeding, wound infection, wound edema, urinary retention, insomnia severity index (ISI) within 7 days, wound healing time, and recurrence rates (prolapse or bleeding) within 12 months
• result The visual analog scale pain scores at 12 h (P = 0.018), 1 day (P = 0.010), 3 days (P = 0.034), and 7 days (P = 0.001) after surgery and total analgesic consumption within 7 days (P = 0.036) in the preoperative anemia group were higher than those in the preoperative non-anemia group.
• result There were no significant differences in delayed bleeding, wound infection, wound edema (P = 0.740), urinary retention (P = 0.648), anal stenosis, or wound healing time (P = 1.101) between the two groups.

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• n The study involved 634 patients, most of whom were women (76.5%).
• population patients with haemorrhoids
• intervention surgical treatment of haemorrhoids
• comparator the quality of life of patients improved significantly after surgery
• primaryOutcome A modified sociological questionnaire was used to assess the physical, emotional and social aspects of respondents' lives.
• result most respondents reported no significant limitations in physical activity, and it did not cause significant discomfort in 88% of cases, although moderate or mild pain persisted in 46% of patients

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• n A total of 686 consecutive patients with III-degree HD were included in the analysis.
• population Symptomatic grade III HD treated between 2016 and 2018.
• intervention Four groups were defined: group 1 included patients treated with MM alone; group 2 received mucopexy on one pile combined with MM on the remaining two; group 3 underwent mucopexy on two piles with MM on the remaining one; and group 4 was treated with mucopexy alone.
• comparator This study compares MM, mucopexy, and hybrid MM/mucopexy procedures in patients with grade III hemorrhoidal disease (HD).
• primaryOutcome Recurrence rates and patient-reported outcome measures (PROMs) using a visual-analogic scale (VAS) at 2 years, postoperative pain at 7 days, early complication rates at 30 days, and PROMs at 30 days.
• result Group 4 had the lowest pain scores and the highest 30-day PROM (p < 0.001), whereas group 1 showed the best long-term results, with the lowest recurrence rate (4.2% versus 14.5% in group 4) and highest long-term PROM.

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• population patients with mixed hemorrhoids treated in our hospital from June 2021 to June 2024
• population Grade II-IV internal hemorrhoid prolapse as the main symptom
• intervention Endoscopic Super-hemorrhoidal Banding (ESHB)
• comparator Milligan-Morgan hemorrhoidectomy (MMH) as the control group
• n 245 patients underwent Milligan-Morgan hemorrhoidectomy (MMH) and 235 patients underwent ESHB
• result The cure rates were 69.36% in the ESHB group and 72.65% in the MMH group, with no statistically significant difference between the two groups (P > 0.05).
• result The observation group had significantly shorter operative time and hospital stay (P < 0.01), lower postoperative anal pain scores and incidence of urinary retention (P < 0.01).
• primaryOutcome Treatment outcomes included efficacy measurement, operative time, hospital stay, postoperative anal pain scores, and incidence of complications like bleeding and urinary retention were compared.

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• n Seventy-eight patients were included (grade II/III: n = 54; grade IV: n = 24).
• population Patients were classified into grade II/III and grade IV groups according to the Goligher classification.
• intervention ADL-mucopexy between July 2022 and March 2024 were retrospectively analyzed
• comparator compared clinical outcomes of ADL-mucopexy between patients with grade II/III and grade IV HD
• primaryOutcome Primary outcomes included postoperative pain and recurrence
• result Despite these early differences, 1-month satisfaction scores were comparable between groups (8.8 vs 8.5). Recurrence was observed in 1 patient in each group during follow-up.

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• n This retrospective cohort study was performed on 201 patients
• population treating grade I-III internal hemorrhoids
• intervention endoscopic rubber band ligation (ERBL), injection sclerotherapy (IS), and endoscopic polidocanol sclerobanding (ESB)
• comparator who were grouped according to their endoscopic treatment (ERBL, IS, and ESB groups)
• primaryOutcome The study analyzed clinical efficacy, short-term and overall recurrence rates, and postoperative adverse events.
• result Both the ERBL and ESB groups demonstrated lower overall recurrence rates compared with the IS group (post-hoc analysis, P' = 0.024 and P' = 0.015, respectively).
• result sclerotherapy resulted in a higher total recurrence rate than that achieved by sclerobanding (45.95% vs 19.57%, P' = 0.03), specifically for grade II-III internal hemorrhoids
• result No significant differences were found among the three groups regarding clinical efficacy or recurrence rates within 6 months post-surgery, even when examined by subgroup.
• followUp the longest follow-up extending to 24 months

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• n Seventeen RCTs including 1,041 SH and 1,031 CH patients were analysed.
• population adult patients with grade II-IV haemorrhoids
• intervention Stapled haemorrhoidopexy (SH)
• comparator conventional haemorrhoidectomy (CH)
• primaryOutcome Primary outcomes included recurrence, reintervention, anal function, and quality of life (QoL).
• result SH was associated with a higher risk of overall recurrence compared with CH (RR = 1.56,95%CI = 1.00-2.44;I2 = 48%).
• result Prolapse-related recurrence was significantly more frequent after SH (RR = 3.28,95%CI = 1.49-7.25;I2 = 12%), whereas bleeding-related recurrence did not differ between groups
• result No significant differences were found for reintervention, persistent anal pain, functional impairment or QoL.
• followUp minimum follow-up of 12 months

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• n a total of 313 patients were included, including 200 in the ERBL group and 113 in the EIS group
• population Patients diagnosed with symptomatic grade I-III internal hemorrhoids who failed conservative treatments such as diet adjustment and medication
• population Patients who were unable or unwilling to receive surgical treatment due to multiple underlying systemic diseases
• intervention endoscopic rubber band ligation (ERBL)
• comparator endoscopic injection sclerotherapy (EIS)
• primaryOutcome Statistical analysis revealed no statistically significant difference in efficacy between the two groups within 3 months after the operation (χ²=0.858, P=0.651).
• result The cure rates of the ERBL group and the EIS group were 64.0% (128/200) and 62.8% (71/113), respectively.
• result Compared with the ERBL group, the EIS group had a lower pain score on the first day after operation [0 (0, 0) vs. 1 (0, 3), Z=-8.211, P<0.001] and a lower incidence of anal distension [25.7% (29/113) vs. 61.5% (123/200), χ²=37.122, P<0.001], with statistically significant differences.
• result The total incidence of complications in the ERBL group was significantly higher than that in the EIS group [29.5% (59/200) vs. 4.4% (5/113), χ²=27.910, P<0.001]
• result in grade III internal hemorrhoids, the recurrence rate of the ERBL group was lower than that of the EIS group [22.2% (10/45) vs. 45.8% (11/24), χ²=4.121, P=0.042]. Still, the difference was not statistically significant after Bonferroni correction (χ²=4.121, corrected P>0.025).

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• n A retrospective analysis was conducted on 158 patients who received endoscopic polidocanol foam sclerotherapy for internal hemorrhoids between October 2022 and September 2023.
• population 158 patients who received endoscopic polidocanol foam sclerotherapy for internal hemorrhoids
• intervention 80 received polidocanol carbon dioxide foam (study group)
• comparator 78 underwent endoscopic polidocanol sclerotherapy with polidocanol air foam (control group)
• primaryOutcome The primary outcomes of this study were clinical effect and the incidence of complications 1 month after surgery.
• result The study group exhibited significantly fewer patients with anal pain and anal swelling compared to the control group (P < 0.05), and importantly, no severe complications were observed.
• result Both groups exhibited comparable clinical effects, surgical costs, hospitalization durations, and dosages of polidocanol, with no statistically significant differences observed (all P > 0.05).

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• n retrospectively analyzed 559 patients
• population Flexible endoscopic therapies are effective for grade II-III internal hemorrhoids
• intervention endoscopic rubber band ligation (ERBL) or polidocanol foam sclerotherapy (EPFS)
• comparator Patients were stratified by anesthesia modality (intravenous propofol vs. no anesthesia)
• primaryOutcome Primary outcomes included procedure time, retreatment rate, symptom improvement, postoperative discomfort, patient satisfaction, total cost, and cost acceptance.
• result The anesthesia group had shorter procedure times (median 10.5 vs. 11.3 min, P = 0.036) and a lower retreatment rate (1.3% vs. 6.2%, P = 0.003). Rates of symptom improvement (83.1% vs. 82.7%, P = 0.940), postoperative discomfort, and patient satisfaction were comparable.

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• population A total of 2764 relevant publications were retrieved from the Web of Science Core Collection (WoSCC).
• intervention characterize the knowledge structure, collaborative networks, research hotspots, and emerging trends in hemorrhoid therapy over the past two decades
• comparator Core research domains identified through keyword co-occurrence and clustering included Rubber Band Ligation (RBL), hemorrhoidectomy (Milligan-Morgan, Ferguson, stapled), laser therapy, pain management, postoperative complications, and quality of life.
• primaryOutcome Analyses included publication trends, country/institutional contributions, author/institutional collaboration networks, journal co-citation analysis, keyword co-occurrence/clustering, thematic evolution, and burst detection.
• result It confirms the established role of conventional surgical techniques while identifying a clear shift towards minimally invasive procedures and outpatient management.
• limitations Key knowledge gaps persist in long-term efficacy comparisons and standardized guideline development.

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• population Hemorrhoid disease is common in the Western world
• intervention Numerous treatments are available, including surgical and nonoperative options.
• comparator Numerous treatments are available, including surgical and nonoperative options.
• primaryOutcome The authors present a review of the disease pathophysiology, diagnosis, and treatment options for hemorrhoid disease.
• result The authors present a review of the disease pathophysiology, diagnosis, and treatment options for hemorrhoid disease.

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• population hemorrhoids, chronic anal fissures, dyssynergic defecation (DD), and fecal incontinence (FI)
• intervention starting with conservative therapy with simpler treatments when feasible (eg, rubber band ligation for grade I-II hemorrhoids), with surgery, usually excisional hemorrhoidectomy, being reserved for more severe disease
• comparator with surgery, usually excisional hemorrhoidectomy, being reserved for more severe disease
• primaryOutcome Treatments are applied stepwise, starting with conservative therapy with simpler treatments when feasible
• result Treatments are applied stepwise, starting with conservative therapy with simpler treatments when feasible (eg, rubber band ligation for grade I-II hemorrhoids), with surgery, usually excisional hemorrhoidectomy, being reserved for more severe disease

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• design this retrospective cohort study analyzed patients with HD treated with RBL and/or PFS between January 2015 and April 2024
• n in total, 441 patients were included
• population office-based treatments for hemorrhoidal disease (HD) are recommended when medical management fails
• intervention Both, rubber band ligation (RBL) and polidocanol foam sclerotherapy (PFS) can be used
• comparator This study aimed to compare the efficacy and safety of PFS versus RBL
• primaryOutcome The outcomes were clinical success (CS), relapse, relapse-free survival (RFS) and treatment failure (TF)
• result Patients treated with RBL were significantly more effective in achieving CS (78.6 % vs 58.1 %, p < .001, phi = .205).
• result patients treated with RBL appeared more likely to achieve CS, while PFS showed a more favorable safety profile.

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• n Forty-four patients (86.4% male) were included.
• population pediatric patients treated with conservative therapy (watchful waiting) or injection sclerotherapy for external hemorrhoids
• intervention injection sclerotherapy
• comparator conservative therapy (watchful waiting)
• primaryOutcome treatment outcomes, and complications
• result Thirty-one patients (70.5%) underwent injection sclerotherapy, with a 69.2% success rate after one, and 90.3% after two injections. Thirteen patients (29.5%) were treated conservatively with watchful waiting, with symptoms resolving within one year, although the lesion(s) persisted. Skin erosion occurred in 35.5% of patients treated with injection sclerotherapy, leading to constipation and defecation anxiety in 9.1% of patients.

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• n They included 514 patients (mean age 49.13 years, 46% men) with different haemorrhoidal degrees.
• population They included 514 patients (mean age 49.13 years, 46% men) with different haemorrhoidal degrees.
• intervention DG-HAL in 259 patients
• comparator The HAL technique was performed in 255 patients
• primaryOutcome The primary aim of this study was to find evidence that the use of Doppler guidance reduces the risk of recurrence.
• result The meta-analysis revealed that the DG-HAL procedure was associated with a significant risk of recurrence (P = 0.007) and similar postoperative pain (P = 0.623) compared to the HAL procedure. In a subgroup analysis of patients treated with a combined RAR procedure, no differences were found between the DG-HAL-RAR and HAL-RAR regarding the risk of recurrence (P = 0.36) and postoperative pain (P = 0.31).

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• population The treatment of hemorrhoidal disease is carried out depending on the symptoms and stage of the disease.
• intervention conservative and interventional treatment options (including sclerotherapy, rubber band ligation) are indicated in early stages (stages I and II)
• comparator surgical procedures are effective treatment options for advanced hemorrhoidal disease (stages III and IV)
• primaryOutcome The ultimate goal of all treatment strategies for hemorrhoidal disease is symptom control and long-term absence of recurrence.
• result Although conservative and interventional treatment options (including sclerotherapy, rubber band ligation) are indicated in early stages (stages I and II), surgical procedures are effective treatment options for advanced hemorrhoidal disease (stages III and IV).

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• population treatment of hemorrhoidal disease (HD)
• population across different grades of hemorrhoids
• intervention Laser hemorrhoidoplasty (LHP)
• comparator compared with traditional surgical methods
• comparator excisional methods remain superior for managing advanced HD
• primaryOutcome critically evaluated the efficacy, safety, and long-term outcomes of LHP
• result offering advantages such as reduced postoperative pain, shorter recovery time, and improved patient satisfaction
• result higher recurrence rates, especially for Grade IV HD, remain a clinical limitation
• result excisional methods remain superior for managing advanced HD, particularly in terms of long-term symptom resolution

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• n We included six studies with a total of 851 patients, of whom 390 (45.8%) underwent surgical treatment.
• population Thrombosed external hemorrhoids are a complication of hemorrhoids characterized by severe pain, swelling, and lump formation due to acute venous engorgement.
• intervention Surgical treatment was associated with a lower risk of recurrence compared to conservative management
• comparator comparing surgery with conservative treatment in thrombosed external hemorrhoids
• primaryOutcome Surgical treatment was associated with a lower risk of recurrence compared to conservative management (RR 0.49; 95% CI 0.26-0.91; P < 0.05; I2 = 54%).
• result there were no significant differences in the risk of bleeding between the groups (RR 0.96; 95% CI 0.27-3.44; P = 0.95; I2 = 60%)

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• n Thirty-two patients who underwent minimally invasive endoscopic treatment for internal hemorrhoids were recruited
• population patients with internal hemorrhoids
• intervention Group A undergoing endoscopic ligation (n=14)
• comparator Group B receiving CAES (n=18)
• primaryOutcome the treatment effect of endoscopic ligation and cap-assisted endoscopic sclerotherapy (CAES) for patients with internal hemorrhoids, symptom relief, complication rate and psychological condition, and the anorectal function were observed
• result There was no significant difference in the treatment effect of postoperative bleeding, prolapse, constipation, and complications between the 2 groups. However, Group A has certain advantages in the treatment of prolapse and constipation before and after treatment, and Group B has certain advantages in bleeding.
• followUp with a 3-month follow-up

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• population Eligible studies included adult patients and at least one arm involving surgical treatment.
• intervention randomized controlled trials (RCTs) comparing treatments for HD
• comparator focusing on classification systems used for patient enrollment
• primaryOutcome evaluate the patient selection criteria and classification systems employed in randomized controlled trials (RCTs) for HD
• result Most studies (86.4%) used the Goligher system, though the majority did not fully describe or cite the system.
• result 70% of these did not provide adequate inclusion criteria or references to Goligher's classification
• limitations 70% of these did not provide adequate inclusion criteria or references to Goligher's classification

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• n A total of 266 patients were enrolled in this study, with 133 allocated to the enema group and 133 to the control group.
• population Patients diagnosed with grade III or IV haemorrhoids and anal fistulas at the Taipei Medical University Shuang-Ho Hospital, Taiwan, between 2022 and 2023, were enrolled
• intervention preoperative enema (intervention)
• comparator no preoperative enema
• primaryOutcome The primary outcome measures included postoperative visual analogue scale scores and analgesic usage from postoperative day 0 to day 7.
• result No significant differences were observed in postoperative visual analogue scale scores, analgesic consumption and postoperative complications between the two groups.
• result in the subgroup of patients undergoing Milligan-Morgan haemorrhoidectomy, the mean(s.d.) visual analogue scale score was significantly higher in the control group than in the enema group on day 2 (5.69(2.14) versus 3.77(2.45), P = 0.021), day 3 (5.85(2.61) versus 3.92(2.73), P = 0.042) and day 4 (5.23(2.55) versus 3.42(2.18), P = 0.027).

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• n Twenty-three patients were available for the analysis at 26 months of follow-up
• population patients who underwent Milligan-Morgan hemorrhoidectomy
• intervention underwent a clinical proctological evaluation, a Doppler TPUS, and an endoscopic check of the anal canal
• comparator A consecutive series of MM patients treated between February 2020 and December 2023 were contacted
• primaryOutcome Outcome measures consisted of the description of Doppler TPUS modifications following MM, and their relationship with clinical and endoscopic findings.
• result No correlation was present between residual symptoms and the Doppler vascular pattern (p = 0.089). The vascular pattern was associated with endoscopic signs of recurrences (p = 0.003), and its absence was able to predict the lack of internal recurrences in all patients (100%).
• followUp 26 months of follow-up (range 14-48)

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• population the physical domain is considered as multilayered tissue (three different layers of rectum: muscle, submucosa and mucosa)
• intervention A Gaussian laser beam is considered as heat source to destroy the abnormal growth inside the rectum.
• comparator The research outcome is verified with the published numerical model with negligible variation.
• primaryOutcome Temperature variation in multi-layered tissue is investigated for laser heat input and absorption radius along the temporal and spatial coordinate.
• result Temperature drop has been evidenced in the interfaces of multi-layered rectum tissue.

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• n A retrospective study was conducted on 47 patients
• population 47 patients from our center who underwent endoscopic resection of hypertrophic anal papillae, with or without internal hemorrhoids ligation
• intervention the anal papillae resection + internal hemorrhoid ligation group
• comparator the anal papillae resection group
• primaryOutcome postoperative pain intensity and duration, postoperative bleeding severity, presence of anal edema, and follow-up outcomes at 3 months postoperatively
• result The postoperative pain intensity was higher in the group undergoing anal papillae resection combined with internal hemorrhoid ligation, with a median Visual Analog Scale (VAS) score of 1 (0, 2), and the duration of pain was longer, with a median of 1 (0, 2) day.
• result However, there were no statistically significant differences in the incidence of postoperative bleeding or anal edema.
• result At the 3-month follow-up, the effective rates were 90.9% and 80.0%, respectively, and there were no statistically significant differences among the groups.

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• population patients with grade I-IV symptomatic hemorrhoids treated with endoscopy
• intervention Shaobei injection
• comparator band ligation
• n 413 patients with grade I-IV symptomatic hemorrhoids treated with endoscopy between January 2019 and March 2023
• primaryOutcome Recurrence rate, postoperative complications, hospitalization costs, hospitalization time, postoperative quality of life (QoL), and postoperative satisfaction were compared
• result Recurrence rates did not differ between groups at 3 months postoperatively (P = 0.439). Postoperative symptom grading did not differ between groups (all P > 0.05) but was improved from baseline (all P < 0.001). However, the injection group experienced significantly less pain than the band ligation group on postoperative days 1 (P < 0.001) and 7 (P = 0.003). Significantly lower incidences were observed in the injection than in the ligation group for postoperative anal distention within 1 day (P < 0.001) and complications within 7 days (P < 0.001).

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• n voted upon by 49 panelists
• population symptomatic hemorrhoids
• intervention Laser hemorrhoidoplasty (LHP)
• comparator The developed recommendations were voted upon by a panelist via the Delphi process.
• primaryOutcome Consensus was a priori defined as agreement of 75% and above, with strong consensus defined as 85% and above.
• result Consensus was reached for all 21 recommendations after the first Delphi round, including 16 recommendations with strong consensus.

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• population patients with grades II and III internal hemorrhoids
• intervention Endoscopic polidocanol foam sclerobanding (EFSB) is a novel approach that could lift the mucosa for easy ligation
• comparator compare ERBL and EFSB in patients with grades II and III internal hemorrhoids
• primaryOutcome long-term relief from prolapse recurrence and reduced 24-h post-procedural pain
• result Results showed that EFSB is a novel therapy for internal hemorrhoids, but future studies with a larger sample, multiple treatment sessions, and long-term follow-up are required to confirm these findings.
• followUp with one-year follow-up

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• population patients with Grade II-III internal hemorrhoids
• intervention integration of endoscopic polidocanol foam sclerotherapy with rubber band ligation
• primaryOutcome long-term symptomatic and endoscopic efficacy of this combined intervention
• result In this discussion, we focus on the procedural steps of this combined strategy and suggest potential avenues for future research.

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• n The survey was completed by 1005 surgeons from 103 countries
• population surgeons from 103 countries
• intervention The most common nonprocedural/conservative treatment consisted of increased daily fibre intake (86.9%), increased water intake (82.7%), and normalization of bowel habits/toilet training (74.4%).
• comparator surgery was the first-line treatment for symptomatic fourth degree haemorrhoids (77.6%)
• primaryOutcome assess a global view of how surgeons manage haemorrhoids
• result Conservative treatment was the first-line treatment for symptomatic first (92.5%), second (72.4%) and third (47.3%) degree haemorrhoids; however, surgery was the first-line treatment for symptomatic fourth degree haemorrhoids (77.6%).

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• n A total of 6 RCTs encompassing 465 patients were captured.
• population compare short- and long-term outcomes of CEH and THD
• intervention transanal haemorrhoidal dearterialization (THD)
• comparator conventional excisional haemorrhoidectomy (CEH)
• primaryOutcome The primary objective was recurrence.
• result THD had a higher recurrence rate (odds ratio = 2.76, 95% confidence interval [CI] = 1.03-7.38, p = 0.04) albeit a shorter return to baseline compared to CEH (mean difference = -14.05 days, 95% CI = -20.38 to -7.72, p &lt; 0.0001).

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• n a total of 2492 patients were included in this systematic review and meta-analysis
• population management of hemorrhoidal disease
• intervention Laser Hemorrhoidoplasty (LHP) is a minimally invasive surgical option
• comparator open hemorrhoidectomy
• primaryOutcome The duration of LHP with both wavelengths was significantly shorter compared to open hemorrhoidectomy, postoperative pain and the rate of postoperative complications were significantly lower following LHP.
• result LHP with 1470-nm wavelength resulted in significantly higher recurrence rate compared to hemorrhoidectomy.

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• population 70 patients with grade II hemorrhoids
• intervention laser hemorrhoidoplasty (LHP)
• comparator Rubber Band Ligation (RBL)
• primaryOutcome The postoperative pain, bleeding, feeling of anal distension(local falling, swelling, foreign body sensation, stool) and postoperative recurrence rate were compared between the two groups.
• result The postoperative pain, bleeding, and feeling of anal distension in the LHP group were improved significantly as compared with the RBL group within 2 weeks after surgery (P < 0.01).
• result There was no difference in the recurrence rate between the two groups at 1 year after surgery (P > 0.05).
• n A total of 70 patients with grade II hemorrhoids were randomly assigned to receive LHP or Rubber Band Ligation (RBL) (n = 35 per group)

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• population Hemorrhoids and anal fissures are two of the most common benign anorectal diseases.
• intervention numerous medical and surgical treatment options are available, each with different rates of success and complications
• comparator numerous medical and surgical treatment options are available, each with different rates of success and complications
• primaryOutcome evidence-based treatment options for hemorrhoids and anal fissures
• result the authors review each step of patient management, with emphasis on evidence-based treatment options for hemorrhoids and anal fissures

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• population adults undergoing haemorrhoid banding
• intervention local anaesthetic
• comparator no regional or local analgesia
• primaryOutcome Primary outcomes were patient-reported pain scores.
• result The mean difference in scores on a 10-point scale was at 1 h,-1.43 (95% CI-2.30 to-0.56, p < 0.01, n = 342 (175 in treatment group)); 6 h,-0.52 (95% CI-1.04 to 0.01, p = 0.05, n = 250 (130 in treatment group)); and 24 h,-0.31 (95% CI-0.82 to 0.19, p = 0.86, n = 247 (127 in treatment group)).
• n n = 342 (175 in treatment group)
• qualityWhy The quality of the evidence was rated down to 'low' due to inconsistency and imprecision.

Taken word for word from the abstract

• n A total of 961 patients met inclusion criteria for grade II (n = 442) and III (n = 519) hemorrhoids.
• population Patients aged 18 to 75 years with grade II or grade III internal hemorrhoids between 2015 and 2020 were included.
• intervention Treatments included hemorrhoidectomy, in-office procedures, and/or medical management.
• comparator Treatments included hemorrhoidectomy, in-office procedures, and/or medical management.
• primaryOutcome Baseline demographics, treatment choices, and time to hemorrhoidectomy (if applicable) were stratified and analyzed on the basis of hemorrhoid grade (grade II and III) and age groupings
• result Patients with grade III versus grade II hemorrhoids were more likely to choose hemorrhoidectomy as the initial treatment management (27.6% vs 4.1%). Patients in the age groups of 18 to 30 and 30 to 50 years were more likely to choose hemorrhoidectomy as the initial treatment management compared to those in the age group of 51 to 75 years (23.5% and 22% vs 12.8%). In patients who were initially treated with medical management or office-based procedures and then progressed to hemorrhoidectomy, no significant differences in the length of time to hemorrhoidectomy were noted on the basis of hemorrhoid grade or age.

Taken word for word from the abstract

• n Of the 346 542 admissions for RBL, 14013 (4.04%) involved a PNB.
• population all admissions for RBL in Australia from 2012 to 2021
• intervention pudendal nerve blocks (PNB) being one analgesic strategy
• comparator with and without a PNB
• primaryOutcome whether use varies by year and patient and hospital characteristics
• result The proportion of patients receiving a PNB increased between 2012-2013 and 2020-2021, from 1.62% to 6.63%

Taken word for word from the abstract

• population included 50 (68.75%) male and 20 (31.25%) female patients with third- and fourth-degree piles
• intervention group II underwent HSH
• comparator Group I underwent SH
• primaryOutcome This study compared the results of stapled hemorrhoidopexy (SH) and harmonic scalpel hemorrhoidectomy (HSH) in the management of grade III and grade IV piles regarding the time of the procedure, postoperative pain, patient satisfaction, wound infection, bleeding, incontinence, and recurrence within 1 year.
• result There were 7 (20%) cases of recurrence at the 1‑year follow-up in group I and 1 (2.9%) case in group II (p = 0.024).
• n included 50 (68.75%) male and 20 (31.25%) female patients

Taken word for word from the abstract

• population Hemorrhoids is a common anorectal disease, usually occurring in middle-aged people aged 25-65 years old
• intervention Injection therapy with a history of more than 150 years is simple to operate, easy to popularize and apply in grass-roots units, causes less intraoperative bleeding and fewer complications, and has reliable efficacy.
• comparator The treatment of hemorrhoids includes conservative, injection, ligation, and various surgical procedures.
• primaryOutcome aiming to guide the reasonable selection of drugs and dosage forms for hemorrhoidal injection treatment, and to provide reference for standardizing the use of different drugs and dosage forms, so as to improve the effectiveness and safety of clinical application of hemorrhoidal injection treatment.
• result This paper attempts to make detailed recommendations on the types and application methods of the preparations commonly used in the injection treatment of hemorrhoids at home and abroad, and form the Chinese Expert Consensus on the Treatment of hemorrhoids by anal injection (2023 edition)

Taken word for word from the abstract

• n In total, 146 patients were included
• population consecutive patients diagnosed with Goligher grade III and IV haemorrhoids, who had undergone Doppler-guided haemorrhoidal artery ligation (DG-HAL) and rectoanal repair (RAR)
• intervention Doppler-guided haemorrhoidal artery ligation (DG-HAL) and rectoanal repair (RAR)
• comparator The study included consecutive patients diagnosed with Goligher grade III and IV haemorrhoids, who had undergone Doppler-guided haemorrhoidal artery ligation (DG-HAL) and rectoanal repair (RAR) at 2 medical centres in Spain.
• primaryOutcome The main objective was to evaluate the number and 12-h clock locations of arterial ligatures necessary to achieve Doppler silence.
• result The average number of ligatures per patient was 7 (range 2-12). Ligature percentages greater than 60% occurred at clock positions 7, 11, 10, 12, 9, and 1. The average number of mucopexies per patient was 3 (range 1-4).

Taken word for word from the abstract

• population total 85 patients aged 18-70 years old with symptomatic Grade 2 and Grade 3 hemorrhoidal disease whose symptoms persisted despite at least one month of medical treatment
• intervention Laser hemorrhoidoplasty
• comparator Milligan-Morgan (MM) hemorrhoidectomy
• primaryOutcome Postoperative VAS score and complications were recorded within 10 days.
• result The incidence of minor perioperative hemorrhage was significantly lower in Group L compared to Group M (P = .035). The postoperative 3rd-hour VAS scores were statistically significantly lower in Group L compared to Group (P < .001).
• result We believe that it is not an advantageous method compared to MM hemorrhoidectomy, both in terms of patient comfort and cost-effectiveness
• n total 85 patients aged 18-70 years old
• followUp Postoperative VAS score and complications were recorded within 10 days.

Taken word for word from the abstract

• population Hemorrhoidal disease (HD) is the most common disease of the anorectal region
• population Patients treated with ADHL and LH for HD
• intervention Doppler-guided ligation of the hemorrhoidal arteries (ADHL)
• comparator Excision of pathological hemorrhoidal structures by providing bipolar energy transfer with Ligasure
• n The number of patients included in the study was 91.
• result The mean operative time was shorter in group 1.
• result The mean hospital stay was 1.5 days in the ADHL-treated group, compared to. 3.05 days in the LH group.
• result bleeding was not observed after an average of 1.4 days in group 1, while this period was 4.9 days in group 2
• result recurrence occurred in 4 patients in the ADHL group, recurrence developed in 3 patients who underwent LH
• primaryOutcome operation time, bleeding during and after the operation, length of hospital stay, postoperative pain scoring, and postoperative results

Taken word for word from the abstract

• population patients with Goligher's grade III hemorrhoidal disease
• intervention hemorrhoidal artery ligation
• comparator excisional hemorrhoidectomy
• primaryOutcome compare them in terms of symptoms, postoperative adverse events, and recurrences at a 24-month follow-up
• result Patients who underwent excisional hemorrhoidectomy had a significantly higher risk of postoperative complication (adjusted OR = 1.58; p = 0.006).
• result recurrence was significantly higher in the hemorrhoidal artery ligation group (adjusted OR = 0.50; p = 0.001)
• n Data from 1681 patients were analyzed.
• limitations The retrospective design and the self-reported nature of data from different centers.
• followUp 24-month follow-up period

Taken word for word from the abstract

• population Haemorrhoids are common in young women and commoner during pregnancy and the puerperium.
• intervention Fiber supplement, stool softener and mild laxatives are generally safe for pregnant women.
• comparator Hemorrhoidectomy is reserved in strangulated or extensively thrombosed hemorrhoids, and hemorrhoids with intractable bleeding.
• primaryOutcome we address the issue of the approach of the obstetrician and surgeons to haemorrhoids and their management
• result Fiber supplement, stool softener and mild laxatives are generally safe for pregnant women. Topical medication or oral phlebotonics may be used with special caution because the strong evidence of their safety and efficacy in pregnancy is lacking.
• result Hemorrhoidectomy is reserved in strangulated or extensively thrombosed hemorrhoids, and hemorrhoids with intractable bleeding.

Taken word for word from the abstract

• n 55 studies were included for the final revision.
• result Laser treatments for hemorrhoids require a shorter operative time and show less postoperative pain and bleeding compared to conventional hemorrhoidectomy, but are more expensive.
• primaryOutcome require a shorter operative time and show less postoperative pain and bleeding
• intervention Laser treatments for hemorrhoids
• comparator compared to conventional hemorrhoidectomy
• population Laser treatments for hemorrhoids

Taken word for word from the abstract

• population the endoscopic management of internal hemorrhoids
• intervention cap-assisted endoscopic sclerotherapy (CAES)
• intervention Rubber band ligation has been adopted by the endoscopist as endoscopic rubber band ligation (ERBL)
• comparator Data is needed on head-to-head comparisons between ERBL, endoscopic sclerotherapy, and CAES.
• primaryOutcome current status and future perspectives of the endoscopic management of internal hemorrhoids
• result demonstrating satisfactory results in treating symptomatic hemorrhoids, although mild postprocedure complications are common
• result Other methods, such as coagulation, are understudied and should be explored further in the endoscopic setting.
• result Meaningful comparisons between treatment methods for internal hemorrhoids have been difficult because of variations in interventional techniques and methods

Taken word for word from the abstract

• n Twenty surgeons enrolled 197 patients.
• population Patients with prolapsed internal hemorrhoids in at least 3 columns were eligible.
• intervention transanal hemorrhoidal dearterialization (THD) with mucopexy
• comparator Ferguson hemorrhoidectomy
• primaryOutcome The primary endpoint was recurrence rates defined as prolapsing internal hemorrhoids.
• result Recurrence rates did not differ between the study arms (5.9% vs 2.4%, P =0.253).
• result THD patients had lower Visual pain scores at postoperative day (POD) 1 (6.2 vs 8.3, P =0.047), POD7 (4.5 vs 7.7, P =0.021), POD14 (2.8 vs 5.3, P <0.001)
• followUp Median follow-up was 3.1 (1.0-5.5) years.
• limitations Participating surgeons performed the operation they knew best enrolling 10 patients each.

Taken word for word from the abstract

• population symptomatic grade 1-2 haemorrhoids in adults (> 18 years)
• intervention rubber band ligation (RBL)
• comparator sclerotherapy (SCL)
• primaryOutcome The primary outcome measures are symptom reduction by means of PROMs, recurrence and complication rates.
• result This protocol describes the methodology of a non-inferiority, multicentre, randomised controlled trial comparing rubber band ligation and sclerotherapy

Taken word for word from the abstract

• n Seventy patients with symptomatic grade I to III hemorrhoids were randomly assigned to the hemorrhoid and combined ligation groups (35 in each group).
• population symptomatic grade I to III hemorrhoids
• intervention ligation of hemorrhoids
• comparator simultaneous ligation of hemorrhoids and proximal normal mucosa (combined ligation)
• primaryOutcome The primary outcome was overall therapeutic success rate (complete resolution and partial resolution rates).
• result No significant differences in overall efficacy, recurrence rate, or efficacy for each symptom (including bleeding, prolapse, pain, anal swelling, itching, soiling, and constipation) were observed between groups.
• result The incidence of postoperative pain was higher in the combined ligation group (74.2% vs. 45.2%, P = 0.02).
• followUp Patients were followed up at 3, 6, and 12 months to assess symptom improvement, complications, and recurrence.

Taken word for word from the abstract

• population compare rubber band ligation and coagulation treatments for haemorrhoids
• intervention Rubber band ligation
• comparator coagulation
• primaryOutcome efficacy rate, postoperative prolapse rate, recurrence rate and postoperative urine retention rate
• result No significant difference was found between rubber band ligation and coagulation in terms of efficacy rate, postoperative prolapse rate, recurrence rate and postoperative urine retention rate after treatment. Patients undergoing rubber band ligation had higher postoperative pain rate and lower postoperative bleeding rate than patients undergoing coagulation.
• qualityWhy All trials were of moderate methodological quality.

Taken word for word from the abstract

• population Hemorrhoid disease (HD) is an anal-rectal ailment
• intervention newer molecules to overcome hemorrhoids
• primaryOutcome safety, clinical efficacy, and marketed formulation for the effective management of hemorrhoids
• result The high incidence of hemorrhoids obliges the development of new molecules; therefore, safe and efficient drugs to confer protection against hemorrhoids are urgently needed.
• comparator various studies carried out in the past

Taken word for word from the abstract

• population patients who underwent LHP due to Grades 2, 3, and 4 internal hemorrhoidal disease
• intervention laser hemorrhoidoplasty (LHP) method
• comparator The data of patients who underwent LHP due to Grades 2, 3, and 4 internal hemorrhoidal disease in our clinic were reviewed retrospectively.
• primaryOutcome symptomatic recovery and recurrence rates, post-operative pain levels, and complication rates
• result Recurrence developed in 16 (17.6%) patients with Grades 2 and 3 disease and in 6 (50%) of 12 patients with Grade 4 disease (p = 0.019).
• n A total of 103 patients were included in the study.
• followUp followed for at least 6 months (6 months, 1 year, and 2 years)

Taken word for word from the abstract

• n 93 patients received conventional Milligan Morgan as control group and 81 patients received laser hemorrhoidoplasty treatment
• population grade III symptomatic HD patients undergoing LHP vs MM
• intervention laser hemorrhoidoplasty treatment using a 1470-nm diode laser
• comparator conventional Milligan Morgan as control group
• primaryOutcome Postoperative pain, wound care management, symptoms' resolution, patients' quality of life, and length of return to daily activity
• result Laser hemorrhoidoplasty patients experienced lower postoperative pain score (p < 0.0001) and smoother wound management
• result the recurrence of symptoms occurred in 8.1% after Milligan-Morgan and 21.6% after laser hemorrhoidoplasty (p < 0.05)
• followUp After 25 ± 8 months follow-up