Skip to content
Beverly Hills · 435 N. Bedford Dr., Suite 308Mon–Fri 9:00 am – 5:00 pmMost PPO insurance accepted
Allen KamravaMD · MBA · FACS · FASCRS

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

In adults with symptomatic internal or external hemorrhoids (Goligher grade I-IV), how do non-surgical treatments (rubber band ligation, sclerotherapy, infrared coagulation, dietary fiber) compare with surgical hemorrhoidectomy (including laser hemorrhoidoplasty) in symptom resolution, recurrence, and need for later surgery?

Evidence review in plain language · compiled 2026-10-22 · checked 2026-10-22 · next 2026-11-22 · automated review, how it works

What the evidence says

Bottom line

Whether you need surgery depends on how severe the hemorrhoids are: for grade I-III, office procedures like banding often work about as well as surgery, but surgery lowers the chance of symptoms coming back.

In a trial of grade III hemorrhoids, rubber band ligation came back far more often within a year than surgery did (48% vs 6%). A separate 5-year trial found surgery, laser treatment, and mucopexy all relieved symptoms similarly, though surgery gave the best overall results. An expert guideline recommends banding or infrared coagulation first for grade 1-3 disease, with surgery reserved for grade 4.

How well studied

Well studied

3 well-conducted randomised trials address this question directly.

This question weighs several approaches rather than testing one treatment, so there is no single works-or-doesn't verdict. What can be shown is how well it has been studied.

answer it directly
8answer it directly
studies found
89studies found
randomised trials
12randomised trials
people studied
436,121people studied
reviews of trials
17reviews of trials
years covered
2023–2026years covered
finished, never published
2finished, never published

What the research shows

  • Symptom resolution (bleeding, prolapse, pain) at 3-12 months

    In a meta-analysis, surgery produced greater overall symptom resolution than conservative treatment (OR 2.96 favoring surgery, p<0.001). In one study, an office-based banding procedure had a cure rate similar to surgical hemorrhoidectomy (69.36% vs 72.65%, not statistically significant) but shorter operative time, less pain, and fewer urinary retention complications. In a separate trial in people with grade III hemorrhoids, rubber band ligation was not noninferior to hemorrhoidectomy, with a much higher 12-month recurrence rate (47.5% vs 6.1%).[1,2,3]

    Found in studies

  • Recurrence rate at 1 year

    Findings differ by study and severity. In grade III hemorrhoids, one trial found banding failed and recurred far more often than surgery (48% vs 6%) within a year. A separate 5-year trial found no statistically significant recurrence difference between surgery, laser treatment, and mucopexy, despite surgery numerically doing best.[1,2]

    Too little evidence

  • Need for subsequent or repeat surgery

    Few trials directly tracked how often people who started with a non-surgical option eventually needed surgery. One retrospective study found about 12% of people treated with office-based banding or sclerotherapy eventually needed surgery, but this wasn't a randomised comparison.[1,2]

    Too little evidence

  • Postoperative pain scores

    Across several trials, laser hemorrhoidoplasty and similar less invasive techniques produced significantly lower postoperative pain scores than excisional or conventional hemorrhoidectomy in the early hours and days after treatment. One trial, however, found that although laser caused less bleeding and lower pain at 3 hours, the extra pain from conventional surgery was easily managed with simple painkillers, and the authors concluded laser offered no clear overall advantage in patient comfort.[1,2,3]

    Found in studies

  • Time to return to normal activity

    One meta-analysis found LigaSure hemorrhoidectomy, a less invasive surgical technique, led to a faster return to daily activities than conventional excisional hemorrhoidectomy. A separate meta-analysis found laser hemorrhoidoplasty let patients return to routine activities about 6 days sooner than LigaSure hemorrhoidectomy. Other studies found office-based banding had a shorter operative time and hospital stay than excisional surgery, but did not directly report days to return to normal activity.[1,2,3]

    Found in studies

  • Complication rate (bleeding, infection, stenosis)

    Less invasive surgical techniques such as LigaSure hemorrhoidectomy and stapled hemorrhoidopexy had lower rates of urinary retention and other wound-related complications than conventional open hemorrhoidectomy in several trials. Rubber band ligation carries a risk of delayed bleeding; one case report describes serious rectal bleeding 15 days after banding. Laser hemorrhoidoplasty has at least one reported case of rectal perforation leading to sepsis and multi-organ failure. These findings come from separate studies rather than one comparison of all options together, so it isn't possible to rank overall safety across approaches from this evidence.[1,2,3,4]

    Too little evidence

What the studies found

  • In one study, an office-based banding procedure (ESHB) achieved a cure rate similar to surgical hemorrhoidectomy (69.36% vs 72.65%, not statistically significant) while causing less pain, a shorter operation and hospital stay, and fewer cases of urinary retention. A separate analysis found that, overall, surgery produced higher rates of complete symptom resolution than conservative (non-surgical) treatment, while conservative treatment was safer and less invasive, though with slower symptom relief and higher recurrence.[1,2]
  • Laser hemorrhoidoplasty, a minimally invasive technique, caused less pain and a faster return to work than traditional excisional surgery in several trials.[1,2,3,4]
  • For grade III hemorrhoids, surgical hemorrhoidectomy produced much lower one-year recurrence than rubber band ligation (about 6% vs 48%) in a randomised trial.[1]
  • At 5 years, surgical hemorrhoidectomy showed the best overall outcomes among hemorrhoidectomy, laser treatment, and mucopexy, although the recurrence differences between them were not statistically significant.[1]
  • An expert clinical guideline recommends trying banding or infrared coagulation first for grade 1-3 hemorrhoids, reserving surgery for grade 4 disease.[1]

Important limitations

  • Many of the available studies compare two non-surgical techniques to each other, or two surgical techniques to each other, rather than directly testing surgery against a non-surgical option, so they can't fully answer this exact question.[1,2,3,4,5,6,7]
  • Most trials that do compare surgery with a non-surgical option are small (under 200 people), from a single center, and not blinded, which can bias results toward whichever treatment doctors or patients preferred.[1,2,3,4]
  • Follow-up for recurrence rarely extends beyond 1-2 years; the one trial that followed patients to 5 years was not large enough to reliably detect small differences in recurrence between treatments.[1]
  • This meta-analysis combined two different laser wavelengths (980 nm and 1470 nm) with different results: recurrence was similar to surgery for the 980 nm laser but significantly higher for the 1470 nm laser, so its overall findings on laser treatment versus surgery do not apply equally to both laser types.[1]

What kind of studies

  • Retrospective27 · 30%
  • Meta-analysis14 · 16%
  • Narrative review14 · 16%
  • Randomised trial12 · 13%
  • Prospective cohort11 · 12%
  • Case series5 · 6%
  • Systematic review3 · 3%
  • Guideline2 · 2%
  • Registry1 · 1%

The key studies

  • Makunaite et al. 2026

    Five-Year Follow-up of the Double-Blinded Randomized Controlled Trial Comparing Laser Hemorrhoidoplasty With Sutured Mucopexy and Excisional Hemorrhoidectomy

    Similar recurrence; surgery rated best overallRandomised trialModerate quality

    102 people5 years

    Five-year symptom recurrence was 24% after excisional hemorrhoidectomy, 29% after laser hemorrhoidoplasty, and 44% after sutured mucopexy, but these differences were not statistically significant; hemorrhoidectomy patients reported the best overall outcomes while laser hemorrhoidoplasty had a shorter, less painful recovery.

    Who was studied
    Adults with symptomatic second- or third-degree (grade II-III) hemorrhoids
    What they received
    Laser hemorrhoidoplasty and sutured mucopexy (non-surgical/minimally invasive options)
    Compared with
    Excisional hemorrhoidectomy (surgery)
    Main outcome
    Recurrence of hemorrhoid symptoms at 5 years
    Quality
    This is a single, small single-center trial, and its main recurrence comparison did not reach statistical significance, so the result carries limited weight.
    Limitations
    Single-center study with a relatively small sample size.

    Taken word for word from the abstract

    • n A total of 102 patients were evaluated at 5 years (34 per group).
    • population Patients with symptomatic second- or third-degree hemorrhoids 5 years after surgery
    • intervention Patients randomly assigned to laser hemorrhoidoplasty, excisional hemorrhoidectomy, and sutured mucopexy were followed up at 5 years after surgery.
    • comparator excisional hemorrhoidectomy
    • primaryOutcome Recurrence of symptoms was the primary outcome
    • result Kaplan-Meier estimates of 5-year symptom recurrence were 24% for excisional hemorrhoidectomy, 29% for laser hemorrhoidoplasty, and 44% for sutured mucopexy; these differences did not reach statistical significance (log-rank p = 0.076).
    • result Patients who underwent excisional hemorrhoidectomy reported the best outcomes; however, laser hemorrhoidoplasty produced only slightly worse results with a significantly shorter and less painful postoperative course.
    • limitations This is a single-center study with a relatively small sample size.

    Dis Colon Rectum · PMID 42478482 · Read it on PubMed ↗

  • Qureshi et al. 2026

    AGA Clinical Practice Update on Diagnosis and Treatment of Hemorrhoids: Expert Review

    Try non-surgical options first; surgery for severe cases.GuidelineLow quality

    size not given2026

    Hemorrhoid banding or infrared coagulation should be employed prior to surgical hemorrhoidectomy for grades 1 to 3 hemorrhoids; Grade 4 internal hemorrhoids require surgical hemorrhoidectomy.

    Who was studied
    Adults with symptomatic hemorrhoids of grades 1 to 4
    Main outcome
    Best practice advice for diagnosis and treatment of hemorrhoid disease
    Quality
    This is an expert consensus review, not a systematic review or trial, so its advice is not graded for evidence quality.
    Limitations
    Because systematic reviews were not performed, these BPA statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations.

    Taken word for word from the abstract

    • population Hemorrhoid banding or infrared coagulation should be employed prior to surgical hemorrhoidectomy for grades 1 to 3 hemorrhoids.
    • population Grade 4 internal hemorrhoids require surgical hemorrhoidectomy.
    • primaryOutcome to provide best practice advice (BPA) covering the diagnosis and treatment of hemorrhoid disease
    • result Hemorrhoid banding or infrared coagulation should be employed prior to surgical hemorrhoidectomy for grades 1 to 3 hemorrhoids.
    • result Grade 4 internal hemorrhoids require surgical hemorrhoidectomy.
    • limitations Because systematic reviews were not performed, these BPA statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations.

    Clin Gastroenterol Hepatol · PMID 42067175 · Read it on PubMed ↗

  • Huang et al. 2026

    Evaluation of short-term outcomes of Endoscopic Super-Hemorrhoidal Banding for mixed hemorrhoids with prolapsed internal hemorrhoids: a retrospective study

    Similar cure, less pain, faster recovery with banding.RetrospectiveLow quality

    480 people2026

    Cure rates were similar between banding and surgery, but banding led to shorter operation and hospital stay, less pain, and fewer urinary retention complications

    Who was studied
    adults with mixed hemorrhoids and grade II-IV internal hemorrhoid prolapse
    What they received
    endoscopic banding procedure (Endoscopic Super-hemorrhoidal Banding, ESHB)
    Compared with
    surgical hemorrhoidectomy (Milligan-Morgan hemorrhoidectomy, MMH)
    Main outcome
    cure rate, operative time, hospital stay, pain and complications
    Quality
    This was a retrospective, non-randomized comparison with only short-term follow-up, so it cannot reliably separate treatment effects from patient selection bias.
    Limitations
    Retrospective design without randomization, no long-term follow-up reported, and potential selection bias between the two treatment groups.

    Taken word for word from the abstract

    • n 245 patients underwent Milligan-Morgan hemorrhoidectomy (MMH) and 235 patients underwent ESHB.
    • population patients with mixed hemorrhoids treated in our hospital from June 2021 to June 2024
    • intervention Endoscopic Super-hemorrhoidal Banding (ESHB)
    • comparator Milligan-Morgan hemorrhoidectomy (MMH) as the control group
    • 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.
    • 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). 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).

    BMC Surg · PMID 41987169 · Read it on PubMed ↗

  • Quan et al. 2025

    Comparison of efficacy and safety between surgical and conservative treatments for hemorrhoids: a meta-analysis

    Surgery faster relief, less recurrenceMeta-analysisModerate quality

    760 people2025

    Surgery produced higher complete symptom resolution and better early pain relief, but pain scores were similar after 10 days; surgery reduced recurrence and sped recovery in pregnant thrombosed cases, with no significant difference in bleeding or urinary retention, though some surgery-specific complications occurred.

    Who was studied
    Adults with hemorrhoids, including pregnant women with thrombosed external hemorrhoids
    What they received
    Surgical treatment for hemorrhoids
    Compared with
    Conservative (non-invasive) treatment for hemorrhoids
    Main outcome
    Complete symptom resolution
    Quality
    It pools only seven studies with 760 patients and does not clearly specify how many were randomised trials versus other designs, so the strength of the underlying evidence is uncertain.
    Limitations
    The abstract does not state how many of the seven included studies were randomised controlled trials, nor does it describe risk of bias or heterogeneity in study design.

    Taken word for word from the abstract

    • n Seven studies, including 760 patients, were analyzed.
    • population Comparable patterns were observed in pregnant women with thrombosed external hemorrhoids.
    • intervention Eligible studies compared surgical treatments with non-invasive conservative treatments in hemorrhoids.
    • comparator Eligible studies compared surgical treatments with non-invasive conservative treatments in hemorrhoids.
    • primaryOutcome Surgery achieved higher rates of complete symptom resolution than conservative therapy (OR = 2.96, 95% CI: 1.66-5.28, p < 0.001).
    • result Surgical treatments provide superior symptom relief, faster recovery, and lower recurrence but with some specific post-treatment complications, while conservative treatments are safer and less invasive but with provides slower symptom relief and higher recurrence rates.

    BMC Gastroenterol · PMID 40596934 · Read it on PubMed ↗

  • van Oostendorp et al. 2025

    Comparison of Rubber Band Ligation and Hemorrhoidectomy in Patients With Symptomatic Hemorrhoids Grade III: A Multicenter, Open-Label, Randomized Controlled Noninferiority Trial

    Surgery lower recurrence; banding faster recovery, less painRandomised trialModerate quality

    87 people12 months

    Rubber band ligation was not noninferior to hemorrhoidectomy in quality-adjusted life years (-0.045; 95% CI, -0.087 to -0.004). Recurrence rate was worse in the rubber band ligation group (47.5% vs 6.1%), with an absolute risk difference of 41% (95% CI, 24%-59%).

    Who was studied
    Patients (aged 18 years or older) with symptomatic grade III (Goligher) hemorrhoids
    What they received
    rubber band ligation
    Compared with
    Hemorrhoidectomy
    Main outcome
    Primary outcomes included 12-month health-related quality of life and recurrence rate.
    Quality
    It is a genuine randomized trial directly comparing banding to surgery, but it was stopped early for funding reasons, leaving a small sample and limited statistical power, and it was open-label.
    Limitations
    The primary limitation of the study was its early termination due to funding constraints, resulting in a relatively small sample size and limited statistical power. Patient recruitment was hindered by significant treatment preferences and the COVID-19 pandemic.

    Taken word for word from the abstract

    • n Eighty-seven patients were randomly assigned (47 rubber band ligation vs 40 hemorrhoidectomy).
    • population Patients (aged 18 years or older) with symptomatic grade III (Goligher) hemorrhoids were included in this study.
    • intervention Randomized 1:1 to rubber band ligation or hemorrhoidectomy, with up to 2 banding sessions allowed.
    • comparator Hemorrhoidectomy is the criterion standard, but rubber band ligation offers a less invasive outpatient alternative.
    • primaryOutcome Primary outcomes included 12-month health-related quality of life and recurrence rate.
    • result Rubber band ligation was not noninferior to hemorrhoidectomy in quality-adjusted life years (-0.045; 95% CI, -0.087 to -0.004). Recurrence rate was worse in the rubber band ligation group (47.5% vs 6.1%), with an absolute risk difference of 41% (95% CI, 24%-59%).

    Dis Colon Rectum · PMID 39952268 · Read it on PubMed ↗

  • Li et al. 2024

    A systematic review comparing the efficacy of 980 nm vs. 1470 nm wavelengths in laser hemorrhoidoplasty

    Laser surgery: less pain, more recurrenceMeta-analysisModerate quality

    2,492 people2024

    Laser hemorrhoidoplasty was quicker, caused less pain and fewer complications than open hemorrhoidectomy, but recurrence was similar for the 980 nm laser and significantly higher for the 1470 nm laser compared with surgery

    Who was studied
    adults with hemorrhoidal disease treated with laser hemorrhoidoplasty or open hemorrhoidectomy
    What they received
    laser hemorrhoidoplasty (LHP) using 980 nm or 1470 nm laser wavelengths
    Compared with
    open hemorrhoidectomy (standard surgery)
    Main outcome
    operative time, postoperative pain, complication rate, and recurrence of hemorrhoids
    Quality
    It pools data from both randomised and non-randomised studies and never directly compares the two laser wavelengths, so its conclusions carry only moderate certainty.
    Limitations
    Includes 12 non-randomized studies alongside 7 RCTs, no head-to-head comparison of the two wavelengths was available, and hemorrhoid grades varied across included studies

    Taken word for word from the abstract

    • population Laser Hemorrhoidoplasty (LHP) is a minimally invasive surgical option for the management of hemorrhoidal disease
    • n a total of 2492 patients were included in this systematic review and meta-analysis
    • intervention Two wavelengths; 980 nm and 1470 nm have been employed in LHP.
    • comparator The duration of LHP with both wavelengths was significantly shorter compared to open hemorrhoidectomy
    • primaryOutcome postoperative pain and the rate of postoperative complications were significantly lower following LHP
    • result There was no statistically significant difference in the rate of recurrence between LHP with the 980-nm wavelength and open hemorrhoidectomy. However, LHP with 1470-nm wavelength resulted in significantly higher recurrence rate compared to hemorrhoidectomy.

    Int J Colorectal Dis · PMID 39048788 · Read it on PubMed ↗

What actually helps, on this site

Treatments Dr. Kamrava performs for this:

All 89 studiesEvery study that answered the question, with its design, size and result.
The other 83 studiesEverything else the search returned, including anything retracted.

  • Barone et al. 2026

    LigaSure versus conventional excisional haemorrhoidectomy: A systematic review and meta-analysis with trial sequential analysis of randomised controlled trials

    Less pain with newer surgical deviceMeta-analysisModerate qualityRelated question

    3,277 people2026

    LigaSure caused less pain in the first two days and weeks after surgery, needed less pain medicine, less blood loss, shorter operation time, faster return to activity, and fewer wound problems, bleeding, or urinary retention; no difference was found in recurrence, infection, incontinence, or several other longer-term outcomes

    Who was studied
    adults having surgery to remove hemorrhoids
    What they received
    LigaSure (energy-based device) hemorrhoidectomy
    Compared with
    conventional excisional hemorrhoidectomy
    Main outcome
    postoperative pain, recovery time, and surgical complications
    Quality
    It pools 43 randomized trials with over 3000 patients, which is a lot of evidence, but it only compares two surgical techniques to each other and does not address whether surgery is needed at all, and the authors say long-term outcome data are still limited.
    Limitations
    Compares two surgical techniques (LigaSure vs conventional hemorrhoidectomy) rather than surgery versus a non-surgical treatment; evidence on recurrence and other long-term anorectal outcomes remains limited.

    Taken word for word from the abstract

    • n Forty-three unique RCTs comprising 3,277 participants were analysed.
    • population Conventional excisional haemorrhoidectomy remains the gold standard treatment for grade IV haemorrhoids
    • intervention We performed a systematic review and meta-analysis of randomised controlled trials comparing LigaSure with conventional haemorrhoidectomy.
    • comparator Randomised controlled trials comparing LigaSure with conventional techniques were included.
    • primaryOutcome LigaSure was associated with lower postoperative pain scores on days 1 and 2 and during the first and second postoperative weeks, reduced analgesic requirements and intraoperative blood loss, shorter operating time and time to return to daily activities, and lower risks of postoperative wound discharge, postoperative bleeding and acute urinary retention.
    • 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.

    Colorectal Dis · PMID 42816945 · Read it on PubMed ↗

  • Ye et al. 2026

    A case report on the management of sepsis complicated by eroded mixed hemorrhoids following breast cancer chemotherapy

    Healed without surgery in emergency case.Case seriesVery low qualityRelated question

    1 people30 days

    after 30 days of conservative treatment the fever resolved and the hemorrhoid healed completely

    Who was studied
    a 51-year-old woman with breast cancer who developed severe sepsis and eroded hemorrhoids after chemotherapy
    What they received
    non-surgical care: antibiotics, blood support, and local wound treatments (including traditional Chinese medicine) instead of surgery
    Compared with
    no comparison treatment; surgery was avoided due to high risk
    Main outcome
    resolution of sepsis and healing of the eroded hemorrhoid
    Quality
    this is a single case report of one critically ill, immunocompromised cancer patient, so it cannot show whether non-surgical treatment works for typical hemorrhoid patients.
    Limitations
    single patient, no comparison group, and the patient's extreme situation (chemotherapy-induced bone marrow suppression and sepsis) is very different from typical hemorrhoid patients considering surgery versus non-surgical treatment.

    Taken word for word from the abstract

    • n A 51-year-old female with stage IIIA human epidermal growth factor receptor 2-positive breast cancer developed a high fever (40.1°C) 1 week after her first cycle of neoadjuvant TCHP
    • population mixed hemorrhoids with erosion and secondary perianal infection
    • intervention Given the high risk of surgery due to critical thrombocytopenia and neutropenia, a conservative strategy was implemented.
    • intervention broad-spectrum systemic antibiotics (meropenem, vancomycin, amikacin, amphotericin B sequentially), aggressive hematologic support (granulocyte colony-stimulating factor, blood transfusions), and meticulous multimodal local wound care
    • comparator standard surgical interventions carry prohibitive risks
    • primaryOutcome After 30 days of treatment, the patient became afebrile, and her perianal swelling and inflammation completely resolved.
    • result The eroded hemorrhoid healed entirely, allowing for a successful transfer to a lower-level hospital for continued supportive care.

    Medicine (Baltimore) · PMID 42798126 · Read it on PubMed ↗

  • Pei et al. 2026

    Dynamic Changes and Influencing Factors of Acute Pain After Elastic Band Ligation of Internal Hemorrhoids in Patients With Mixed Hemorrhoids

    Pain after banding varies widely.RetrospectiveLow qualityRelated question

    173 peoplepostoperative days 1, 3, 7, and 14

    two distinct pain recovery patterns were found: about half the patients had rapid pain relief and about half had poor relief, with younger age, more anxiety/depression, less social support, and more ligations linked to poor relief

    Who was studied
    adults with grade III or IV mixed hemorrhoids undergoing rubber band ligation of internal hemorrhoids
    What they received
    elastic band (rubber band) ligation of internal hemorrhoids
    Main outcome
    pattern of acute pain over time after banding
    Quality
    single-center retrospective study with no comparison group, so it describes pain patterns after one procedure but cannot show whether banding is better or worse than any other treatment.
    Limitations
    Retrospective, single-center design with no surgical or other comparator group; looks only at pain trajectories after banding, not at whether banding avoids the need for surgery.

    Taken word for word from the abstract

    • 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
    • primaryOutcome the dynamic trajectory of acute pain after elastic band ligation of internal hemorrhoids
    • result GMM analysis identified two pain progression trajectories: a rapid relief group (82 cases, 47.4%) and a poor relief group (91 cases, 52.6%).
    • n This single-center retrospective study included 173 patients with mixed hemorrhoids (grade III or IV)

    Ann Ital Chir · PMID 42755315 · Read it on PubMed ↗

  • Zamlout et al. 2026

    Laser hemorrhoidoplasty versus LigaSure hemorrhoidectomy for grade II-IV hemorrhoidal disease: a systematic review and meta-analysis

    Less pain and faster recovery, but more recurrence than surgeryMeta-analysisVery low quality

    461 people2026

    Laser hemorrhoidoplasty caused less pain, faster return to activity, shorter operation and hospital stay, but had a higher recurrence rate than LigaSure hemorrhoidectomy; complication rates were similar

    Who was studied
    adults with grade II-IV hemorrhoids
    What they received
    laser hemorrhoidoplasty (a minimally invasive, non-excisional technique)
    Compared with
    LigaSure hemorrhoidectomy (a surgical excision technique)
    Main outcome
    postoperative pain, time to return to routine activities, and recurrence
    Quality
    The authors themselves rate the certainty of evidence as very low, based on pooling only five studies with risk of bias and call for further high-quality randomized trials.
    Limitations
    The certainty of evidence is very low. Further high-quality randomized trials are needed to confirm these results.

    Taken word for word from the abstract

    • n Data from 461 patients (213 LHP, 248 LigH) across five studies were analyzed.
    • population We included all eligible studies involving adults with grade II-IV hemorrhoids.
    • intervention laser hemorrhoidoplasty (LHP)
    • comparator LigaSure hemorrhoidectomy (LigH)
    • primaryOutcome Primary outcomes included postoperative pain, time to return to routine activities, and recurrence.
    • result Patients in the LHP group reported significantly lower pain scores on postoperative day 1 (MD: - 1.61 points; p = 0.025), earlier return to routine activities (MD: -5.75 days; p = 0.0002), shorter operative time (MD: -6.5 min; p = 0.002), and shorter hospital stay (MD: -0.3 days; p < 0.0001) compared to the LigH group. Conversely, LigH demonstrated a significantly lower risk of recurrence (RD: 0.12; 95% CI: [0.05, 0.19]).
    • qualityWhy The certainty of evidence is very low.
    • limitations The certainty of evidence is very low. Further high-quality randomized trials are needed to confirm these results.

    BMC Surg · PMID 42374341 · Read it on PubMed ↗

  • Anwar et al. 2026

    Long-term impact of haemorrhoidal artery ligation on anal function and continence

    Low rate of incontinence after HAL surgery.Systematic reviewLow qualityRelated question

    671 peoplebeyond six months

    17 of 671 patients (2.5%) developed incontinence after HAL-type procedures, mostly mild and temporary; HAL-RAR had the highest rate (5.7%)

    Who was studied
    adults with hemorrhoids who had haemorrhoidal artery ligation (HAL) type procedures
    What they received
    haemorrhoidal artery ligation and variants (DG-HAL, HAL-RAR, THD) \u2013 minimally invasive surgical techniques
    Compared with
    different HAL technique variants compared with each other, not surgery vs non-surgical treatment
    Main outcome
    long-term faecal incontinence (more than 6 months after the procedure)
    Quality
    it pools mostly observational cohort studies (only 3 of 6 were RCTs) looking at a surgical technique's side effects, not a trial comparing surgery against a non-surgical option.
    Limitations
    Includes retrospective and prospective cohorts as well as RCTs, does not compare surgery to non-surgical treatment, and focuses only on continence outcomes rather than overall effectiveness.

    Taken word for word from the abstract

    • n total n=671 patients
    • population studies 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 Six studies (3 RCTs, 1 prospective, 2 retrospective cohorts; total n=671 patients) met PICOS criteria
    • 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.

    Ir Med J · PMID 42348182 · Read it on PubMed ↗

  • Elhardello et al. 2026

    Laser hemorrhoidoplasty: two-year outcomes from a retrospective observational cohort study

    High satisfaction, low pain with laser treatmentRetrospectiveLow qualityRelated question

    77 people2 years

    Over 90% had complete symptom resolution at 1 year, 9.1% recurrence, minimal pain, one day average hospital stay, 81% highly satisfied, one complication (abscess needing surgery)

    Who was studied
    Adults with symptomatic grade II-IV hemorrhoids with minimal to moderate prolapse
    What they received
    Laser hemorrhoidoplasty (LHP)
    Main outcome
    Symptom resolution, recurrence, pain, complications, and patient satisfaction after laser treatment
    Quality
    This is a single-arm retrospective study with no comparison group and substantial loss to follow-up by 2 years, so it cannot show whether laser treatment works better or worse than surgery or other options.
    Limitations
    No comparator arm (not compared to surgery or other non-surgical options); retrospective design; only 33.8% of patients were followed to 2 years, limiting conclusions about long-term outcomes.

    Taken word for word from the abstract

    • population Inclusion criteria were an age above 18 years old, symptomatic haemorrhoids of grade 2 to 4 with minimal to moderate prolapse.
    • intervention Laser hemorrhoidoplasty (LHP)
    • n LHP was carried out in 77 patients (83% of them had grade III or grade IV) treated over a two-year period.
    • primaryOutcome Post operative pain, recurrence of the disease, persistence of symptoms, complications, length of stay and patients' satisfaction were all documented.
    • result Over 90% of patients achieved complete and sustained symptom resolution over 1-year follow-up period, despite the predominance of advanced disease. Disease recurrence occurred in 9.1% of patients.
    • result Overall, 81% of patients were highly satisfied, and 90% reported satisfactory outcomes.
    • result Postoperative complications occurred in only one patient, who developed a submucosal abscess requiring surgical intervention.

    Lasers Med Sci · PMID 42337174 · Read it on PubMed ↗

  • Wu et al. 2026

    Cap-assisted endoscopic sclerotherapy for bleeding-predominant grade III hemorrhoids: efficacy and risk factor analysis focusing on two dimensions of bleeding score

    Sclerotherapy reduced bleeding, no surgery comparisonRetrospectiveLow qualityRelated question

    82 people24 months

    85.4% overall efficacy rate; bleeding symptom improved in 96.3%, prolapse in 58.2%; 25.3% had bleeding recurrence over 24 months; no severe complications reported

    Who was studied
    Adults with bleeding-predominant grade III internal hemorrhoids
    What they received
    Cap-assisted endoscopic sclerotherapy (CAES) with long-needle polidocanol injection
    Main outcome
    Improvement in hemorrhoid symptom severity score and bleeding recurrence after treatment
    Quality
    This is a single-arm retrospective study with no comparison group, so it cannot show whether sclerotherapy works better or worse than surgery.
    Limitations
    No control group, retrospective single-arm design, single-center, and no comparison to surgical treatment.

    Taken word for word from the abstract

    • population included 82 patients with bleeding-predominant grade III internal HDs
    • intervention Cap-assisted endoscopic sclerotherapy (CAES) via a long needle
    • primaryOutcome Treatment efficacy was assessed at 3 months post-CAES using the conventional Hemorrhoid Disease Severity Score (HDSS; based on the frequency of symptoms, including bleeding)
    • result The overall efficacy rate was 85.4%. The effective rates for bleeding and prolapse symptoms were 96.3% and 58.2%, respectively.
    • result During a follow-up of 24 months, the bleeding recurrence rate was 25.3% (20/79).
    • result No severe complications were reported.
    • n This single-arm retrospective observational study included 82 patients

    Tech Coloproctol · PMID 42323500 · Read it on PubMed ↗

  • Gravante et al. 2026

    Early hemodynamic changes following endoscopic sclerotherapy for hemorrhoidal disease assessed by transperineal ultrasound and their relationship with clinical outcomes

    Sclerotherapy helps short-term, fades in severe casesProspective cohortLow qualityRelated question

    37 people30 days

    In lower-grade disease, blood flow measures improved and stayed improved at 30 days; in higher-grade disease, blood flow measures did not improve and symptom scores worsened again between 7 and 30 days

    Who was studied
    Adults with grade I-IV internal hemorrhoids treated with sclerotherapy
    What they received
    Polidocanol foam sclerotherapy (endoscopic)
    Main outcome
    Changes in blood flow (ultrasound) and symptom scores after treatment
    Quality
    Small, uncontrolled study with no comparison group, so it cannot show whether sclerotherapy works better or worse than surgery.
    Limitations
    No control or surgical comparison arm; small sample (37); short follow-up (30 days); single-treatment mechanistic study, not a comparison of surgical vs non-surgical approaches.

    Taken word for word from the abstract

    • n Thirty-seven patients completed follow-up.
    • population patients with Goligher grade I-IV HD treated with endoscopic PF sclerotherapy
    • intervention endoscopic PF sclerotherapy
    • primaryOutcome TPUS Doppler assessment of peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI) was performed at baseline, 7 days, and 30 days post-treatment.
    • 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 no significant changes in PSV or RI were observed in higher-grade HD, while EDV increased at 30 days (p = 0.012).
    • result symptom scores increased between 7 and 30 days in higher-grade HD.

    Int J Colorectal Dis · PMID 42257743 · Read it on PubMed ↗

  • Tan et al. 2026

    Cautionary tips to avoid complications for a simple laser hemorrhoidoplasty procedure

    Technique tips, no outcome dataCase seriesVery low qualityRelated question

    size not given2026

    Counted as a related question: This study describes technical tips for performing laser hemorrhoidoplasty safely, not a comparison of surgical versus non-surgical treatment approaches for hemorrhoids.

    The video states that when the described technique is carefully followed, laser hemorrhoidoplasty results in minimal morbidity and low recurrence, but no numerical data or comparison group is given

    What they received
    Laser hemorrhoidoplasty, with specific technical tips for a straight laser path and confirming complete ablation
    Main outcome
    Prevention of complications (such as rectal perforation) and recurrence after the procedure
    Quality
    This is an instructional video describing technique tips, not a study with measured outcomes, a control group, or reported patient numbers.
    Limitations
    No patient numbers, no comparison group, and no quantitative outcome data are reported; it is a technique demonstration rather than a clinical trial.

    Taken word for word from the abstract

    • intervention This video demonstrates key technical steps for safe and effective laser hemorrhoidoplasty (LHP).
    • primaryOutcome the presented techniques aim to prevent serious complications such as rectal perforation
    • result When meticulously followed, LHP results in minimal morbidity and low recurrence rates.

    Tech Coloproctol · PMID 42128976 · Read it on PubMed ↗

  • Alam et al. 2026

    Perioperative and Postoperative Complications Associated with Stapled Hemorrhoidopexy

    Stapling less painful, but pricier surgeryProspective cohortLow qualityRelated question

    130 people2026

    Stapled hemorrhoidopexy caused less pain, fewer urinary retention cases, shorter hospital stay, faster return to work and no reactionary hemorrhage, but cost much more than open hemorrhoidectomy

    Who was studied
    adults in Bangladesh with Grade III and IV hemorrhoids
    What they received
    stapled hemorrhoidopexy
    Compared with
    open hemorrhoidectomy
    Main outcome
    postoperative pain, complications, hospital stay, return to work and cost
    Quality
    It is a single-center 'comparative study' of surgical techniques, not clearly randomized, so it cannot answer whether surgery itself is needed versus non-surgical treatment.
    Limitations
    Both study arms received surgery (stapled vs open hemorrhoidectomy); the study does not compare surgery with any non-surgical treatment, and randomization is not stated.

    Taken word for word from the abstract

    • population 130 patients (65 per group) with Grade III and IV hemorrhoids
    • intervention Stapled hemorrhoidopexy (SH)
    • comparator open hemorrhoidectomy (OH)
    • primaryOutcome perioperative blood loss, postoperative pain (VAS), complications, hospital stay, return to work and treatment cost were analyzed
    • result SH was associated with lower postoperative pain (80.0% mild; no severe cases), reduced urinary retention (13.8% vs. 40.0%, p=0.001) and shorter hospital stays (mean 2.89 vs. 7.12 days, p<0.001)
    • result SH incurred significantly higher costs (mean Tk. 18,876.92 vs. Tk. 6,690.77, p<0.001)
    • n 130 patients (65 per group)

    Mymensingh Med J · PMID 41914085 · Read it on PubMed ↗

  • Yu et al. 2026

    Effectiveness and safety of 3% polidocanol foam sclerotherapy in hemorrhoidal disease: a multicenter, prospective study

    Sclerotherapy and banding worked similarly well.Prospective cohortLow qualityRelated question

    222 people12 weeks

    Cure rates were similar between groups (74.19% PFS vs 83.13% RBL, not statistically significant); PFS showed faster improvement in bleeding scores; adverse event rates were low and similar in both groups

    Who was studied
    Adults with grade I, II, or III internal or mixed hemorrhoids
    What they received
    3% polidocanol foam sclerotherapy (PFS) under anoscopy
    Compared with
    Rubber band ligation (RBL)
    Main outcome
    Clinical cure rate under anoscopy and symptom assessment at 4 weeks
    Quality
    Treatment was chosen by physician and patient preference rather than randomized, so differences between groups could be due to selection rather than the treatments themselves.
    Limitations
    Open-label, non-randomized design with treatment assignment based on physician assessment and patient willingness, creating risk of selection bias; this study compares two non-surgical options to each other, not surgery versus non-surgical treatment.

    Taken word for word from the abstract

    • n A total of 222 patients from 14 centers participated in the study
    • population enrolled 222 patients with Goligher grade I, II, or III HD (internal or mixed)
    • intervention 3% polidocanol foam sclerotherapy (PFS) injection under anoscopy
    • comparator rubber band ligation (RBL)
    • primaryOutcome The primary endpoint was the clinical cure rate under anoscopy and clinical symptoms assessment at 4 weeks post-treatment.
    • result the clinical cure rate was 74.19% (69/93) in the PFS group and 83.13% (69/83) in the RBL group (P > 0.05)
    • result The PFS group showed quicker and better improvement in hemorrhage score post-treatment than the RBL group
    • result The incidences of adverse events (AEs) were 2.36% (3/127) in the PFS group and 3.16% (3/95) in the RBL group, respectively, and no serious adverse events (SAEs) occurred in both groups.

    Int J Colorectal Dis · PMID 41748745 · Read it on PubMed ↗

  • Zu et al. 2026

    Endoscopic rubber band ligation, injection sclerotherapy, and sclerobanding for the treatment of internal hemorrhoids

    Sclerobanding had less recurrence and pain than sclerotherapy alone.RetrospectiveLow qualityRelated question

    201 people24 months

    Both ERBL and ESB had lower overall recurrence than IS; for grade II-III hemorrhoids, sclerotherapy alone recurred more than sclerobanding (45.95% vs 19.57%), and ERBL caused more postoperative pain than the other two methods; no differences were seen in grade I hemorrhoids or within the first 6 months for any grade.

    Who was studied
    adults with grade I-III internal hemorrhoids
    What they received
    endoscopic rubber band ligation (ERBL) and endoscopic polidocanol sclerobanding (ESB)
    Compared with
    injection sclerotherapy (IS)
    Main outcome
    clinical efficacy, recurrence rates, and postoperative adverse events (pain)
    Quality
    This was a retrospective, non-randomized comparison of three endoscopic techniques, so differences between groups could reflect patient selection rather than the treatments themselves.
    Limitations
    Retrospective cohort design without randomization; compares only non-surgical endoscopic methods to each other, with no surgical comparison group.

    Taken word for word from the abstract

    • population treating grade I-III internal hemorrhoids
    • intervention endoscopic rubber band ligation (ERBL), injection sclerotherapy (IS), and endoscopic polidocanol sclerobanding (ESB)
    • comparator injection sclerotherapy (IS)
    • primaryOutcome The study analyzed clinical efficacy, short-term and overall recurrence rates, and postoperative adverse events.
    • n This retrospective cohort study was performed on 201 patients
    • 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 The ERBL group exhibited a higher incidence of postoperative pain, a worse median visual analog scale score, and a longer median duration of pain compared with those reported by the other groups (P < 0.001).
    • 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

    World J Gastroenterol · PMID 41693967 · Read it on PubMed ↗

  • Wang et al. 2026

    Conventional<em> </em><em>vs.</em> Laser Haemorrhoidectomy for Symptomatic Haemorrhoids: A Meta-Analysis

    Laser surgery: less bleeding and pain than open surgeryMeta-analysisModerate qualityRelated question

    size not given2026

    Laser surgery caused less bleeding during the operation, less bleeding afterward, and less pain than conventional surgery

    Who was studied
    adults with symptomatic internal or external hemorrhoids
    What they received
    diode laser haemorrhoidoplasty (a laser surgical technique)
    Compared with
    conventional hemorrhoidectomy (Milligan-Morgan or Ferguson surgical techniques)
    Main outcome
    blood loss, bleeding after surgery, pain, complications, recovery time and recurrence
    Quality
    It pools 13 studies with statistical analysis, but the abstract does not report total patient numbers, study quality, or heterogeneity details needed to judge how reliable the pooled estimate is.
    Limitations
    The abstract does not report the number of patients, the quality of the included studies, or how much results varied between studies (heterogeneity was only said to be 'assessed', not reported).

    Taken word for word from the abstract

    • population symptomatic haemorrhoids
    • intervention Diode laser haemorrhoidoplasty (DLH)
    • comparator conventional haemorrhoidectomy (CH) techniques, namely Milligan-Morgan haemorrhoidectomy (MMH) and Ferguson haemorrhoidectomy (FH)
    • primaryOutcome Primary outcomes included intraoperative blood loss, postoperative bleeding, pain (measured by VAS), complications (e.g., urinary retention and anal stenosis), recovery time, and recurrence rate
    • result DLH offered significant benefits over MMH and FH, including reduced intraoperative blood loss (MD = -20.19 mL, 95% CI: -28.32 -12.07; p <0.001), lower postoperative bleeding (OR = 0.32, 95% CI: 0.11 - 0.93; p = 0.04), and less postoperative pain, both immediately and one week later

    J Coll Physicians Surg Pak · PMID 41689325 · Read it on PubMed ↗

  • Yin et al. 2026

    Preliminary Results of Open Excisional Hemorrhoidectomy Combined With 3% Polidocanol Foam Sclerotherapy in Patients With Grade IV Hemorrhoidal Disease: A Randomized Controlled Open-Label Single-Center Study

    Adding sclerotherapy sped recovery after surgeryRandomised trialLow qualityRelated question

    36 people1 to 2 months

    Adding sclerotherapy to surgery let patients return to activities about 6 days sooner, with less bleeding and less pain medication use, though overall satisfaction was similar between groups

    Who was studied
    adults aged 18 to 75 with grade IV hemorrhoids
    What they received
    surgical removal of hemorrhoids (Milligan-Morgan hemorrhoidectomy) plus polidocanol foam injection (sclerotherapy)
    Compared with
    surgical removal of hemorrhoids (Milligan-Morgan hemorrhoidectomy) alone, no added treatment
    Main outcome
    time until patients could return to normal daily activities
    Quality
    Very small trial (36 patients) at one hospital, not blinded, and followed for only a short time, so results could easily be due to chance or bias.
    Limitations
    Small sample size, nonblinded, single-center design, and short follow-up period.

    Taken word for word from the abstract

    • n Thirty-six patients aged 18 to 75 years with grade IV hemorrhoidal disease were enrolled and randomized equally to 2 groups.
    • population Thirty-six patients aged 18 to 75 years with grade IV hemorrhoidal disease were enrolled
    • intervention The experimental group underwent Milligan-Morgan hemorrhoidectomy combined with 3% polidocanol foam sclerotherapy
    • comparator the control group underwent Milligan-Morgan hemorrhoidectomy with no additional therapy
    • primaryOutcome The primary outcome was the time to return to daily activities.
    • result The experimental group demonstrated a mean 5.78-day earlier return to normal activities and work than the control group (mean ± SD: 19.28 ± 8.35 vs 25.06 ± 7.85 days; 95% CI, -11.27 to -0.29 days; p = 0.04), reduced postoperative bleeding (0-3 scale; estimate -0.45; 95% CI, -0.72 to -0.16; p = 0.002), lower analgesic use (0-3 scale; estimate -0.38; 95% CI, -0.66 to -0.09; p = 0.009), and improved symptom scores at 1 to 2 months (Z -2.52 and -2.11, p < 0.05). Median satisfaction scores were 10 versus 9.5 ( p = 0.12).

    Dis Colon Rectum · PMID 41603644 · Read it on PubMed ↗

  • Fernandez-Hurtado et al. 2025

    Open excisional haemorrhoidectomy versus transanal haemorrhoidal dearterialization for grade III haemorrhoids: open-label randomized clinical trial

    Surgery beat THD, but hurt more.Randomised trialLow qualityRelated question

    50 people12 months

    Open surgery (OEH) was more effective than THD, with a much lower clinical failure rate (8% vs 61%) and no reoperations, but OEH caused more early pain and a longer return to work (21 vs 14 days).

    Who was studied
    Adults with grade III hemorrhoids
    What they received
    Open excisional hemorrhoidectomy (traditional surgery)
    Compared with
    Transanal hemorrhoidal dearterialization (THD, a less invasive surgical technique)
    Main outcome
    Change in symptom and quality-of-life scores at 12 months, and clinical failure rate
    Quality
    This was a small, single-center, open-label trial with only 50 patients and some loss to follow-up, and it compares two surgical techniques rather than surgery versus a non-surgical option.
    Limitations
    Both treatments compared are surgical procedures (traditional hemorrhoidectomy vs. a minimally invasive surgical technique), so this trial does not address surgery versus non-surgical treatment; it is single-center and open-label with small sample size.

    Taken word for word from the abstract

    • population patients with grade III haemorrhoids
    • n 50 patients were randomized (25 OEH patients and 25 THD patients)
    • intervention Open excisional haemorrhoidectomy (OEH) remains the standard treatment
    • comparator Transanal haemorrhoidal dearterialization (THD) is an alternative with reduced pain but potentially higher recurrence
    • primaryOutcome The primary outcome was the relative change at 12 months in Haemorrhoidal Disease Symptom Score (HDSS) and Short Health Scale adapted for Haemorrhoidal Disease (SHS-HD) from baseline
    • result CFR was significantly higher in the THD group (14 of 23 (61%)) versus the OEH group (2 of 24 (8%)) (P <0.001). All eigth reoperations occurred in the THD group (P = 0.001)
    • result OEH was associated with greater early postoperative pain and a longer time to return to work (median of 21 versus 14 days; P = 0.010)

    Br J Surg · PMID 41553737 · Read it on PubMed ↗

  • Lauricella et al. 2026

    Long-term outcomes of stapled haemorrhoidopexy versus conventional haemorrhoidectomy: An updated systematic review, meta-analysis and trial-sequential analysis of randomized controlled trials

    Stapled surgery recurs more than traditional surgeryMeta-analysisModerate qualityRelated question

    2,072 peopleminimum follow-up of 12 months

    Stapled surgery had a higher risk of long-term recurrence than conventional surgery, particularly prolapse-related recurrence, but no significant differences in reintervention, persistent pain, functional impairment or quality of life

    Who was studied
    adult patients with grade II-IV haemorrhoids
    What they received
    stapled haemorrhoidopexy (SH), a surgical stapling technique
    Compared with
    conventional haemorrhoidectomy (CH), traditional surgical removal
    Main outcome
    long-term recurrence, need for repeat procedure, anal function, and quality of life
    Quality
    It pools 17 randomized trials with over 2,000 patients, but the trial-sequential analysis shows the evidence is still underpowered and there is moderate heterogeneity in the main result.
    Limitations
    The trial-sequential analysis showed the accrued information size (1,913 patients) did not reach the required information size (2,608 patients), meaning the evidence is still underpowered; moderate heterogeneity (I2=48%) was present for the main recurrence outcome.

    Taken word for word from the abstract

    • 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) offers well-established short-term advantages over conventional haemorrhoidectomy (CH)
    • comparator compare long-term outcomes of SH versus CH in adult patients with grade II-IV haemorrhoids
    • 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.

    Int J Colorectal Dis · PMID 41535511 · Read it on PubMed ↗

  • Liao et al. 2025

    [Endoscopic rubber band ligation and injection therapy for grade I - III internal hemorrhoids: analysis of clinical efficacy and safety]

    Similar relief; EIS had fewer complications.RetrospectiveLow qualityRelated question

    613 people3 months

    Cure and effective rates were similar between ERBL and EIS (no significant difference), and overall recurrence was not significantly different; EIS caused less pain and fewer complications (bleeding, urinary retention) than ERBL, while ERBL showed a trend toward lower recurrence in grade III disease that did not remain significant after correction for multiple comparisons.

    Who was studied
    Adults with grade I to III internal hemorrhoids who had not improved with diet/medication and could not or would not have surgery
    What they received
    Endoscopic rubber band ligation (ERBL)
    Compared with
    Endoscopic injection sclerotherapy (EIS)
    Main outcome
    Treatment success (cure/effective rate) and recurrence within 3 months after treatment
    Quality
    This is a retrospective, single-center cohort comparing two non-surgical procedures (not surgery vs. non-surgical), so even though propensity matching was used, it cannot establish causal comparative effectiveness and does not address the surgery question directly.
    Limitations
    Retrospective design, single center, propensity-score matching rather than randomization, and the comparison is between two non-surgical techniques rather than surgery versus a non-surgical option.

    Taken word for word from the abstract

    • n A total of 613 patients with grade I to III internal hemorrhoids who underwent ERBL or EIS at The Sixth Affiliated Hospital of Sun Yat-sen University from December 2019 to November 2023 were retrospectively collected.
    • population Patients diagnosed with symptomatic grade I-III internal hemorrhoids who failed conservative treatments such as diet adjustment and medication
    • 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 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 Still, the difference was not statistically significant after Bonferroni correction (χ²=4.121, corrected P>0.025).

    Zhonghua Wei Chang Wai Ke Za Zhi · PMID 41397826 · Read it on PubMed ↗

  • Xiang et al. 2025

    The effect of endoscopic polidocanol carbon dioxide foam for internal hemorrhoids: a retrospective study

    Similar results, less pain with CO2 foamRetrospectiveLow qualityRelated question

    158 people1 month

    Both foam types had similar success rates, but CO2 foam caused significantly fewer cases of anal pain and swelling

    Who was studied
    Adults with internal hemorrhoids undergoing endoscopic sclerotherapy
    What they received
    Endoscopic polidocanol carbon dioxide foam sclerotherapy
    Compared with
    Endoscopic polidocanol air foam sclerotherapy
    Main outcome
    Clinical effectiveness and complication rate 1 month after treatment
    Quality
    This is a retrospective, non-randomized comparison of two sclerotherapy foam variants, not a trial testing surgery versus non-surgical treatment, so it carries little weight for this question.
    Limitations
    Retrospective design with no randomization; compares two variants of the same non-surgical sclerotherapy technique rather than surgery versus a non-surgical option; no mention of blinding or long-term follow-up beyond 1 month.

    Taken word for word from the abstract

    • 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 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. Both groups exhibited comparable clinical effects, surgical costs, hospitalization durations, and dosages of polidocanol, with no statistically significant differences observed (all P > 0.05).

    PeerJ · PMID 41282992 · Read it on PubMed ↗

  • Dai et al. 2026

    Flexible endoscopic treatment of internal hemorrhoids with versus without intravenous anesthesia: a retrospective study of 559 cases

    Anesthesia speeds endoscopic treatment, cuts retreatment.RetrospectiveLow qualityRelated question

    559 people2026

    Anesthesia group had shorter procedure times and lower retreatment rates, but similar symptom improvement, discomfort, and satisfaction; cost was higher with anesthesia

    Who was studied
    Adults with grade II-III internal hemorrhoids undergoing flexible endoscopic treatment
    What they received
    Endoscopic rubber band ligation or sclerotherapy performed with intravenous anesthesia
    Compared with
    Endoscopic rubber band ligation or sclerotherapy performed without anesthesia
    Main outcome
    Procedure time, retreatment rate, symptom improvement, discomfort, satisfaction, and cost
    Quality
    This is a retrospective, non-randomized comparison of anesthesia methods within endoscopic treatment, not a trial comparing surgery with a non-surgical option, so it carries little weight for that question.
    Limitations
    Retrospective design without randomization; compares anesthesia modality during endoscopic therapy, not surgery versus non-surgical treatment.

    Taken word for word from the abstract

    • n We retrospectively analyzed 559 patients who underwent endoscopic rubber band ligation (ERBL) or polidocanol foam sclerotherapy (EPFS) from May 2023 to November 2024.
    • population Flexible endoscopic therapies are effective for grade II-III internal hemorrhoids
    • intervention intravenous propofol
    • comparator 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. Although the total treatment cost was higher in the anesthesia group (CNY 2,140.6 vs. 1,732.7, P < 0.001), cost acceptance remained high in both groups (85.8% vs. 91.4%, P = 0.173).

    Surg Endosc · PMID 41269316 · Read it on PubMed ↗

  • Egawa et al. 2026

    Hemorrhoids

    General review, no specific results given.Narrative reviewLow qualityRelated question

    size not given2026

    The abstract reports that the authors present a review of disease pathophysiology, diagnosis, and treatment options, recommending that care be tailored to disease anatomy, symptom severity, and relevant medical comorbidities; it does not report trial outcomes, effect sizes, or comparative results for any specific surgical or nonoperative treatment.

    Who was studied
    people with hemorrhoid disease
    Main outcome
    overview of treatment options for hemorrhoid disease
    Quality
    This is a narrative review describing available treatments and general management philosophy rather than a systematic synthesis or trial reporting outcome data, so it cannot establish which approach works better.
    Limitations
    No methodology is described for how studies were selected or synthesized, no outcome data, effect sizes, or follow-up are reported, and the abstract gives no results comparing surgical versus nonoperative options.

    Taken word for word from the abstract

    • population Hemorrhoid disease is common in the Western world
    • primaryOutcome treatment options for hemorrhoid disease
    • result The authors present a review of the disease pathophysiology, diagnosis, and treatment options for hemorrhoid disease.
    • result A plan of care should be made that is tailored to disease anatomy, symptom severity, and relevant medical comorbidities after addressing modifiable risk factors.

    Surg Clin North Am · PMID 41241446 · Read it on PubMed ↗

  • Wang et al. 2025

    Comparative effectiveness and recurrence rates of endoscopic sclerotherapy, ligation, and combined therapy for grades I-III internal hemorrhoids

    Combined banding plus sclerotherapy worked best among non-surgical optionsRetrospectiveLow qualityRelated question

    253 peoplemore than 3 months

    Combined ligation-sclerotherapy had the highest efficacy (95.8%) and lowest recurrence (4.3%), followed by banding (92.6% efficacy, 9.7% recurrence) and sclerotherapy alone (90.6% efficacy, 11.6% recurrence); adverse events were low and similar across groups

    Who was studied
    Adults with grade I-III internal hemorrhoids
    What they received
    Non-surgical endoscopic treatments: sclerotherapy, rubber band ligation, or combined ligation-sclerotherapy
    Compared with
    Each non-surgical method compared against the other two (no surgical group)
    Main outcome
    Treatment efficacy and recurrence of hemorrhoid symptoms
    Quality
    This is a retrospective chart review without randomization or a surgical comparison group, so it cannot show whether non-surgical treatment is as good as surgery.
    Limitations
    Retrospective design, no surgical comparator, unequal and small group sizes (especially the combined-therapy group of 24), and no long-term follow-up beyond initial recurrence check.

    Taken word for word from the abstract

    • population grades I - III internal hemorrhoids
    • intervention endoscopic sclerotherapy (ES), endoscopic rubber band ligation (RBL), and combined ligation - sclerotherapy (CT)
    • comparator Patients were divided into ES, RBL, and CT groups.
    • primaryOutcome Efficacy was assessed within 3 months post-treatment, and recurrence was defined as symptom reappearance > 3 months post-treatment.
    • result the efficacy rate was 90.6% (95/107) for ES, 92.6% (113/122) for RBL, and 95.8% (23/24) for CT
    • result For recurrence rates, CT had the lowest rate (4.3% [1/23]), followed by RBL (9.7% [11/113]) and ES (11.6% [11/95])
    • n A total of 253 patients were included

    BMC Surg · PMID 41239416 · Read it on PubMed ↗

  • Bharucha et al. 2026

    An Evidence-Based Practical Review on Common Benign Anorectal Disorders: Hemorrhoids, Anal Fissure, Dyssynergic Defecation, and Fecal Incontinence

    Conservative treatment first, surgery only if severe.Narrative reviewLow quality

    size not given2026

    The review states treatment is applied stepwise, starting with conservative therapy such as banding for milder (grade I-II) hemorrhoids, with surgery reserved for more severe disease

    Who was studied
    Adults with hemorrhoids, mainly grade I-II for banding, more severe disease treated surgically
    What they received
    Conservative treatments such as rubber band ligation
    Compared with
    Surgery, usually excisional hemorrhoidectomy
    Main outcome
    Which treatment approach is used based on hemorrhoid severity
    Quality
    This is a general narrative review summarizing expert treatment recommendations rather than presenting original comparative trial data on surgery versus non-surgical options.
    Limitations
    No specific trial data, outcome statistics, or sample sizes are given; the statement is a general clinical recommendation rather than a comparative study result.

    Taken word for word from the abstract

    • population rubber band ligation for grade I-II hemorrhoids
    • intervention starting with conservative therapy with simpler treatments when feasible (eg, rubber band ligation for grade I-II hemorrhoids)
    • 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

    Gastroenterology · PMID 41236452 · Read it on PubMed ↗

  • Turunen et al. 2025

    Massive Rectal Bleeding After Rubber Band Ligation of Internal Hemorrhoids: A Case Report

    Rare severe bleeding after banding.Case seriesVery low qualityRelated question

    1 people2025

    The patient had massive rectal bleeding 15 days after RBL, found to be from an ulcer at the banding site; bleeding was stopped with endoscopic clipping and hemostatic spray, and she recovered.

    Who was studied
    a 34-year-old woman with internal hemorrhoids treated with rubber band ligation
    What they received
    rubber band ligation (RBL) of internal hemorrhoids
    Main outcome
    delayed rectal bleeding complication after banding
    Quality
    This is a single case report with no comparison group, so it cannot show whether banding is better or worse than other treatments, only that a rare bleeding complication can occur.
    Limitations
    Single patient case report; no control group; cannot establish how common this complication is or compare treatments.

    Taken word for word from the abstract

    • n A 34-year-old White woman presented with massive rectal bleeding 15 days after suction RBL of internal hemorrhoids.
    • population A 34-year-old White woman presented with massive rectal bleeding 15 days after suction RBL of internal hemorrhoids.
    • intervention Rubber band ligation (RBL) is a common treatment for internal hemorrhoids.
    • primaryOutcome complications such as delayed bleeding can occur
    • result Flexible sigmoidoscopy revealed a 10-mm ulcer with a visible vessel at the previous banding site. Hemostasis was achieved with clip placement and hemostatic spray. She recovered without further complications.

    WMJ · PMID 41197059 · Read it on PubMed ↗

  • Guimarães et al. 2026

    Office-based treatments for hemorrhoidal disease grades I-III ‒ Comparing rubber band ligation and polidocanol foam sclerotherapy

    Banding beat sclerotherapy; sclerotherapy saferRetrospectiveLow qualityRelated question

    441 peoplemedian 15.5 months to relapse

    RBL had higher clinical success than PFS (78.6% vs 58.1%), but PFS had fewer adverse events; relapse-free survival did not differ between groups, and 12.4% of patients overall eventually needed surgery

    Who was studied
    adults with hemorrhoidal disease grades I-III treated in an office setting
    What they received
    rubber band ligation (RBL)
    Compared with
    polidocanol foam sclerotherapy (PFS)
    Main outcome
    clinical success, relapse, relapse-free survival, and treatment failure
    Quality
    this is a retrospective, non-randomized cohort comparing two office-based treatments, so differences could reflect patient selection rather than true treatment effects, and it does not include a surgical comparison arm.
    Limitations
    retrospective design without randomization; compares two non-surgical treatments (RBL vs PFS) rather than directly testing surgery versus a non-surgical option, so it cannot answer whether surgery is needed.

    Taken word for word from the abstract

    • n in total, 441 patients were included
    • population office-based treatments for hemorrhoidal disease (HD) are recommended when medical management fails
    • intervention rubber band ligation (RBL)
    • comparator polidocanol foam sclerotherapy (PFS)
    • 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
    • result A total of 49/395 (12.4 %) required surgery

    Rev Esp Enferm Dig · PMID 41128083 · Read it on PubMed ↗

  • Wang et al. 2025

    Modified sclerobanding versus rubber band ligation for grade II/III hemorrhoidal disease: a retrospective study

    Fewer failures with modified banding-sclerotherapyRetrospectiveLow qualityRelated question

    307 people1-year

    modified sclerobanding had lower recurrence (6.8% vs 17.0%) and treatment failure (6.8% vs 18.6%) and no delayed major bleeding, compared with 5 cases of delayed major bleeding in the rubber band ligation group; one-year symptom and satisfaction scores were similar between groups

    Who was studied
    adults with grade II or III hemorrhoids
    What they received
    modified sclerobanding (rubber band ligation plus polidocanol foam sclerotherapy)
    Compared with
    traditional rubber band ligation alone
    Main outcome
    treatment failure rate and delayed major bleeding after the procedure
    Quality
    this was a retrospective, non-randomized comparison at a single hospital comparing two different time periods, so differences could be due to factors other than the treatment itself.
    Limitations
    Retrospective design, not randomized, patients treated in different calendar years (RBL in 2021, mSB in 2022-2023), single center, and it compares two non-surgical techniques rather than surgery versus a non-surgical option.

    Taken word for word from the abstract

    • population patients with grade II/III HD
    • intervention modified sclerobanding (mSB) procedure, which combines rubber band ligation (RBL) with 3% polidocanol foam sclerotherapy (PFS)
    • comparator traditional RBL
    • primaryOutcome The primary outcomes assessed were treatment failure rates and the incidence of delayed massive bleeding (DMB)
    • result The mSB group had no cases of delayed major bleeding, compared to five cases in the RBL group. The recurrence (6.8% vs. 17.0%) and treatment failure (6.8% vs. 18.6%) rates were significantly lower in the mSB group (P < 0.05).
    • n Among the 307 patients, 162 received mSB and 125 underwent traditional RBL.
    • followUp One-year follow-up revealed no significant differences in the HDSS, SHS-HD, or PS.

    Int J Colorectal Dis · PMID 41047429 · Read it on PubMed ↗

  • Suzuki 2025

    Combined therapy of HIFU rectoanal lifting (HIFU-RAL) and sclerotherapy for prolapsed hemorrhoids and rectal mucosal prolapse: A case series

    Prolapse reduced, no recurrence seenCase seriesVery low qualityRelated question

    10 peoplemedian: 16.0 months

    prolapsed lesions were visibly reduced or resolved immediately after the procedure, and no adverse events or recurrences were observed during follow-up

    Who was studied
    symptomatic patients with prolapsed hemorrhoids (Goligher grade III-IV) or rectal mucosal prolapse
    What they received
    HIFU rectoanal lifting (HIFU-RAL) combined with ALTA sclerotherapy
    Main outcome
    reduction or resolution of prolapsed lesions and recurrence over time
    Quality
    This is an uncontrolled case series of only 10 patients with no comparison group, so it cannot show how this treatment compares to surgery or other non-surgical options.
    Limitations
    Small sample size (n=10), no control or comparator group, single-center case series, and short median follow-up relative to a chronic condition.

    Taken word for word from the abstract

    • n This case series included 10 symptomatic patients, consisting of 5 men and 5 women.
    • population Clinical examination identified 8 cases of prolapsed hemorrhoids (Goligher grade III-IV) and 2 cases of rectal mucosal prolapse.
    • intervention we applied a transanal high-intensity focused ultrasound (HIFU) technique, namely HIFU rectal lifting (HIFU-RAL), combined with aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy for treating prolapsed hemorrhoids
    • primaryOutcome The combined efficacy of HIFU-RAL and ALTA sclerotherapy was evaluated over time.
    • result In all cases, the prolapsed lesions were visibly reduced or resolved immediately after the procedure. During the follow-up period (median: 16.0 months; interquartile range: 10.5-25.8 months), no adverse events or recurrences were observed.
    • followUp median: 16.0 months; interquartile range: 10.5-25.8 months

    Medicine (Baltimore) · PMID 40922264 · Read it on PubMed ↗

  • Al Jnainati et al. 2025

    Outcomes of embolization therapy of superior rectal arteries for the management of grade 1 to 3 internal hemorrhoids: a systematic Review of clinical studies

    Embolization relieves symptoms, rarely compared to surgerySystematic reviewLow qualityRelated question

    810 people2025

    technical success 93-100%, clinical success 63-94%, complications mild and self-limited, recurrence needing repeat treatment in 8-20%

    Who was studied
    adults with grade I to III internal hemorrhoids
    What they received
    superior rectal artery embolization ('Emborrhoid' procedure)
    Compared with
    no consistent comparator; only two small studies compared to rubber-band ligation or sclerotherapy
    Main outcome
    technical success, symptom improvement, complications, and recurrence
    Quality
    this is a systematic review of mostly single-arm, heterogeneous studies that could not even be pooled statistically, so the findings are weak evidence.
    Limitations
    Substantial heterogeneity blocked meta-analysis; only two small, heterogeneous comparative studies versus rubber-band ligation or sclerotherapy were available, precluding a pooled analysis; small single-center cohorts, disparate techniques, and scarce head-to-head trials limit external validity.

    Taken word for word from the abstract

    • n Twenty-two studies encompassing 810 procedures qualified.
    • population grade I-III internal hemorrhoids
    • intervention Superior rectal artery embolization ("Emborrhoid") offers a catheter-based alternative for grade I-III internal hemorrhoids
    • comparator Only two small, heterogeneous comparative studies versus rubber-band ligation or sclerotherapy were available, precluding a pooled analysis.
    • primaryOutcome Prespecified outcomes were technical success, clinical success (≥ 2-point fall in bleeding score or equivalent), adverse events, and recurrence.
    • result Technical success reached 93-100%. Clinical success ranged from 63 to 94%, yielding marked bleeding control and symptom relief.
    • result Recurrence necessitating repeat treatment affected 8-20% of patients, usually when collateral arterial supply persisted.

    Int J Colorectal Dis · PMID 40877526 · Read it on PubMed ↗

  • Zhu et al. 2025

    Multicenter analysis of the efficacy and factors related to recurrence of endoscopic sclerotherapy for internal hemorrhoids: a large-sample, retrospective cohort study

    Sclerotherapy often worked, some recurrenceRetrospectiveLow qualityRelated question

    1,147 people3 to 49 months (mean: 25.61 ± 13.23 months)

    Counted as a related question: This study tests only endoscopic sclerotherapy alone in a single-arm design with no comparison group, rather than comparing surgical versus non-surgical approaches to answer whether surgery is necessary.

    92.85% of patients had successful treatment; overall recurrence was 12.21%, with recurrence timing and rate varying by hemorrhoid grade

    Who was studied
    Adults with internal hemorrhoids of various grades treated with endoscopic sclerotherapy
    What they received
    Endoscopic sclerotherapy
    Main outcome
    How well sclerotherapy worked and how often hemorrhoids came back
    Quality
    This is a retrospective, single-arm study with no comparison group, so while it shows sclerotherapy can work, it cannot tell us how it compares to surgery or other treatments.
    Limitations
    Retrospective design, no control or comparator arm, and follow-up duration varied widely between patients (3 to 49 months).

    Taken word for word from the abstract

    • n A total of 1147 patients underwent the procedure
    • population patients with internal hemorrhoids treated with endoscopic sclerotherapy
    • intervention endoscopic sclerotherapy
    • primaryOutcome Clinical and follow-up data were collected to assess hemorrhoid grading, treatment efficacy, complications, and recurrence rates.
    • result The overall effective rate was 92.85% (1065/1147).
    • result The overall recurrence rate was 12.21% (130/1065)

    Surg Endosc · PMID 40856750 · Read it on PubMed ↗

  • Hajjar et al. 2025

    Safety of Hemorrhoid Procedures in Patients Who Are Immunocompromised: The Mayo Clinic Experience

    Both approaches seemed safe in immunocompromised patients.RetrospectiveLow qualityRelated question

    55 people2025

    16 adverse events occurred in 14 of 55 patients (25%), mainly postoperative cellulitis in 3 cases; no cases of pelvic sepsis or need for IV antibiotics were reported

    Who was studied
    adults with hemorrhoidal disease who were immunocompromised (mostly due to medications such as steroids or methotrexate)
    What they received
    office-based procedures and operative surgery for hemorrhoids (including hemorrhoidectomy and excision of thrombosed hemorrhoids)
    Main outcome
    infectious or wound complications after treatment
    Quality
    This is a small, retrospective, single-center case series without a comparison group, so it can only describe safety, not prove one approach is better.
    Limitations
    The retrospective nature of the study and the heterogeneity of the study population.

    Taken word for word from the abstract

    • n Fifty-five immunocompromised patients, with a median age of 60 years, underwent a total of 68 hemorrhoidal procedures
    • population Adult patients were included who had hemorrhoidal disease and primarily medication-induced immunosuppression
    • intervention undergoing an office-based procedure or operative intervention for hemorrhoidal disease while on immunosuppression
    • primaryOutcome The primary outcome was the development of infectious complications or wound complications.
    • result Sixteen adverse events were reported in 14 patients (25%). Three cases of postoperative cellulitis were documented after thrombosed external hemorrhoid excision, hemorrhoidopexy, and Whitehead hemorrhoidectomy. No postoperative intravenous antibiotics were administered. No cases of pelvic sepsis were documented.

    Dis Colon Rectum · PMID 40810375 · Read it on PubMed ↗

  • Huang et al. 2025

    Tissue selecting therapy stapler minimally invasive surgery to treat severe hemorrhoids

    One surgery type beat two other surgery typesRandomised trialLow qualityRelated question

    141 people3 months

    TST had a higher effective rate (93.62%) and lower complication rate (10.64%) than PPH (74.47% effective, 27.66% complications) and EPH (72.34% effective, 31.91% complications)

    Who was studied
    Patients with severe (grade III-IV) hemorrhoids
    What they received
    Tissue selecting therapy (TST) stapler minimally invasive surgery
    Compared with
    PPH stapled hemorrhoidopexy and EPH (rubber band ligation plus dislocation) surgery
    Main outcome
    Clinical efficacy, postoperative complications, and anal dynamics
    Quality
    Small single-center trial comparing three surgical techniques with no blinding described and no comparison to a non-surgical option, so it cannot speak to surgery versus non-surgical treatment.
    Limitations
    All three compared groups are surgical procedures; the study does not include a non-surgical arm, so it does not address whether surgery is needed versus non-surgical treatment.

    Taken word for word from the abstract

    • population 141 patients with severe hemorrhoids
    • intervention tissue-selective therapy stapler (TST) minimally invasive surgery
    • comparator the PPH group, and the eastern rubber band ligation and coincident of dislocation for prolapse and hemorrhoid (EPH)group
    • primaryOutcome clinical efficacy, postoperative complications, and anal dynamics
    • result The total effective rate in the TST group was 93.62%, which was higher than the 74.47% and 72.34% in the PPH and EPH groups, respectively, after treatment.
    • result the complication rate in the TST group was 10.64%, which was lower than the 27.66% and 31.91% reported in the PPH and EPH groups, respectively
    • n 141 patients with severe hemorrhoids were included into three groups

    BMC Surg · PMID 40634906 · Read it on PubMed ↗

  • Schwandner 2025

    [Hemorrhoidal disease and stage-dependent treatment (including anal prolapse)]

    Treatment choice depends on hemorrhoid stage, not a head-to-head comparison.Narrative reviewVery low qualityRelated question

    size not given2025

    Early-stage disease (I-II) managed with conservative and interventional options like sclerotherapy and rubber band ligation, while advanced disease (III-IV) is treated with surgical procedures, including minimally invasive techniques; acute anal prolapse managed conservatively.

    Who was studied
    Adults with hemorrhoidal disease (including anal prolapse), stages I-IV
    Main outcome
    Symptom control and long-term absence of recurrence
    Quality
    This is a narrative review summarizing general practice rather than a study reporting original data or a systematic comparison of treatments.
    Limitations
    Review article with no original data, no systematic search described, and no quantitative outcomes reported; abstract only in English for a German-language review.

    Taken word for word from the abstract

    • population The treatment of hemorrhoidal disease is carried out depending on the symptoms and stage of the disease.
    • 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).
    • primaryOutcome The ultimate goal of all treatment strategies for hemorrhoidal disease is symptom control and long-term absence of recurrence.

    Chirurgie (Heidelb) · PMID 40586790 · Read it on PubMed ↗

  • di Schiano di Visconte 2025

    Laser Hemorrhoidoplasty: Procedure, Outcomes and Future Directions

    Laser helps mild cases; surgery better for severe.Narrative reviewLow qualityRelated question

    size not given2025

    Laser hemorrhoidoplasty works well for early-grade (II-III) hemorrhoids with less pain and faster recovery, but has higher recurrence in grade IV disease; excisional surgery remains better for advanced cases and long-term symptom control

    Who was studied
    Adults with hemorrhoidal disease of varying grades (I-IV)
    What they received
    Laser hemorrhoidoplasty
    Compared with
    Traditional excisional surgical methods
    Main outcome
    Efficacy, safety, and long-term outcomes of laser treatment
    Quality
    This is a narrative review summarizing existing literature without a systematic search method or pooled statistical analysis, so it cannot establish causality or strength of evidence.
    Limitations
    No systematic methodology is described, no patient numbers are given, and conclusions appear to be based on the authors' narrative synthesis of various studies rather than a controlled comparison.

    Taken word for word from the abstract

    • population the management of early-grade hemorrhoids, particularly grades II and III
    • intervention Laser hemorrhoidoplasty (LHP) has emerged as a minimally invasive technique for the treatment of hemorrhoidal disease (HD)
    • comparator excisional methods remain superior for managing advanced HD, particularly in terms of long-term symptom resolution
    • primaryOutcome This study critically evaluated the efficacy, safety, and long-term outcomes of LHP across different grades of hemorrhoids.
    • result Although LHP demonstrates clear benefits in the management of early-grade hemorrhoids, particularly grades II and III, its limitations are more apparent in advanced cases.
    • 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

    ANZ J Surg · PMID 40586452 · Read it on PubMed ↗

  • Martins et al. 2026

    Operative versus nonoperative treatment of thrombosed external hemorrhoids: a systematic review and meta-analysis

    Surgery lowers recurrence, not bleeding.Meta-analysisLow qualityRelated question

    851 people2026

    surgery had lower recurrence but similar bleeding risk compared with conservative treatment

    Who was studied
    adults with thrombosed external hemorrhoids
    What they received
    surgical removal of thrombosed external hemorrhoids
    Compared with
    conservative (nonoperative) management
    Main outcome
    recurrence and bleeding after treatment
    Quality
    it pools six studies described only as 'clinical trials' with moderate-to-high heterogeneity (I2 up to 60%) and unclear randomisation, so the pooled estimates are not very reliable.
    Limitations
    The abstract does not specify whether all six included studies were randomised, heterogeneity was moderate-to-high (I2 54-60%), and the population is thrombosed external hemorrhoids specifically, not the broader graded internal/external hemorrhoid population in the question.

    Taken word for word from the abstract

    • 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 identify clinical trials 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%)

    Updates Surg · PMID 40576944 · Read it on PubMed ↗

  • Zhang et al. 2025

    The Comparison Between Endoscopic Ligation and Sclerotherapy on the Treatment Effect and Anorectal Function in Patients With Internal Hemorrhoids

    No difference, banding vs sclerotherapyProspective cohortLow qualityRelated question

    32 people3-month follow-up

    no significant difference between ligation and sclerotherapy in treatment effect, bleeding, prolapse, constipation, complications, or anorectal function overall, though each method showed some specific advantages

    Who was studied
    adults with internal hemorrhoids undergoing minimally invasive endoscopic treatment
    What they received
    endoscopic rubber band ligation
    Compared with
    cap-assisted endoscopic sclerotherapy (CAES)
    Main outcome
    treatment effect, symptom relief, complication rate, and anorectal function
    Quality
    Very small study (32 patients) with only 3-month follow-up and no clear statement that patients were randomized, so it cannot reliably show whether one approach is better.
    Limitations
    Small sample size, short 3-month follow-up, unclear randomization, and this study compares two non-surgical techniques rather than surgery versus non-surgical treatment.

    Taken word for word from the abstract

    • population Thirty-two patients who underwent minimally invasive endoscopic treatment for internal hemorrhoids were recruited
    • 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.
    • n Thirty-two patients who underwent minimally invasive endoscopic treatment for internal hemorrhoids were recruited

    Surg Laparosc Endosc Percutan Tech · PMID 40530787 · Read it on PubMed ↗

  • van Oostendorp et al. 2025

    Cost-Effectiveness of Rubber Band Ligation Versus Hemorrhoidectomy for the Treatment of Grade III Hemorrhoids: Analysis Using Evidence From the HOLLAND Randomized Controlled Trial

    Surgery works better but costs more.RetrospectiveLow qualityRelated question

    79 people24 months

    Using the same patients as the original HOLLAND randomized trial, this cost analysis found hemorrhoidectomy gave better clinical outcomes (higher quality-adjusted life years, lower recurrence) but cost more; whether it was 'cost-effective' depended on how much society is willing to pay per QALY.

    Who was studied
    Adults with symptomatic grade III hemorrhoids
    What they received
    Rubber band ligation (up to 2 sessions)
    Compared with
    Excisional hemorrhoidectomy
    Main outcome
    Cost per quality-adjusted life year gained and cost per recurrence avoided over 24 months
    Quality
    This is a secondary cost-effectiveness analysis of the same small HOLLAND trial (79 patients) already counted elsewhere, not a new independent randomized comparison, so it should not be tallied as an additional trial.
    Limitations
    Small sample size may limit generalizability and the ability to detect rare but costly complications; procedural costs were based on average hospital prices rather than detailed bottom-up costing; this is an economic re-analysis of existing trial data, not a new trial.

    Taken word for word from the abstract

    • n Seventy-nine patients were analyzed (33 for hemorrhoidectomy and 46 for rubber band ligation).
    • population Adults with symptomatic grade III hemorrhoids randomly assigned to receive rubber band ligation or hemorrhoidectomy treatment.
    • intervention Rubber band ligation (up to 2 sessions) or excisional hemorrhoidectomy.
    • comparator Rubber band ligation (up to 2 sessions) or excisional hemorrhoidectomy.
    • primaryOutcome Cost per quality-adjusted life year gained and cost per recurrence avoided over 24 months from a societal perspective.
    • result Hemorrhoidectomy resulted in better clinical outcomes with a quality-adjusted life year difference of 0.08 (95% CI, 0.04-0.13) and a recurrence difference of 33.5% (95% CI, 15.3%-51.7%).
    • result The probability of hemorrhoidectomy being cost-effective was 45.5% at €20,000 per quality-adjusted life year and 83.9% at €50,000 per quality-adjusted life year.
    • design Cost-effectiveness and cost-utility analyses using data from a multicenter, randomized controlled trial.
    • limitations The small sample size may limit generalizability and the ability to detect rare but costly complications.

    Dis Colon Rectum · PMID 40492557 · Read it on PubMed ↗

  • Gallo et al. 2025

    Real-world use of polidocanol foam sclerotherapy for hemorrhoidal disease: insights from an international survey and systematic review with clinical practice recommendations

    Experts favor sclerotherapy over banding, no trial proofSystematic reviewVery low qualityRelated question

    size not given2025

    Experts perceived polidocanol foam sclerotherapy as having higher success (88.3% vs 66.7%) and lower recurrence (16.1% vs 41.2%) than rubber band ligation, based on survey and literature review, not a controlled comparison

    Who was studied
    Adults with hemorrhoidal disease, mostly Goligher grade II-III
    What they received
    Polidocanol foam sclerotherapy (a non-surgical injection treatment)
    Compared with
    Rubber band ligation
    Main outcome
    Perceived success and recurrence rates of treatment
    Quality
    This is an international expert survey and Delphi consensus combined with a systematic review of mixed, non-randomized studies, not a controlled trial, so the comparison numbers reflect opinion and heterogeneous data rather than directly measured outcomes.
    Limitations
    Based on expert survey and non-randomized/heterogeneous studies; no randomized trial directly compares polidocanol sclerotherapy with rubber band ligation or with surgery; success/recurrence figures are self-reported perceptions, not pooled trial outcomes.

    Taken word for word from the abstract

    • population Most experts (90%) reported using polidocanol foam sclerotherapy primarily for Goligher grade II HD, with 67% extending its use to grade III cases.
    • intervention Polidocanol foam sclerotherapy has gained increasing attention as a minimally invasive treatment for hemorrhoidal disease (HD).
    • comparator Compared to rubber band ligation, polidocanol foam was perceived as having higher success rates (88.3% vs. 66.7%) and lower recurrence rates (16.1% vs. 41.2%).
    • primaryOutcome Compared to rubber band ligation, polidocanol foam was perceived as having higher success rates (88.3% vs. 66.7%) and lower recurrence rates (16.1% vs. 41.2%).
    • result Compared to rubber band ligation, polidocanol foam was perceived as having higher success rates (88.3% vs. 66.7%) and lower recurrence rates (16.1% vs. 41.2%). Adverse events were infrequent.

    Updates Surg · PMID 40481245 · Read it on PubMed ↗

  • Carvalho et al. 2025

    Efficacy and safety of office-based procedures for hemorrhoidal disease in patients with inflammatory bowel disease

    Office procedures worked well in IBD patients.RetrospectiveLow qualityRelated question

    129 people2025

    The treatment of HD was effective in 88% of patients, of which 16% relapsed

    Who was studied
    adults with inflammatory bowel disease who also had symptomatic hemorrhoids
    What they received
    office-based procedures (rubber band ligation and polidocanol sclerotherapy) for hemorrhoids
    Compared with
    rubber band ligation compared with polidocanol sclerotherapy (no surgical comparison group)
    Main outcome
    treatment success, recurrence, and complications of hemorrhoid treatment
    Quality
    This is a retrospective study with no surgical comparison group, in a narrow population (IBD patients), so it cannot show whether avoiding surgery is as good as having it.
    Limitations
    Retrospective design, no comparison to surgery, and the population (IBD patients) differs from the general adult population with hemorrhoids addressed by the question.

    Taken word for word from the abstract

    • population A total of 129 patients were included, 90 with ulcerative colitis and 37 with Crohn's disease.
    • intervention 77 patients underwent rubber band ligation (RBL), 44 underwent polidocanol injection, and 8 had both treatments, for a total of 304 procedures
    • comparator Clinical success and recurrence were similar between RBL and polidocanol foam sclerotherapy (PFS). RBL had more complications than PFS (15.6% versus 2.6%).
    • primaryOutcome Data regarding the patients' IBD (type, disease location, medication, endoscopic remission) and HD (clinical success, recurrence, complications) were analyzed.
    • result The treatment of HD was effective in 88% of patients, of which 16% relapsed
    • n A total of 129 patients were included

    Tech Coloproctol · PMID 40338393 · Read it on PubMed ↗

  • Gravante 2025

    Sclerotherapy for hemorrhoidal disease: Recent evolutions of an oldies goldy

    Editorial on a sclerotherapy technique, no trial dataNarrative reviewVery low qualityRelated question

    size not given2025

    The editorial reports that the results of the discussed study were promising, without providing specific outcome data of its own.

    Who was studied
    adults with grade II-III internal hemorrhoids
    What they received
    sclerobanding (endoscopic polidocanol foam sclerotherapy combined with rubber-band ligation)
    Compared with
    endoscopic rubber band ligation alone
    Main outcome
    not clearly stated; the editorial discusses clinical outcomes of the technique commented upon
    Quality
    This is a commentary on another study, not an original trial, so it provides no independent data on patient numbers, methodology or outcomes.
    Limitations
    No original patient data, sample size, or statistical results are reported; it is an opinion/commentary piece referencing another publication (Qu et al.).

    Taken word for word from the abstract

    • population patients with grade II-III internal hemorrhoids
    • intervention a technique called "sclerobanding"
    • comparator present results compared with endoscopic rubber band ligation
    • primaryOutcome The results achieved are promising.
    • result The results achieved are promising.

    World J Gastroenterol · PMID 40062327 · Read it on PubMed ↗

  • Gallo et al. 2025

    Clinical evidence and rationale of topical nifedipine and lidocaine ointment in the treatment of anal fissure and hemorrhoidal disease

    Topical ointment eases fissure and hemorrhoid pain, not surgery comparisonNarrative reviewLow qualityRelated question

    size not given2025

    Nifedipine/lidocaine ointment was reported to work better than lidocaine alone or lidocaine plus hydrocortisone for these anorectal symptoms

    Who was studied
    Adults with hemorrhoidal disease, anal fissure, or pain after hemorrhoidectomy
    What they received
    Topical ointment combining nifedipine 0.3% and lidocaine 1.5%
    Compared with
    Topical lidocaine 1.5% alone, or lidocaine with hydrocortisone acetate 1%
    Main outcome
    Pain relief, resolution of thrombosed hemorrhoids, healing of anal fissures, and post-hemorrhoidectomy pain control
    Quality
    This is a non-systematic narrative review of a limited body of literature, not a new controlled trial, so it carries less weight for deciding between surgery and non-surgical care.
    Limitations
    The review is not a systematic review (no stated systematic search/selection criteria beyond a literature search supplemented by ad hoc sources), the authors themselves state the available literature is limited, and it compares two topical treatments to each other rather than comparing surgery to a non-surgical option.

    Taken word for word from the abstract

    • population Anorectal conditions such as hemorrhoidal disease and anal fissure are frequently painful and debilitating.
    • intervention An ointment formulation containing the calcium channel blocker nifedipine and the local anesthetic lidocaine
    • comparator The ointment was significantly better than controls consisting of topical lidocaine 1.5% alone or in combination with hydrocortisone acetate 1%.
    • primaryOutcome effective in relieving pain and aiding the resolution of thrombosed hemorrhoids, reducing resting anal pressure and healing chronic anal fissures, and controlling pain after hemorrhoidectomy
    • result The ointment was significantly better than controls consisting of topical lidocaine 1.5% alone or in combination with hydrocortisone acetate 1%.
    • limitations Although the available literature on the topical application of nifedipine and lidocaine in anorectal diseases is limited

    Minerva Surg · PMID 39945661 · Read it on PubMed ↗

  • Sapkota Upadhya et al. 2024

    Efficacy and Safety of Colonoscopic Band Ligation for Lower Gastrointestinal Bleeding due to Hemorrhoid

    Good symptom relief, no surgery comparison.Prospective cohortLow qualityRelated question

    28 people3 months

    symptoms resolved in almost all patients by 3 months, with some post-procedure complications and high patient satisfaction

    Who was studied
    adults with grade II internal hemorrhoids causing lower gastrointestinal bleeding at a tertiary care center in Nepal
    What they received
    colonoscopic rubber band ligation
    Compared with
    none (single-group study, no comparison treatment)
    Main outcome
    resolution of hemorrhoid symptoms (bleeding, prolapse, irritation, discharge, pain) and safety/satisfaction at follow-up
    Quality
    this is a small, single-arm study of only 28 patients with no comparison group and short follow-up, so it cannot show whether this treatment works better or worse than surgery or other options.
    Limitations
    No comparator group, small sample size, short follow-up, single-center design; the abstract itself calls for further multicenter research with longer follow-up.

    Taken word for word from the abstract

    • n We included 28 among 108 patients presenting to the surgical outpatient department with Lower gastrointestinal bleeding.
    • population treatment of symptomatic grade II hemorrhoids
    • intervention Colonoscopic Rubber band ligation is feasible, safe and efficient for the treatment of symptomatic grade II hemorrhoids
    • comparator This study, conducted in a tertiary care center of Nepal over one year, explores the immediate, late complications, efficacy and treatment satisfaction of patients undergoing Colonoscopic Rubber band ligation for lower GI bleeding due to hemorrhoids.
    • primaryOutcome Symptoms of irritation, discharge, pain resolved in all patients at 3 months and that of bleeding and prolapse in 96.4% and 92% respectively.
    • result Post-procedure complications were reported in 53.5% of cases. 78.6% of patients rated Colonoscopic Rubber band ligation treatment as "excellent help".

    J Nepal Health Res Counc · PMID 39923169 · Read it on PubMed ↗

  • Li et al. 2025

    Rubber band ligation or shaobei injection for the endoscopic treatment of symptomatic hemorrhoids? A retrospective study

    Similar recurrence, less pain with injectionRetrospectiveLow qualityRelated question

    413 people3 months

    Recurrence rates and symptom improvement were similar between groups, but the injection group had significantly less pain on days 1 and 7 and fewer complications within 7 days

    Who was studied
    Adults with grade I-IV symptomatic hemorrhoids treated endoscopically
    What they received
    Endoscopic Shaobei injection (a sclerosant injection technique)
    Compared with
    Endoscopic rubber band ligation
    Main outcome
    Recurrence rate, postoperative complications, pain, quality of life and satisfaction at 3 months
    Quality
    This is a retrospective, non-randomized comparison with uneven group sizes before matching, so it cannot reliably establish cause and effect.
    Limitations
    Retrospective design, unequal group sizes requiring propensity score matching, no randomization, short 3-month follow-up, and the comparison is between two non-surgical techniques rather than surgery versus non-surgical treatment.

    Taken word for word from the abstract

    • population grade I-IV symptomatic hemorrhoids treated with endoscopy
    • intervention Shaobei injection (treatment group; n = 79)
    • comparator band ligation (control group; n = 334) groups
    • n collected clinical data from 413 patients with grade I-IV symptomatic hemorrhoids treated with endoscopy
    • 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).
    • result the injection group experienced significantly less pain than the band ligation group on postoperative days 1 (P < 0.001) and 7 (P = 0.003).
    • result 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).

    Surg Endosc · PMID 39762601 · Read it on PubMed ↗

  • Mou et al. 2024

    Endoscopic polidocanol foam sclerobanding for treatment of internal hemorrhoids: A novel outpatient procedure

    New banding technique shows promise, more study neededNarrative reviewVery low qualityRelated question

    size not givenone-year follow-up

    The commentary reports that the study by Qu et al found EFSB to be a novel therapy for internal hemorrhoids, but states larger, longer-term studies are needed to confirm these findings.

    Who was studied
    adults with grade II and III internal hemorrhoids
    What they received
    endoscopic polidocanol foam sclerobanding (EFSB)
    Compared with
    endoscopic rubber band ligation (ERBL)
    Main outcome
    prolapse recurrence and post-procedural pain
    Quality
    This is an editorial commentary discussing another study, not an independent trial, so it carries little weight on its own.
    Limitations
    This is a commentary on another article rather than a primary study, compares two non-surgical techniques rather than surgery vs non-surgical treatment, and does not report its own sample size or methodology.

    Taken word for word from the abstract

    • population patients with grades II and III internal hemorrhoids
    • intervention Endoscopic polidocanol foam sclerobanding (EFSB) is a novel approach
    • comparator Endoscopic rubber band ligation (ERBL) is a safe, convenient, quick, and economical outpatient procedure
    • 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.

    World J Gastroenterol · PMID 39563748 · Read it on PubMed ↗

  • Zakaria et al. 2025

    Laser hemorrhoidoplasty versus hemorrhoidectomy in the treatment of surgically indicated hemorrhoids in inflammatory bowel patients: a randomized comparative clinical study

    Laser easier recovery, but more leftover hemorrhoidsRandomised trialLow qualityRelated question

    48 people2025

    Laser treatment had shorter operation time, less and shorter pain, less anal discharge, faster return to work, and higher satisfaction than traditional surgery, and was also better for postoperative bleeding and anal stenosis; however, more patients in the laser group had leftover (residual) hemorrhoids.

    Who was studied
    Adults with inflammatory bowel disease who have hemorrhoids needing surgery
    What they received
    Laser hemorrhoidoplasty
    Compared with
    Traditional hemorrhoidectomy (open surgery)
    Main outcome
    Operation time, pain, bleeding, anal stenosis, return to work, satisfaction, and residual hemorrhoids
    Quality
    This was a small, single-center trial limited to patients with inflammatory bowel disease, and patients were assigned to groups by odd or even numbers rather than true random allocation, so the result is not very reliable or generalizable.
    Limitations
    Allocation was done by odd/even numbers (not true randomization), the trial was small (48 patients), single-center, unblinded, and restricted to a specific population with inflammatory bowel disease rather than the general hemorrhoid population.

    Taken word for word from the abstract

    • n The study comprised 48 patients who were admitted during this period and had inflammatory bowel disease along with hemorrhoids.
    • population inflammatory bowel disease along with hemorrhoids
    • intervention Group I consisted of 24 patients who underwent laser hemorrhoidoplasty, selected based on odd numbers
    • comparator Group II consisted of 24 patients who underwent traditional surgery, selected based on even numbers
    • primaryOutcome regarding operation time, pain score and duration, postoperative anal discharge, return to work time, and patient satisfaction
    • result demonstrated significantly better outcomes than traditional surgery (p < 0.001) regarding operation time, pain score and duration, postoperative anal discharge, return to work time, and patient satisfaction
    • result there was a higher frequency of residual hemorrhoids in laser group

    Surg Endosc · PMID 39511001 · Read it on PubMed ↗

  • Zhang et al. 2024

    Endoscopic polidocanol foam sclerobanding for the treatment of Grade II-III internal hemorrhoids: The focus of clinical practice

    Commentary only, no new dataNarrative reviewVery low qualityRelated question

    size not given2024

    This is a letter commenting on another group's trial; it does not itself report new outcome data, only discusses procedural steps and suggests areas for future research.

    Who was studied
    people with grade II-III internal hemorrhoids (as described in the study being discussed)
    What they received
    combined endoscopic polidocanol foam sclerotherapy and rubber band ligation
    Main outcome
    long-term symptom relief and endoscopic healing, as evaluated in the discussed study
    Quality
    This is an editorial letter discussing another study's methods, not an original trial with its own patients or outcome data.
    Limitations
    The abstract is a commentary/letter, not a primary study; it reports no independent patient data, sample size, or comparative results of its own.

    Taken word for word from the abstract

    • population patients with Grade II-III internal hemorrhoids
    • intervention integration of endoscopic polidocanol foam sclerotherapy with rubber band ligation
    • primaryOutcome evaluate the 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.

    World J Gastroenterol · PMID 39493328 · Read it on PubMed ↗

  • Rao et al. 2024

    Redefining hemorrhoid therapy with endoscopic polidocanol foam sclerobanding

    Newer banding method beat standard bandingNarrative reviewLow qualityRelated question

    195 people2024

    EFSB significantly reduced recurrence rates and post-procedural pain while improving symptom relief and patient satisfaction compared to ERBL

    Who was studied
    adults with grade II and III internal hemorrhoids
    What they received
    endoscopic polidocanol foam sclerobanding (EFSB), a newer banding technique
    Compared with
    endoscopic rubber band ligation (ERBL), standard banding
    Main outcome
    hemorrhoid recurrence, pain after the procedure, symptom relief and satisfaction
    Quality
    This is an editorial commentary discussing another group's trial rather than original data, and the trial itself was single-blind with a short follow-up period.
    Limitations
    Single-blind design and relatively short follow-up period; this is an editorial summary, not the primary trial report, and compares two non-surgical techniques rather than surgery versus non-surgical treatment.

    Taken word for word from the abstract

    • population 195 patients with grade II and III internal hemorrhoids
    • n This multicenter randomized trial involved 195 patients
    • intervention endoscopic poli-docanol foam sclerobanding (EFSB)
    • comparator endoscopic rubber band ligation (ERBL)
    • primaryOutcome significantly reduced recurrence rates and post-procedural pain while improving symptom relief and patient satisfaction
    • result demonstrated that EFSB significantly reduced recurrence rates and post-procedural pain while improving symptom relief and patient satisfaction compared to ERBL

    World J Gastroenterol · PMID 39351248 · Read it on PubMed ↗

  • Samalavicius et al. 2024

    Global treatment of haemorrhoids-A worldwide snapshot audit conducted by the International Society of University Colon and Rectal Surgeons

    Surgeons mostly try conservative care firstRetrospectiveLow qualityRelated question

    1,005 people2024

    Conservative treatment was first-line for most grade I-III hemorrhoids, with surgery becoming first-line only for grade IV; rubber band ligation was a common second-line option for lower grades while surgery was second-line for grade III

    Who was studied
    Colorectal surgeons worldwide treating patients with internal and external hemorrhoids
    What they received
    Conservative/nonprocedural treatment (fiber, water intake, bowel habit changes) and office procedures like rubber band ligation
    Compared with
    Surgical hemorrhoidectomy
    Main outcome
    Which treatment approach surgeons use first-line and second-line by hemorrhoid grade
    Quality
    This is a self-reported survey of surgeon practice patterns, not a trial measuring patient outcomes, so it cannot show whether one approach works better than another.
    Limitations
    Survey-based, reflects surgeon opinion and practice habits rather than measured patient outcomes; no control group or outcome data; subject to response and recall bias

    Taken word for word from the abstract

    • n The survey was completed by 1005 surgeons from 103 countries
    • population evaluating surgeons' experience, volume and treatment approaches to haemorrhoids
    • 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 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%).
    • result Rubber band ligation was the second-line treatment in first (50.7%) and second (47.2%) degree haemorrhoids, whereas surgery was the second-line treatment in third (82.9%) and fourth (16.7%) degree symptomatic haemorrhoids.

    Colorectal Dis · PMID 39169548 · Read it on PubMed ↗

  • Godeberge et al. 2024

    An international observational study assessing conservative management in hemorrhoidal disease: results of CHORALIS (aCute HemORrhoidal disease evALuation International Study)

    Drug therapy eased symptoms, no surgery comparisonProspective cohortLow qualityRelated question

    3,505 people4 weeks

    Conservative drug-based treatments, mostly venoactive drugs including MPFF, improved symptoms and quality of life over the 4-week follow-up, with MPFF outperforming diosmin on several measures; the study did not include a surgical comparison group

    Who was studied
    Adults with acute hemorrhoidal disease (mostly Goligher grade I-II), seen in outpatient clinics internationally
    What they received
    Conservative (non-surgical) treatments, mainly venoactive drugs such as micronized purified flavonoid fraction (MPFF) and diosmin
    Main outcome
    Change in hemorrhoid symptoms (pain, bleeding, swelling, itching) and quality of life after conservative treatment
    Quality
    It was a large but uncontrolled observational study with no surgical comparator and no randomization, so it cannot show whether surgery works better or worse than non-surgical care.
    Limitations
    Observational design without a control or surgical comparison group, open-label, mostly mild-grade (I-II) hemorrhoids, short 4-week follow-up.

    Taken word for word from the abstract

    • population adult outpatients consulting for spontaneous complaints of hemorrhoids (graded using Goligher classification) and prescribed conservative treatments according to usual clinical practice
    • intervention Most treatments were venoactive drugs (VADs; 90.9%), particularly micronized purified flavonoid fraction (MPFF; 73.7%) and diosmin (14.6%).
    • primaryOutcome This international study collected clinical practice data on the effectiveness of conservative treatments for acute HD on symptoms and quality of life (QoL)
    • result All VAD-based therapies improved signs/symptoms (number/intensity/frequency of pain, discomfort, bleeding, swelling, itching and soiling) and QoL.
    • n Of 3592 participants, 3505 were analyzed
    • followUp The 4-week observational prospective CHORALIS study

    J Comp Eff Res · PMID 39132755 · Read it on PubMed ↗

  • Qu et al. 2024

    Endoscopic polidocanol foam sclerobanding for the treatment of grade II-III internal hemorrhoids: A prospective, multi-center, randomized study

    Combined banding method beat banding aloneRandomised trialModerate qualityRelated question

    195 people12 months

    Combined sclerotherapy-banding had lower symptom scores, lower prolapse recurrence (11.2% vs 21.6%), and less pain than banding alone at 12 months

    Who was studied
    adults with grade II-III internal hemorrhoids
    What they received
    combined sclerotherapy (polidocanol foam) plus rubber band ligation (EFSB)
    Compared with
    standard endoscopic rubber band ligation alone (ERBL)
    Main outcome
    hemorrhoid symptom severity, prolapse recurrence, and post-procedure pain at 12 months
    Quality
    it is a multicenter randomized trial with a reasonable sample size and 12-month follow-up, but it compares two non-surgical techniques to each other, not surgery versus non-surgical treatment, so it cannot speak to that question
    Limitations
    this trial compares two non-surgical techniques (sclerotherapy-banding vs banding alone) rather than comparing a non-surgical option against surgery, so it does not address whether hemorrhoids need surgery

    Taken word for word from the abstract

    • population 195 consecutive patients diagnosed with grade II-III internal hemorrhoids were enrolled from four tertiary hospitals
    • intervention cap-assisted endoscopic polidocanol foam sclerobanding (EFSB)
    • comparator an ERBL group
    • primaryOutcome Symptom-based severity and post-procedural pain were assessed using a hemorrhoid severity score (HSS) and a visual analog scale (VAS)
    • result The prolapse recurrence rate was lower in the EFSB group at 12 months (11.2% vs 21.6%, P = 0.038)
    • result The median VAS was lower in the EFSB group than in the ERBL [2.0 (1.0-3.0) vs 3.0 (2.0-4.0), P < 0.001]
    • n One hundred and ninety-five patients were enrolled, with 98 in the EFSB group.

    World J Gastroenterol · PMID 39086750 · Read it on PubMed ↗

  • Kavraal et al. 2024

    Hemorrhoidal laser ablation procedure: a minimally invasive treatment for grades II, III, and IV using a 1470 nm diode laser

    Low recurrence after laser treatment.RetrospectiveLow qualityRelated question

    138 peopleup to five years

    No intraoperative complications; recurrence was 0.8% at about one month and 5% over up to five years; 95% of patients were satisfied with symptom relief

    Who was studied
    Adults with symptomatic grade II, III, and IV internal hemorrhoids
    What they received
    Hemorrhoidal laser ablation using a 1470 nm diode laser
    Main outcome
    Symptom resolution, hemorrhoid size reduction, recurrence, and patient satisfaction after laser treatment
    Quality
    This is a retrospective case series with no comparison group, so it cannot show whether laser treatment works better or worse than surgery or other non-surgical options.
    Limitations
    Retrospective design with no control or comparator group, so results cannot be directly compared to surgery or other treatments; relies on data from three centers over several years which may introduce variability.

    Taken word for word from the abstract

    • n The cohort included 138 patients with symptomatic hemorrhoids who underwent Hemorrhoidal Laser Ablation at three different medical centers in 2017-2022.
    • population symptomatic grade II, III, and IV internal hemorrhoids
    • intervention Patients were treated with a 1470 nm diode laser.
    • primaryOutcome evaluate the efficacy and safety of this relatively recent technique
    • result No evidence of intraoperative complications occurred.
    • result The short- -term recurrence rate was 0.8% within roughly a month after the laser surgery, while the long-term recurrence rate was 5% over up to five years of follow-up.
    • result The overall satisfaction rate was 95% with symptomatic relief.

    Pol Przegl Chir · PMID 38965992 · Read it on PubMed ↗

  • Chen et al. 2024

    Clinical outcomes of laser hemorrhoidoplasty with feeding vessels suture ligation: a retrospective study in a single center

    Less pain than surgeryRetrospectiveLow quality

    323 people2024

    The laser hemorrhoidoplasty group had less pain after surgery and a lower rate of urinary retention than the traditional surgery group, with statistically significant differences.

    Who was studied
    patients with symptomatic grade II-III hemorrhoids
    What they received
    laser hemorrhoidoplasty with suture ligation of the feeding vessels
    Compared with
    Milligan-Morgan hemorrhoidectomy (traditional surgery)
    Main outcome
    postoperative pain and complications
    Quality
    This was a retrospective, non-randomized comparison of records from a single hospital, so it is more prone to bias than a randomized trial.
    Limitations
    Retrospective design drawing on inpatient records and telephone follow-up rather than a randomized trial, conducted at a single center, so groups may differ in ways that affect results.

    Taken word for word from the abstract

    • n The study included 323 patients, with 173 undergoing laser hemorrhoidoplasty (LHP) and 150 undergoing Milligan-Morgan hemorrhoidectomy.
    • population patients with symptomatic grade II-III hemorrhoids who underwent laser hemorrhoidoplasty with feeding vessel suture ligation and Milligan-Morgan hemorrhoidectomy
    • intervention laser hemorrhoidoplasty with feeding vessel suture ligation
    • comparator Milligan-Morgan hemorrhoidectomy
    • primaryOutcome postoperative pain, discomfort after discharge, hemorrhoid recurrence, and any complications were collected
    • result the LHP group exhibited superior performance compared to traditional surgery at postoperative 4 h, before discharge, and during the first and second outpatient visits, with statistically significant differences. Additionally, the LHP group had a lower rate of urinary retention and experienced significantly less pain, with statistically significant differences.

    Tech Coloproctol · PMID 38955875 · Read it on PubMed ↗

  • Smets et al. 2024

    Rectal perforation after laser hemorrhoidoplasty: a case report

    Serious injury after laser treatment.Case seriesVery low qualityRelated question

    1 people2024

    Counted as a related question: This case report documents a complication of laser hemorrhoidoplasty rather than comparing surgical versus non-surgical treatment approaches for hemorrhoids.

    The patient developed a rectal perforation that led to acute abdomen, sepsis, and multiorgan failure, requiring urgent laparoscopic surgery and a double-loop colostomy, with a later relapse of pelvic infection.

    Who was studied
    a 31-year-old woman treated with laser hemorrhoidoplasty for hemorrhoids
    What they received
    laser hemorrhoidoplasty
    Main outcome
    serious complication after the procedure (rectal perforation and its consequences)
    Quality
    This is a single case report with no comparison group, so it cannot show how common this problem is, only that it can happen.
    Limitations
    Only one patient is described, so the frequency and generalizability of this complication are unknown.

    Taken word for word from the abstract

    • population rectal perforation following laser hemorrhoidoplasty in a 31-year-old female
    • intervention Laser hemorrhoidoplasty has gained widespread acceptance for its minimally invasive approach in treating hemorrhoids.
    • primaryOutcome rectal perforation following laser hemorrhoidoplasty in a 31-year-old female, leading to an acute abdomen, sepsis, and multiorgan failure
    • result Urgent laparoscopic exploration and the establishment of a double-loop colostomy were undertaken, marking the beginning of a complex course characterized by relapsed pelvic sepsis.
    • n a 31-year-old female
    • harm This case report outlines the intricate management of rectal perforation following laser hemorrhoidoplasty in a 31-year-old female, leading to an acute abdomen, sepsis, and multiorgan failure.

    Tech Coloproctol · PMID 38849668 · Read it on PubMed ↗

  • Men et al. 2024

    Is routine histopathological analysis of hemorrhoidectomy specimens necessary? A systematic review and meta-analysis

    Cancer rarely found in removed tissue.Meta-analysisModerate qualityRelated question

    48,365 people2024

    cancer was found in about 0.13% of specimens, and cancer plus precancerous changes combined in about 1.16%

    Who was studied
    adults who had surgery (hemorrhoidectomy) to remove hemorrhoids
    What they received
    routine histopathological (microscopic) analysis of the removed hemorrhoid tissue
    Main outcome
    how often cancer or precancerous changes (AIN) were found in the removed tissue
    Quality
    it pools a large number of specimens but relies mostly on retrospective studies, so the true rate of missed cancers could be biased.
    Limitations
    Most included studies were retrospective, and the review notes no clear risk factors exist yet to pick which specimens truly need pathology review; this is about pathology testing after surgery, not about comparing surgery to non-surgical treatments.

    Taken word for word from the abstract

    • n 48,365 resected specimens from hemorrhoidectomy
    • population Hemorrhoidectomy is a common procedure used to treat symptomatic hemorrhoids.
    • intervention routinely conducting histopathological analysis on excised tissue samples
    • primaryOutcome the pooled proportions of cancer and anal intraepithelial neoplasia (AIN)
    • result the prevalence of anal cancer was low, at 0.13% (95% CI: 0.05%-0.31%). The prevalence of anal cancer and AIN combined was 1.16% (95% CI: 0.53%-2.52%).

    World J Surg · PMID 38797982 · Read it on PubMed ↗

  • Cheng et al. 2024

    Diode laser hemorrhoidoplasty versus conventional Milligan-Morgan and Ferguson hemorrhoidectomy for symptomatic hemorrhoids: Meta-analysis

    Laser surgery: less bleeding and pain than standard surgery.Meta-analysisModerate qualityRelated question

    1,196 people2024

    Counted as a related question: This study compares two surgical approaches (laser hemorrhoidoplasty versus conventional hemorrhoidectomy), not non-surgical versus surgical treatment—it does not address whether hemorrhoids can be treated without an operation.

    Laser hemorrhoidoplasty had less operative blood loss, less postoperative bleeding, shorter operative time, lower pain scores on day 1, and less anal stenosis than conventional hemorrhoidectomy, but no significant difference in fecal/flatus incontinence, urinary retention, or hemorrhoid recurrence.

    Who was studied
    patients with symptomatic hemorrhoids
    What they received
    laser hemorrhoidoplasty
    Compared with
    conventional hemorrhoidectomy (Milligan-Morgan and Ferguson techniques)
    Main outcome
    operative blood loss and postoperative hemorrhage
    Quality
    This is a meta-analysis pooling 17 trials with consistent results across several subgroups including low-risk-of-bias studies, but the abstract does not detail the quality of most individual trials.
    Limitations
    The abstract does not report the risk-of-bias status of most of the 17 included trials, only noting a subgroup of 'studies with low risk of bias' among the five subgroup analyses.

    Taken word for word from the abstract

    • n we included 17 trials with 1196 patients, of whom 596 (49.8 %) underwent laser hemorrhoidoplasty and 600 (50.2 %) underwent conventional hemorrhoidectomy
    • population symptomatic haemorrhoids
    • intervention laser hemorrhoidoplasty
    • comparator conventional hemorrhoidectomies, including Milligan-Morgan and Ferguson techniques
    • primaryOutcome The primary outcomes were operative blood loss and postoperative haemorrhage
    • result we found that laser hemorrhoidoplasty showed benefits in operative blood loss (weighted mean difference [WMD]: -16.43 ml, 95 % confidence interval [CI]: -23.82 to -9.04), postoperative hemorrhage/bleeding (odds ratio [OR]: 0.16, 95 % CI: 0.10 to 0.28), operative time (WMD: -12.42 min, 95 % CI: -14.56 to -10.28), postoperative pain score on day 1 (WMD: -2.50, 95 % CI: -3.13 to -1.88), and anal stenosis (OR: 0.14, 95 % CI: 0.03 to 0.65) in comparison with conventional hemorrhoidectomy. However, incidence of fecal/flatus incontinence, urinary retention and hemorrhoid recurrence were not significantly different between the 2 groups.

    Asian J Surg · PMID 38762410 · Read it on PubMed ↗

  • Akinmoladun et al. 2024

    Management of Hemorrhoids and Anal Fissures

    General review, no specific comparison dataNarrative reviewVery low qualityRelated question

    size not given2024

    The abstract describes a narrative review covering diagnosis, medical management, and procedures, noting diagnostic accuracy for anorectal disease is only 70% for surgeons and that numerous treatment options have different rates of success and complications, without reporting specific trial data or outcome comparisons

    Who was studied
    adults with hemorrhoids and anal fissures
    What they received
    various medical and surgical treatment options for hemorrhoids
    Quality
    This is a narrative review describing general management steps and options without presenting specific trial results, so it cannot answer whether surgery or non-surgical treatment works better.
    Limitations
    The abstract provides no specific data comparing surgical versus non-surgical approaches; it is a general overview covering both hemorrhoids and anal fissures together.

    Taken word for word from the abstract

    • 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
    • result diagnostic accuracy of benign anorectal disease is suboptimal at 70% for surgeons, especially for hemorrhoidal diseases
    • result In this article, the authors review each step of patient management, with emphasis on evidence-based treatment options for hemorrhoids and anal fissures

    Surg Clin North Am · PMID 38677814 · Read it on PubMed ↗

  • Fathallah et al. 2024

    Hemorrhoidal disease: Epidemiological study and analysis of predictive factors for surgical management

    Surgery more effective, fewer need itProspective cohortLow qualityRelated question

    472 people2024

    Both bleeding and prolapse scores improved significantly after treatment, but improvement and satisfaction were greater with surgery (73% 'very good satisfaction' vs 54% with non-surgical treatment, P=0.003); only 17% of patients overall received surgery

    Who was studied
    Adults presenting with symptomatic hemorrhoidal disease at a single center
    What they received
    Surgical treatment for hemorrhoids
    Compared with
    Medical and/or instrumental (non-surgical) treatment
    Main outcome
    Change in bleeding and prolapse scores and patient satisfaction after treatment
    Quality
    This was an observational study where treatment was not randomly assigned, so patients given surgery may have had worse disease to begin with, making the comparison unreliable.
    Limitations
    Single-center, non-randomized design where treatment choice was based on clinical judgment rather than randomization, so results may reflect patient selection rather than treatment effect; follow-up duration not specified.

    Taken word for word from the abstract

    • population Prospective single-center study from July to December 2021 including 472 patients.
    • intervention surgical (17%)
    • comparator Treatment modalities were medical (44%),±instrumental (72%), and surgical (17%).
    • primaryOutcome the bleeding score and prolapse score decreased significantly (P=0.002 and P≤0.0001, respectively)
    • result improvement was more marked in the surgery group with a better rate of "very good satisfaction" (73% vs. 54%, P=0.003)
    • n including 472 patients
    • result Less than 20% of patients who present with hemorrhoidal disease require surgical treatment, but it is associated with better effectiveness despite more complex postoperative consequences

    J Visc Surg · PMID 38580520 · Read it on PubMed ↗

  • Gallo et al. 2024

    Sclerotherapy with 3% polidocanol foam for the treatment of mucocutaneous bridges and/or residual piles after open excisional hemorrhoidectomy

    Combined surgery plus sclerotherapy eased symptomsRetrospectiveVery low qualityRelated question

    18 people3 months

    77.8% of patients were symptom-free at 3 months, with a significant drop in symptom scores from 16 before treatment to 2 at 3 months, and no bleeding or complications

    Who was studied
    Adults aged 18-75 with grade IV hemorrhoidal disease
    What they received
    Sclerotherapy with polidocanol foam combined with open excisional hemorrhoidectomy (for leftover tissue after surgery)
    Main outcome
    Symptom score (HDSS) and quality-of-life/continence scores after treatment
    Quality
    This is a small, single-center retrospective case series of only 18 patients with no comparison group and short follow-up, so it cannot show whether surgery or non-surgical treatment alone is better.
    Limitations
    No control/comparator group, very small sample, single center, short follow-up (3 months), and it studies a combination of surgery plus sclerotherapy rather than comparing surgery against a non-surgical option.

    Taken word for word from the abstract

    • n a total of 18 patients with IV-degree HD, aged between 18 and 75 years
    • population 18 patients with IV-degree HD, aged between 18 and 75 years with symptomatic HD according to the Goligher classification
    • intervention the combined treatment of open excisional hemorrhoidectomy and the use of ST on the remnant muco-cutaneous bridges/residual piles
    • primaryOutcome The Hemorrhoidal Disease Symptom Score (HDSS), the Short Health Scale for HD (SHS-HD) score and the Vaizey Incontinence Score were used to assess symptoms and their impact on quality of life and continence.
    • result A total of 77.8% (14/18) of the patients were symptom-free (hemorrhoidal disease symptom score (HDSS) score = 0) after 3 months. Moreover, a statistically significant decrease in the median HDSS and short health scale for HD (SHS-HD) score was registered from 16 preoperatively (T0) to 2 at 3-month follow-up (T3). Neither post-operative bleeding nor any type of complications occurred.

    Updates Surg · PMID 38480640 · Read it on PubMed ↗

  • Watson et al. 2024

    Analgesic effect of local anaesthetic in haemorrhoid banding: systematic review and meta-analysis

    Numbing shot eases pain right after banding.Meta-analysisLow qualityRelated question

    342 people24 h

    Local anaesthetic lowered pain scores shortly after banding, but the benefit faded and was not significant by 24 hours; vasovagal symptom rates were similar between groups

    Who was studied
    adults undergoing haemorrhoid rubber band ligation
    What they received
    local anaesthetic given during banding
    Compared with
    no regional or local analgesia (no studies found on pudendal nerve block)
    Main outcome
    patient-reported pain scores after banding
    Quality
    The authors graded the evidence 'low' themselves because of inconsistency between studies and imprecise, small samples.
    Limitations
    Small sample sizes and substantial heterogeneity across studies; no studies on pudendal nerve block were found.

    Taken word for word from the abstract

    • population adults undergoing haemorrhoid banding who have received local anaesthetic, a pudendal nerve block or no regional or local analgesia
    • intervention randomised trials of local anaesthetic or pudendal nerve block use in banding
    • 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)

    Int J Colorectal Dis · PMID 38436741 · Read it on PubMed ↗

  • Manaki et al. 2024

    Aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy for hemorrhoidal disease: a systematic review and meta-analysis

    Low recurrence with sclerotherapy aloneMeta-analysisLow qualityRelated question

    4,249 people2024

    pooled recurrence rate was about 10% and complication rate about 5.2%, with no significant link between recurrence and hemorrhoid grade

    Who was studied
    adults with hemorrhoidal disease (grades II, III and IV)
    What they received
    ALTA (aluminum potassium sulfate and tannic acid) sclerotherapy
    Main outcome
    recurrence of hemorrhoids after treatment
    Quality
    it pools data from twelve studies of unclear design and quality without a comparison group, so it cannot show how ALTA stacks up against surgery or other treatments.
    Limitations
    the abstract does not compare ALTA sclerotherapy to surgery or other non-surgical options, and calls for high-quality randomized controlled trials to define its role.

    Taken word for word from the abstract

    • n Twelve studies with 4249 patients met all the inclusion criteria and were eventually included.
    • population patients with hemorrhoidal disease
    • intervention Aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy for the treatment of hemorrhoidal disease
    • primaryOutcome Primary endpoints included overall recurrence and type of recurrence
    • result The crude and pooled estimates of the overall recurrence and complications by the end of follow-up were 10% (95% CI, 6.52%-14.08%) and 5.20% (95% CI, 2.59%-8.52%), respectively.

    Acta Chir Belg · PMID 38428446 · Read it on PubMed ↗

  • Capece et al. 2024

    Hemorrhoidectomy: Does Age Make a Difference?

    Younger patients chose surgery more often.RetrospectiveLow qualityRelated question

    961 people2015 to 2020 (study period)

    Patients with grade III hemorrhoids chose hemorrhoidectomy as initial treatment far more often than those with grade II (27.6% vs 4.1%), and younger patients (18-30 and 31-50 years) chose hemorrhoidectomy first more often than older patients (51-75 years) (23.5% and 22% vs 12.8%). Among those who progressed to surgery after initial non-surgical treatment, there was no significant difference in time to hemorrhoidectomy by grade or age.

    Who was studied
    Adults aged 18 to 75 with symptomatic grade II or grade III internal hemorrhoids
    Main outcome
    Choice of initial treatment (hemorrhoidectomy vs. office-based procedures vs. medical management) and time to hemorrhoidectomy, by hemorrhoid grade and age group
    Quality
    This is a single-institution retrospective cohort study describing treatment choice patterns rather than comparing outcomes of surgery versus non-surgical treatment, so it cannot show which approach works better.
    Limitations
    Data only looked at age groups and their treatment selection. Personal biases of surgeon and patient may alter results.

    Taken word for word from the abstract

    • population Patients aged 18 to 75 years with grade II or grade III internal hemorrhoids between 2015 and 2020 were included.
    • n A total of 961 patients met inclusion criteria for grade II (n = 442) and III (n = 519) hemorrhoids.
    • 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.

    Dis Colon Rectum · PMID 38408874 · Read it on PubMed ↗

  • Xu et al. 2024

    Effect of lidocaine on postoperative analgesia of endoscopic rubber band ligation combined with injection sclerotherapy for treatment of internal hemorrhoids: A retrospective study (with video)

    Less pain with added lidocaineRetrospectiveLow qualityRelated question

    66 people1 month

    Pain scores and time to pain relief were lower with lidocaine plus lauromacrogol than with lauromacrogol alone, with no difference in adverse reactions or 1-month treatment outcome

    Who was studied
    Adults with grade III internal hemorrhoids undergoing endoscopic rubber band ligation plus sclerotherapy
    What they received
    Lidocaine plus lauromacrogol added to the sclerotherapy solution
    Compared with
    Lauromacrogol alone
    Main outcome
    Postoperative pain severity (VAS score) and time to pain relief
    Quality
    This was a small, retrospective, single-center study with unequal group sizes and no randomization, comparing two non-surgical additive regimens rather than surgery versus a non-surgical approach.
    Limitations
    Retrospective design, small and unequal group sizes (46 vs 20), single center, short 1-month follow-up, and it compares two non-surgical regimens rather than surgery versus a non-surgical option.

    Taken word for word from the abstract

    • population grade Ⅲ internal hemorrhoids patients who underwent ERBL combined with IS
    • intervention lidocaine plus lauromacrogol group, 20 patients
    • comparator control group (lauromacrogol group, 46 patients)
    • primaryOutcome Postoperative pain (quantized by Visual Analogue Scale, VAS), pain relief time and postoperative adverse reactions were compared
    • result VAS of postoperative pain was 0.80 ± 0.42 points and pain relief time was 0.90 ± 0.56 days in the study group, while VAS of postoperative pain was 4.11 ± 1.37 points and pain relief time was 2.57 ± 0.83 days in the control group, there was statistical difference between them (P < 0.05).
    • n control group (lauromacrogol group, 46 patients) and study group (lidocaine plus lauromacrogol group, 20 patients)

    Arab J Gastroenterol · PMID 38403495 · Read it on PubMed ↗

  • Xu et al. 2024

    Evaluation of a novel disposable endoscope for retroflexed endoscopic rubber band ligation of internal hemorrhoids: a randomized pilot study

    Disposable and reusable scopes worked the same.Randomised trialLow qualityRelated question

    42 peoplepostoperative Day 30

    Both endoscope types were similarly safe and effective; therapeutic effect at 30 days and complication rates were not significantly different, aside from one minor difference in diastolic blood pressure stability

    Who was studied
    Adults with Grade II and III internal hemorrhoids undergoing endoscopic banding treatment
    What they received
    Rubber band ligation using a disposable (single-use) endoscope
    Compared with
    Rubber band ligation using a traditional reusable endoscope
    Main outcome
    Safety (equipment failure, adverse events, vital sign stability) and effectiveness (therapeutic response, complications) of the banding procedure
    Quality
    This is a small pilot trial of only 42 patients comparing two types of equipment for the same banding procedure, not a comparison of surgery versus non-surgical treatment.
    Limitations
    Small pilot sample, short follow-up (30 days), and the comparison is between two devices for the same non-surgical procedure rather than between surgical and non-surgical treatment approaches.

    Taken word for word from the abstract

    • population 42 patients who underwent ERBL for Grade II and III internal hemorrhoids
    • intervention a disposable endoscope (n = 21)
    • comparator a reusable endoscope (n = 21)
    • primaryOutcome Safety was assessed by the incidence of equipment failure, device-related adverse events, and in-procedure stability of vital signs. Effectiveness was assessed by the postoperative therapeutic effect, feasibility of retroflexed ERBL, and incidence of complications.
    • result In terms of effectiveness, the therapeutic effects on postoperative Day 30 were similar in both groups.
    • n This prospective randomized controlled trial involved 42 patients

    Postgrad Med J · PMID 38330500 · Read it on PubMed ↗

  • Gallo et al. 2024

    Sclerotherapy for hemorrhoidal disease: systematic review and meta-analysis

    Sclerotherapy as effective, fewer complications.Meta-analysisModerate qualityRelated question

    9,729 people2024

    Sclerotherapy was not inferior to other treatments for success rate (RR 1.00) and recurrence rate (RR 1.11), and had fewer complications (RR 0.46)

    Who was studied
    Adults with hemorrhoidal disease of varying Goligher grades, from 44 studies
    What they received
    Sclerotherapy (mainly polidocanol injection) for hemorrhoids
    Compared with
    Other conservative or surgical treatments used as controls in the pooled trials
    Main outcome
    Success rate, recurrence rate, and complication rate
    Quality
    Although it pools 14 randomized trials with thousands of patients, the comparator group mixes different conservative and surgical treatments, so it cannot isolate a direct surgery-vs-non-surgical comparison.
    Limitations
    The comparator interventions across the 14 RCTs are not specified as uniformly surgical or non-surgical, limiting ability to answer the surgery-vs-non-surgical question directly; study heterogeneity across 40 years and multiple countries.

    Taken word for word from the abstract

    • n 44 studies met the inclusion criteria, involving 9729 patients
    • population The Goligher grade distribution indicated varying degrees of HD severity.
    • intervention Sclerotherapy was predominantly administered through anoscopy, with polidocanol being the most commonly used agent.
    • comparator sclerotherapy was not inferior to control interventions in terms of success rate
    • primaryOutcome success rate (risk ratio [RR] 1.00, 95% CI 0.71-1.41) and recurrence rate (RR 1.11, 95% CI 0.69-1.77), while resulting in fewer complications (RR 0.46, 95% CI 0.23-0.92)
    • result sclerotherapy was not inferior to control interventions in terms of success rate (risk ratio [RR] 1.00, 95% CI 0.71-1.41) and recurrence rate (RR 1.11, 95% CI 0.69-1.77), while resulting in fewer complications (RR 0.46, 95% CI 0.23-0.92).

    Tech Coloproctol · PMID 38261136 · Read it on PubMed ↗

  • Batra et al. 2025

    Injection sclerotherapy for the treatment of haemorrhoids in anticoagulated patients

    Sclerotherapy stopped bleeding in most.RetrospectiveLow qualityRelated question

    20 peopleat least six months

    90% of patients had their bleeding resolve after sclerotherapy while staying on blood thinners, with no reported complications

    Who was studied
    Adults with symptomatic internal or external hemorrhoids who were on anticoagulation medication
    What they received
    Injection sclerotherapy
    Compared with
    None (single-arm case series; no comparison group)
    Main outcome
    Resolution of bleeding symptoms for at least six months
    Quality
    This was a small, retrospective review of case notes with no comparison group, so it cannot show whether sclerotherapy works better or worse than surgery or other treatments.
    Limitations
    Retrospective design, no control or comparator group, small sample of 20 patients, and the population was specifically selected for being high-risk anticoagulated patients rather than a general hemorrhoid population.

    Taken word for word from the abstract

    • population Patients treated with an IST for SH between 1 April 2014 and 30 November 2021 were identified. Anticoagulation was not stopped in these patients as they were at high risk of developing thromboembolism
    • intervention Injection sclerotherapy (IST) has been proposed as a treatment option for these patients.
    • comparator A retrospective review of case notes was performed in a colorectal surgery department
    • primaryOutcome The primary outcome was symptom resolution, defined as no patient reporting bleeding for at least six months.
    • result Symptom resolution was achieved in 18 (90%) patients using IST while continuing anticoagulation treatment, with two (10%) patients requiring alternative interventions.
    • n A total of 20 patients with a median age of 64 years (range 35-86, 14 male) who underwent 32 IST treatments were identified.

    Ann R Coll Surg Engl · PMID 38174849 · Read it on PubMed ↗

  • Watson et al. 2024

    Use of pudendal nerve blocks in rubber band ligation of haemorrhoids: an Australia-wide cross-sectional analysis

    Nerve block use varies by hospital, not efficacyRegistryLow qualityRelated question

    346,542 people2024

    Of 346,542 admissions for rubber band ligation, 4.04% involved a pudendal nerve block; use rose from 1.62% in 2012-2013 to 6.63% in 2020-2021, and was more likely in females, those aged 25-34, major-city hospitals, and private hospitals (more than three times as likely in private vs public hospitals).

    Who was studied
    adults who had rubber band ligation for hemorrhoids in Australian hospitals between 2012 and 2021
    What they received
    rubber band ligation performed with a pudendal nerve block for pain control
    Compared with
    rubber band ligation performed without a pudendal nerve block
    Main outcome
    how often a pudendal nerve block was used during rubber band ligation, and whether this varied by patient and hospital factors
    Quality
    This is a large national administrative database analysis, but it only tracks how often a nerve block was used during banding and does not measure pain relief, hemorrhoid cure, or compare banding to surgery, so it cannot speak to whether surgery is needed.
    Limitations
    The abstract does not report any outcome related to symptom relief, recurrence, or comparison with surgical treatment; it only describes practice variation in anesthesia technique during one non-surgical procedure.

    Taken word for word from the abstract

    • n Of the 346 542 admissions for RBL, 14013 (4.04%) involved a PNB.
    • population Aggregate data from the National Hospital Morbidity Database was obtained for all admissions for RBL in Australia from 2012 to 2021
    • intervention pudendal nerve blocks (PNB) being one analgesic strategy
    • comparator all admissions for RBL in Australia from 2012 to 2021, 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% (adj. RR 3.99, CI 3.64-4.36).
    • result Blocks were more than three times as likely to be used in private compared to public hospitals.

    ANZ J Surg · PMID 38174653 · Read it on PubMed ↗

  • Anorectal Branch of Chinese Medical Doctor Association et al. 2023

    [Chinese expert consensus on the treatment of hemorrhoids by injection(2023 edition)]

    Expert guidance, not a trial.GuidelineLow qualityRelated question

    size not given2023

    Consensus statement giving recommendations on types and methods of injection treatment for hemorrhoids, based on review of existing evidence and GRADE assessment; not a trial comparing surgery to non-surgical treatment

    Who was studied
    Adults with hemorrhoids, usually aged 25-65
    Main outcome
    Expert recommendations on injection therapy for hemorrhoids
    Quality
    This is an expert consensus/guideline document summarizing existing literature, not a new trial, so it cannot by itself establish comparative effectiveness.
    Limitations
    This is a consensus statement based on review of existing evidence and expert opinion, not a primary comparative study; it does not report a head-to-head trial of surgery versus non-surgical treatment.

    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
    • result experts in related fields in China were invited to review the latest evidence-based medical evidence at home and abroad and conducted evidence quality assessment and recommendation strength classification according to the GRADE system
    • primaryOutcome 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

    Zhonghua Wei Chang Wai Ke Za Zhi · PMID 38110270 · Read it on PubMed ↗

  • Tsunoda et al. 2023

    Mid-term outcome of a novel nonexcisional technique using aluminum potassium sulfate and tannic acid sclerotherapy with mucopexy on patients with grade III hemorrhoids

    Non-surgical option worked well long-term.RetrospectiveLow qualityRelated question

    size not givenfive years

    high cumulative success rates (96.5% at 1 year, 85.3% at 3 and 5 years), low complication rates, low pain/analgesic use, and high patient satisfaction (≥9/10) over the follow-up period

    Who was studied
    adults with grade III internal hemorrhoids
    What they received
    a non-excisional sclerotherapy technique (ALTA) combined with rectal mucopexy
    Main outcome
    treatment success rate, postoperative pain/complications and patient satisfaction
    Quality
    it is a single-center retrospective analysis of one group of patients with no comparison group, so it cannot show whether this approach is better or worse than surgery.
    Limitations
    No comparator (e.g., surgery) was included, so this study cannot address whether hemorrhoids need surgery; it only reports outcomes of one non-excisional technique.

    Taken word for word from the abstract

    • population Patients with grade III hemorrhoids who underwent AM surgery were enrolled
    • intervention ALTA therapy with rectal mucopexy (AM) is a new approach for treating hemorrhoidal prolapse.
    • primaryOutcome Cumulative success rates, postoperative symptoms, including pain scores, analgesic requirements, and postoperative complications, and patient satisfaction were assessed.
    • result Cumulative success rates at one, three, and five years were 96.5%, 85.3%, and 85.3%, respectively.
    • result Patient satisfaction scores, which were assessed using a 10-point scale, were ≥9 at each postoperative year.
    • design retrospective analysis of prospectively collected data from a single institution

    Tech Coloproctol · PMID 37848640 · Read it on PubMed ↗

  • Cemil et al. 2024

    Comparison of Laser Hemorrhoidoplasty and Milligan-Morgan Hemorrhoidectomy Techniques in the Treatment of Grade 2 and 3 Hemorrhoidal Disease

    Less early pain and bleeding with laserRandomised trialModerate quality

    85 people10 days

    Laser treatment caused less bleeding and less pain at 3 hours after the procedure, but the surgery group's extra pain was easily managed with simple painkillers, so the authors concluded laser was not clearly better overall

    Who was studied
    adults aged 18-70 with grade 2 or 3 hemorrhoids whose symptoms persisted despite at least one month of medical treatment
    What they received
    laser hemorrhoidoplasty (non-surgical laser treatment)
    Compared with
    Milligan-Morgan hemorrhoidectomy (traditional surgery)
    Main outcome
    postoperative pain, bleeding and need for rescue painkillers after treatment
    Quality
    it was a randomized trial but small, with unequal group sizes and only very short (10-day) follow-up, so it mainly shows early recovery differences rather than long-term outcomes
    Limitations
    small and unevenly sized groups (54 vs 31), only 10 days of follow-up, single-center setting, and outcomes limited to early postoperative pain and bleeding rather than longer-term recurrence or healing

    Taken word for word from the abstract

    • n total 85 patients aged 18-70 years old with symptomatic Grade 2 and Grade 3 hemorrhoidal disease
    • 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 (LH) are among the accepted treatment methods in Grade 2-3 HD treatment
    • comparator Milligan-Morgan (MM) hemorrhoidectomy which is the most well-known and frequently applied surgical treatment method
    • 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
    • followUp Postoperative VAS score and complications were recorded within 10 days.

    Am Surg · PMID 37846728 · Read it on PubMed ↗

  • Onder et al. 2023

    A retrospective comparative study of hemorrhoidal artery ligation versus ligasure hemorrhoidectomy for the third degree hemorrhoidal disease

    Two surgical methods compared, similar recurrenceRetrospectiveLow qualityRelated question

    91 people2023

    Artery ligation had shorter operative time, shorter hospital stay (1.5 vs 3.05 days), and quicker resolution of postoperative bleeding (1.4 vs 4.9 days) than Ligasure hemorrhoidectomy; recurrence was similar (4 vs 3 patients)

    Who was studied
    Adults with grade III (third degree) hemorrhoidal disease treated at a surgery clinic
    What they received
    Doppler-guided hemorrhoidal artery ligation (a minimally invasive surgical technique)
    Compared with
    Ligasure hemorrhoidectomy (surgical removal using an electrosurgical bipolar device)
    Main outcome
    Operative time, hospital stay, postoperative pain/bleeding, and recurrence
    Quality
    This is a small, retrospective, non-randomized comparison of two surgical techniques with no blinding or control for confounding, so it carries little weight.
    Limitations
    Retrospective design, no randomization, small sample size, and the authors themselves state prospective randomized controlled studies are needed; both compared treatments are surgical procedures, not a non-surgical option, so this does not address surgery versus non-surgical treatment.

    Taken word for word from the abstract

    • population Patients treated with ADHL and LH for HD in our Surgery Clinic were included in the study.
    • intervention the vascular plexus is provided by Doppler-guided ligation of the hemorrhoidal arteries (ADHL)
    • comparator Excision of pathological hemorrhoidal structures by providing bipolar energy transfer with Ligasure, which is basically an electrosurgical device, is one of the treatment methods Ligasure hemorrhoidectomy (LH).
    • primaryOutcome operation time, bleeding during and after the operation, length of hospital stay, postoperative pain scoring, and postoperative results were evaluated
    • n The number of patients included in the study was 91.
    • result The mean hospital stay was 1.5 days in the ADHL-treated group, compared to. 3.05 days in the LH group.
    • result While recurrence occurred in 4 patients in the ADHL group, recurrence developed in 3 patients who underwent LH.

    Asian J Surg · PMID 37659951 · Read it on PubMed ↗

  • Zhang et al. 2023

    Positive efficacy of Lactiplantibacillus plantarum MH-301 as a postoperative adjunct to endoscopic sclerotherapy for internal hemorrhoids: a randomized, double-blind, placebo-controlled trial

    Probiotic improved sclerotherapy recovery, not surgery comparisonRandomised trialLow qualityRelated question

    103 people4 weeks

    Improvement rate was higher with the probiotic than placebo (87.8% vs 70.2%, P = 0.045); no difference in complications or adverse events

    Who was studied
    Adults with internal hemorrhoids graded I-III undergoing endoscopic sclerotherapy
    What they received
    Probiotic (Lactiplantibacillus plantarum MH-301) taken for 4 weeks after sclerotherapy
    Compared with
    Placebo after sclerotherapy
    Main outcome
    Percentage of patients whose symptom score (n-HDSS) dropped to zero after the procedure
    Quality
    Single small trial testing a probiotic add-on to one non-surgical procedure, not a comparison between surgery and non-surgical treatment.
    Limitations
    This trial compares a probiotic supplement versus placebo both given after sclerotherapy; it does not compare surgery to a non-surgical option, so it cannot inform the surgery-vs-no-surgery question directly.

    Taken word for word from the abstract

    • population patients (≥18 years) with internal hemorrhoids that conformed to Goligher's classification of grade I-III received administration of L. plantarum MH-301 for 4 weeks following endoscopic sclerotherapy
    • intervention administration of L. plantarum MH-301 for 4 weeks following endoscopic sclerotherapy
    • comparator 51 in the LP group and 52 in the C group
    • primaryOutcome The primary clinical endpoint in this study was the improvement rate, which was defined as the percentage of patients whose n-HDSS score decreased to 0 following the procedure.
    • result The primary clinical endpoint showed a higher improvement rate in the LP group (87.8% vs. 70.2%, P = 0.045).
    • n A total of 103 participants (51 in the LP group and 52 in the C group) were recruited, with 96 completing the entire trial (49 in the LP group and 47 in the C group).

    Food Funct · PMID 37655699 · Read it on PubMed ↗

  • Fiordaliso et al. 2023

    Treatment of haemorrhoids in pregnancy: A retrospective review

    Surgery reserved for severe cases onlyNarrative reviewLow qualityRelated question

    size not given2023

    Fiber and stool softeners considered safe; surgery (hemorrhoidectomy) reserved only for severe cases like strangulation, thrombosis, or uncontrolled bleeding

    Who was studied
    pregnant women with hemorrhoids
    Main outcome
    how hemorrhoids are managed in pregnancy
    Quality
    This is a narrative literature review without meta-analysis or pooled data, focused specifically on pregnancy rather than the general question of surgery versus non-surgical treatment.
    Limitations
    Review of existing literature on a specific population (pregnant women); does not independently compare surgical versus non-surgical approaches with trial data; no numbers of included studies or patients given.

    Taken word for word from the abstract

    • population Haemorrhoids are common in young women and commoner during pregnancy and the puerperium.
    • result Fiber supplement, stool softener and mild laxatives are generally safe for pregnant women.
    • result 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

    Ann Ital Chir · PMID 37530049 · Read it on PubMed ↗

  • Solari et al. 2023

    Laser technology in proctological diseases: is it really the wave of the future?

    Laser less pain, but costlyNarrative reviewLow qualityRelated question

    size not given2023

    Laser treatment for hemorrhoids had shorter operative time and less postoperative pain/bleeding than conventional hemorrhoidectomy but was more expensive; evidence is limited with only 3 RCTs and heterogeneous study designs

    Who was studied
    Adults with proctological conditions including hemorrhoids, anal fistula, and pilonidal sinus disease
    What they received
    Laser treatments (including laser for hemorrhoids, FiLaC for fistula, SiLaT for pilonidal sinus)
    Compared with
    Conventional surgical techniques (e.g. conventional hemorrhoidectomy)
    Main outcome
    Operative time, postoperative pain, bleeding, healing rates, cost
    Quality
    This is a scoping review (not meta-analysis) of only 55 heterogeneous studies with just 3 RCTs on laser hemorrhoid treatment, so it cannot reliably establish comparative effectiveness.
    Limitations
    No meta-analysis performed due to heterogeneity of study designs, endpoints, and follow-up; only 3 RCTs available; long-term outcome data lacking for most techniques

    Taken word for word from the abstract

    • population Different types of lasers have been applied for various proctological conditions.
    • intervention Laser treatments for hemorrhoids
    • comparator compared to conventional hemorrhoidectomy
    • primaryOutcome require a shorter operative time and show less postoperative pain and bleeding compared to conventional hemorrhoidectomy, but are more expensive
    • 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. Studies are heterogeneous in design, endpoints, postoperative assessment, length of follow-up and outcome measures. Only 3 RCTs are available and only three studies evaluate long-term outcomes.

    Updates Surg · PMID 37438655 · Read it on PubMed ↗

  • Kodilinye et al. 2023

    Endoscopic approaches to the management of hemorrhoids

    More research needed on treatments.Narrative reviewLow qualityRelated question

    size not given2023

    The review found endoscopic rubber band ligation gives satisfactory results but with common mild complications, newer methods like cap-assisted sclerotherapy are promising but understudied, and head-to-head trials comparing these endoscopic methods to each other or to surgery are lacking

    Who was studied
    Adults with internal hemorrhoids
    What they received
    Endoscopic treatments such as rubber band ligation, sclerotherapy, and coagulation
    Main outcome
    Effectiveness and complications of endoscopic treatment methods for hemorrhoids
    Quality
    This is a narrative literature review, not a controlled trial, and it explicitly notes that research is slow, comparisons are difficult, and standardized trials are lacking.
    Limitations
    No systematic search method described, no original comparative data, and the review itself states meaningful head-to-head comparisons between treatments are lacking due to variation in techniques and hemorrhoid grading.

    Taken word for word from the abstract

    • population the endoscopic management of internal hemorrhoids
    • intervention Rubber band ligation has been adopted by the endoscopist as endoscopic rubber band ligation (ERBL)
    • primaryOutcome To review the literature within the last 5 years on the 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 Data is needed on head-to-head comparisons between ERBL, endoscopic sclerotherapy, and CAES
    • result Meaningful comparisons between treatment methods for internal hemorrhoids have been difficult because of variations in interventional techniques and methods, differences in the grading of hemorrhoids, and lack of standardization of clinical trials

    Curr Opin Gastroenterol · PMID 37389425 · Read it on PubMed ↗

  • Pastor Peinado et al. 2023

    Quality of life and outcomes after rubber band ligation for haemorrhoidal disease

    Symptoms and quality of life improved with bandingProspective cohortLow qualityRelated question

    100 people6 months

    Counted as a related question: This study tests only rubber band ligation in patients who failed conservative treatment, not whether hemorrhoids can be treated without surgery versus requiring surgery—it doesn't compare surgical versus non-surgical approaches.

    quality of life scores improved significantly, 76% of patients were highly satisfied, overall success rate was 89%, and 12% had complications (mainly severe anal pain and self-limiting bleeding)

    Who was studied
    adults with symptomatic grade II-III hemorrhoids that did not improve after 6 months of conservative treatment
    What they received
    rubber band ligation
    Main outcome
    quality of life scores (symptom score and health scale) after rubber band ligation
    Quality
    this was a single-arm observational study with no comparison group, so it cannot show whether banding works better or worse than surgery or other options, only that patients improved after it.
    Limitations
    no control or comparator group; only short-term follow-up to 6 months; observational design without randomisation

    Taken word for word from the abstract

    • population patients with symptomatic grade II-III haemorrhoids who did not improve after 6 months of conservative treatment
    • intervention rubber band ligation (RBL)
    • primaryOutcome Patient´s quality of life was assessed by scores: HDSS (Hemorrhoidal Disease Symptom Score) and SHS (Short Health Scale)
    • result a significant reduction was found in the HDSS and SHS scores (p < 0.001)
    • result A high degree of satisfaction with the procedure was reported by 76% of patients
    • result The overall success rate of banding was 89%
    • result A 12% complication rate was detected, the most frequent complication was severe anal pain (58.3%) and self-limiting bleeding (41.7%)
    • n A total of 100 patients were finally included

    Langenbecks Arch Surg · PMID 37349572 · Read it on PubMed ↗

  • Gachabayov et al. 2023

    Transanal Hemorrhoidal Dearterialization With Mucopexy Versus Ferguson Hemorrhoidectomy for Prolapsed Internal Hemorrhoids: A Multicenter Prospective Study

    Similar recurrence, less early pain with THDProspective cohortLow qualityRelated question

    197 people3.1 (1.0-5.5) years

    No significant difference in recurrence between THD and Ferguson hemorrhoidectomy, though THD had less pain in the first two weeks and higher satisfaction at 2 weeks and 3 months (not sustained at 6 months or 1 year)

    Who was studied
    Adults with prolapsed internal hemorrhoids in at least 3 columns
    What they received
    Transanal hemorrhoidal dearterialization (THD) with mucopexy, a minimally invasive surgical technique
    Compared with
    Ferguson hemorrhoidectomy, a traditional surgical excision
    Main outcome
    Recurrence of prolapsing internal hemorrhoids
    Quality
    Surgeons chose which operation to perform based on what they knew best rather than random assignment, so differences between groups could reflect surgeon skill or patient selection rather than the procedures themselves.
    Limitations
    Not randomized - surgeons performed the operation they knew best rather than patients being randomly assigned; this compares two surgical techniques, neither of which is a non-surgical option.

    Taken word for word from the abstract

    • population Patients with prolapsed internal hemorrhoids in at least 3 columns were eligible.
    • n Twenty surgeons enrolled 197 patients.
    • 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)
    • result Patient satisfaction rate was higher after THD at POD14 (76.4% vs 52.5%, P =0.031) and 3 months (95.1% vs 63.3%, P =0.029), but did not differ at 6 months (91.7% vs 88%, P =0.228) and 1 year (94.2% vs 88%, P =0.836).
    • limitations Participating surgeons performed the operation they knew best enrolling 10 patients each.

    Ann Surg · PMID 37325897 · Read it on PubMed ↗

  • Pfeil et al. 2023

    [Hemorroids Therapy: a Tailored Approch]

    Most managed without surgery.Narrative reviewLow qualityRelated question

    size not given2023

    The abstract states most patients can be treated conservatively with excellent quality-of-life results, sclerotherapy controls symptoms at any stage, and surgery is reserved for conservative treatment failure, with postoperative bleeding, pain and incontinence described as rare complications.

    Who was studied
    Adults with symptomatic hemorrhoids of various grades seeing a specialist
    What they received
    Conservative treatments such as sclerotherapy and other non-surgical measures
    Compared with
    Surgical procedures such as Ferguson, Milligan-Morgan, hemorrhoidopexy, HAL-RAR, IRT, LT, RFA
    Main outcome
    Symptom control and quality of life with treatment, and complication rates after surgery
    Quality
    This is a narrative overview (English abstract only) describing general practice and complication rates without a controlled study design or quantitative data comparing approaches.
    Limitations
    No study design, sample size, or comparative data are given; it is a narrative summary of clinical practice rather than a trial comparing surgical versus non-surgical treatment.

    Taken word for word from the abstract

    • population symptomatic haemorrhoids
    • intervention The vast majority of patients can be treated conservatively with excellent results in terms of quality of life.
    • intervention Sclerotherapy provides good control of symptoms at any stage of haemorrhoidal disease.
    • comparator Besides well-known procedures such as Fergusson, Milligan-Morgan procedure or haemorrhoidopexy (Longo) there are less invasive options such as HAL-RAR, IRT, LT and RFA.
    • primaryOutcome The vast majority of patients can be treated conservatively with excellent results in terms of quality of life.
    • primaryOutcome Postoperative bleeding, pain and faecal incontinence are rare complications after surgery.
    • result If conservative treatment fails, there are various surgical options.
    • result Postoperative bleeding, pain and faecal incontinence are rare complications after surgery.

    Zentralbl Chir · PMID 37267978 · Read it on PubMed ↗

  • Tian et al. 2023

    Efficacy of two endoscopic rubber band ligation methods for symptomatic hemorrhoids: a randomized controlled trial

    Both banding methods worked similarly; one hurt more.Randomised trialModerate qualityRelated question

    70 people12 months

    No significant difference in overall success, recurrence, or symptom relief between the two banding methods; the combined method caused more post-procedure pain

    Who was studied
    Adults with symptomatic grade I to III hemorrhoids
    What they received
    Rubber band ligation of hemorrhoids alone
    Compared with
    Combined ligation of hemorrhoids plus nearby normal tissue
    Main outcome
    Overall success rate (complete or partial symptom resolution) at 12 months
    Quality
    Small, single-center, open-label randomized trial comparing two non-surgical banding techniques, not surgery versus non-surgical treatment.
    Limitations
    Open-label design, small sample (70 randomized, 62 completed follow-up), and it compares two variants of rubber band ligation rather than surgery versus a non-surgical option.

    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).

    Surg Endosc · PMID 37188908 · Read it on PubMed ↗

  • Patel et al. 2023

    HEmoRhoidal disease management with Band ligation versus polidocanol Sclerotherapy: a systematic review and meta-analysis (the HerBS Review)

    Sclerotherapy beat banding for hemorrhoidsMeta-analysisLow qualityRelated question

    size not given2023

    Sclerotherapy had a higher success rate than banding (93% vs 75%), while complication rates were not significantly different between the two treatments.

    Who was studied
    adults with grade I-III internal hemorrhoids who had not responded to lifestyle or medical treatment
    What they received
    polidocanol sclerotherapy
    Compared with
    rubber band ligation (RBL)
    Main outcome
    treatment success and complications after the procedure
    Quality
    The review pooled mostly small, non-randomized and single-arm studies, plus unpublished conference abstracts, so the comparison is not based on well-conducted randomized trials.
    Limitations
    Includes single-arm studies and conference abstracts rather than only randomized trials; compares two non-surgical treatments, not surgery versus a non-surgical option.

    Taken word for word from the abstract

    • population Patients with grade I-III hemorrhoids, who fail lifestyle and medical management, may benefit from office-based procedures.
    • intervention Polidocanol sclerotherapy is a relatively new approach for these patients.
    • comparator rubber band ligation (RBL) is the first-line office-based treatment
    • primaryOutcome Treatments were evaluated for therapeutic success and post-procedure morbidity.
    • result The patients undergoing sclerotherapy had a 93% (151/163) therapeutic success rate compared to 75% (68/91) in the RBL group (OR 3.39, 95% CI 1.48-7.74, p < 0.01). The post-procedure morbidity was 8% (17/200) in the sclerotherapy group and 18% (23/128) in the RBL group (OR 0.53, 95% CI 0.15-1.82, p = 0.31).

    Int J Colorectal Dis · PMID 37133577 · Read it on PubMed ↗

  • Ding et al. 2023

    Rubber band ligation versus coagulation for the treatment of haemorrhoids: a meta-analysis of randomised controlled trials

    Banding and coagulation work about the same.Meta-analysisModerate qualityRelated question

    size not given2023

    no significant difference in efficacy, prolapse, recurrence or urine retention; rubber band ligation caused more pain but less bleeding than coagulation

    Who was studied
    adults with hemorrhoids
    What they received
    rubber band ligation
    Compared with
    coagulation (infrared or non-infrared)
    Main outcome
    treatment success and post-treatment complications (efficacy, prolapse, recurrence, bleeding, pain, urine retention)
    Quality
    it pools nine randomised trials but the abstract itself says all trials were only of moderate methodological quality, so the pooled result is not strong evidence.
    Limitations
    abstract states all included trials were of moderate methodological quality; this compares two non-surgical treatments against each other, not surgery versus non-surgical care.

    Taken word for word from the abstract

    • population treatments for haemorrhoids
    • intervention Rubber band ligation and coagulation are two kinds of non-surgical therapies.
    • comparator compare rubber band ligation and coagulation treatments for haemorrhoids
    • primaryOutcome efficacy rate, postoperative prolapse rate, recurrence rate and postoperative urine retention rate after treatment
    • 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.
    • result Patients undergoing rubber band ligation had higher postoperative pain rate and lower postoperative bleeding rate than patients undergoing coagulation.

    Postgrad Med J · PMID 37117040 · Read it on PubMed ↗

  • Dursun et al. 2023

    Effectiveness of laser hemorrhoidoplasty in the treatment of hemorrhoidal disease

    Laser treatment worked, more recurrence in severe casesRetrospectiveLow qualityRelated question

    103 peopleat least 6 months (6 months, 1 year, and 2 years)

    Minor complications occurred in 2.9% of patients; recurrence was 17.6% in grade 2-3 disease and 50% in grade 4 disease (p=0.019)

    Who was studied
    Adults with grade 2, 3, or 4 internal hemorrhoids
    What they received
    Laser hemorrhoidoplasty (LHP)
    Main outcome
    Symptom recovery, recurrence rate, pain, and complication rate after treatment
    Quality
    This is a retrospective, single-arm case series without a comparison group, so it cannot show how laser treatment stacks up against surgery or other non-surgical options.
    Limitations
    Retrospective design, no control or comparator group, single-center, no randomization, and no direct comparison to surgical or other non-surgical treatments.

    Taken word for word from the abstract

    • n A total of 103 patients were included in the study.
    • population patients who underwent LHP due to Grades 2, 3, and 4 internal hemorrhoidal disease
    • intervention laser hemorrhoidoplasty (LHP) method
    • primaryOutcome symptomatic recovery and recurrence rates, post-operative pain levels, and complication rates
    • result minor complications developed in 3 (2.9%) patients postoperatively
    • 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)
    • followUp followed for at least 6 months (6 months, 1 year, and 2 years)

    Cir Cir · PMID 37084307 · Read it on PubMed ↗

  • Xiong et al. 2023

    Comparison of the long-term efficacy and safety of multiple endoscopic rubber band ligations in a single session for varying grades of internal hemorrhoids

    Banding relieved most symptoms; worked less for severe gradesProspective cohortLow qualityRelated question

    120 people14.3 ± 7.9 (1.3-30.9) months

    78.8% of patients had no symptoms at 6 weeks, with better results and fewer bands needed for grade II than grade III hemorrhoids, and recurrence was higher in grade III (32.8%) than grade I–II (14.6%); using more bands lowered recurrence for grade III without raising complication rates

    Who was studied
    adults with grade I–IV internal hemorrhoids treated with rubber band ligation
    What they received
    endoscopic rubber band ligation using multiple bands in one session
    Main outcome
    no hemorrhoid symptoms 6 weeks after treatment
    Quality
    This is a single-arm study of banding alone with no comparison to surgery, so it cannot show whether surgery or non-surgical treatment works better, only how banding technique affects its own outcomes.
    Limitations
    No surgical or other comparator group was included, so the study cannot address whether surgery is needed; follow-up time varied widely between patients (1.3 to 30.9 months).

    Taken word for word from the abstract

    • n One hundred twenty-three eligible patients met the inclusion criteria, and 3 patients were excluded.
    • population Patients with IH were treated with ERBL.
    • intervention Patients with IH were treated with ERBL.
    • intervention There is no consensus on the number of ligation bands for varying grades of internal hemorrhoids (IH) in a single session of endoscopic rubber band ligation (ERBL).
    • primaryOutcome The primary endpoint was no hemorrhoid symptoms 6 weeks after ERBL.
    • result 78.8% of patients achieved the primary endpoint. The efficacy of grade II hemorrhoids was higher than that of grade III hemorrhoids (87.8% vs 69.2%).
    • result The overall recurrence rate was 25.0%, with grade III significantly higher than grade I-II (32.8% vs 14.6%, P = 0.027).
    • followUp The median follow-up time was 14.3 ± 7.9 (1.3-30.9) months.

    Ir J Med Sci · PMID 37059872 · Read it on PubMed ↗

  • Gambardella et al. 2023

    Mid-term efficacy and postoperative wound management of laser hemorrhoidoplasty (LHP) vs conventional excisional hemorrhoidectomy in grade III hemorrhoidal disease: the twisting trend

    Less pain but more recurrence with laser.RetrospectiveLow qualityRelated question

    174 people25 ± 8 months follow-up

    Laser hemorrhoidoplasty caused less postoperative pain and easier wound care but had a higher recurrence rate (21.6% vs 8.1%) than conventional hemorrhoidectomy

    Who was studied
    adults with grade III symptomatic hemorrhoid disease
    What they received
    laser hemorrhoidoplasty (LHP) using a diode laser
    Compared with
    conventional Milligan-Morgan hemorrhoidectomy
    Main outcome
    postoperative pain, wound care, symptom resolution, and recurrence of hemorrhoids
    Quality
    It was a retrospective, non-randomized comparison of two surgical techniques, so differences could be due to patient selection rather than the treatments themselves.
    Limitations
    Retrospective design without randomization, comparing two surgical techniques rather than surgery versus a non-surgical option.

    Taken word for word from the abstract

    • population grade III symptomatic HD patients
    • 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)
    • n 93 patients received conventional Milligan Morgan as control group and 81 patients received laser hemorrhoidoplasty treatment
    • followUp After 25 ± 8 months follow-up

    Langenbecks Arch Surg · PMID 37020091 · Read it on PubMed ↗

  • Laurain et al. 2023

    French multicentre prospective evaluation of radiofrequency ablation in the management of haemorrhoidal disease

    Symptoms and quality of life improved after RFA.Prospective cohortLow qualityRelated question

    129 people3 months (primary outcome); some data to 1 year mentioned in title but not detailed in results)

    Quality of life score improved significantly (from 17.4/100 to 0/100), and bleeding, prolapse and anal discomfort rates dropped significantly at 3 months; 5.4% needed re-operation for relapse and some had complications including hemorrhage and abscess

    Who was studied
    Adults with grade II-III hemorrhoids
    What they received
    Radiofrequency ablation (RFA) of hemorrhoids
    Compared with
    None - single-arm study, patients compared to their own pre-treatment scores
    Main outcome
    Change in hemorrhoid-related quality-of-life score at 3 months
    Quality
    This was a single-group study with no comparison group, so it cannot show whether RFA works better or worse than surgery or other non-surgical options.
    Limitations
    No control or comparator group was used, so improvement cannot be attributed to RFA alone versus natural history or placebo effect; the study does not compare RFA to surgery or to other non-surgical treatments.

    Taken word for word from the abstract

    • n A total of 129 patients (69% men, median age 49 years) were operated on in 16 French centres.
    • population outpatients with grade II-III haemorrhoids
    • intervention This prospective multicentre study assessed RFA (Rafaelo©) in outpatients with grade II-III haemorrhoids.
    • comparator Median HEMO-FISS-QoL score dropped significantly from 17.4/100 to 0/100 (p < 0.0001) at 3 months.
    • primaryOutcome Primary endpoint was the evolution of a quality-of-life score adapted to the haemorrhoid pathology (HEMO-FISS-QoL) 3 months after surgery.
    • result Median HEMO-FISS-QoL score dropped significantly from 17.4/100 to 0/100 (p < 0.0001) at 3 months. At 3 months, the rate of patients reporting bleeding (21% vs. 84%, p < 0.001), prolapse (34% vs. 91.3%, p < 0.001) and anal discomfort (0/10 vs. 5/10, p < 0.0001) decreased significantly.
    • result Seven patients (5.4%) were reoperated on by haemorrhoidectomy for relapse, and three for complications.

    Tech Coloproctol · PMID 37005961 · Read it on PubMed ↗

  • Kwok et al. 2023

    Topical Lidocaine or Lidocaine/Diltiazem Ointment Following Rubber Band Ligation of Hemorrhoids: A Prospective 3-Armed Randomized Controlled Trial

    Numbing gel eased pain after bandingRandomised trialModerate qualityRelated question

    99 people2023

    both lidocaine and lidocaine/diltiazem reduced pain at 1 hour versus placebo; lidocaine/diltiazem also improved satisfaction and cut analgesic use by about 45%, with no difference in complications

    Who was studied
    adults having rubber band ligation for hemorrhoids
    What they received
    topical lidocaine, or lidocaine combined with diltiazem, applied after banding
    Compared with
    placebo ointment after banding
    Main outcome
    pain score, use of opiate painkillers, and patient satisfaction after banding
    Quality
    it was a randomized, double-blinded, placebo-controlled trial, but it was small (99 patients), hospital-based only, and measured only short-term pain relief after one non-surgical procedure, not surgery versus non-surgical treatment.
    Limitations
    No cost/benefit analysis was done, the pain relief seemed short term, and procedures were only done in hospital, not outpatient, settings.

    Taken word for word from the abstract

    • population Consecutive patients aged ≥18 years undergoing hemorrhoid banding were selected.
    • intervention Patients were randomly assigned to 2% lidocaine, 2% lidocaine with 2% diltiazem, or a placebo ointment.
    • comparator a placebo ointment
    • primaryOutcome Visual analog pain score, opiate analgesia usage, and patient satisfaction were the main outcome measures.
    • result Pain scores were reduced at 1 hour for the lidocaine (OR 4.15 [1.12-15.41]; p = 0.03) and lidocaine/diltiazem groups (OR 3.85 [1.05-14.11]; p = 0.04) compared with placebo.
    • result Patients in the lidocaine/diltiazem group required approximately 45% less total and in-hospital analgesia compared with the placebo.
    • n Of 159 eligible patients, 99 were randomly assigned (33 in each group).

    Dis Colon Rectum · PMID 36940309 · Read it on PubMed ↗

How we searchedThe exact query, the date it ran, and what came back — so you can run it yourself.
Searched
PubMed · ClinicalTrials.gov · Crossref on 2026-10-22
The exact search — paste this into PubMed to repeat it
("Hemorrhoids/surgery"[Mesh] OR "Hemorrhoids/therapy"[Mesh]) AND ("Hemorrhoidectomy"[Mesh] OR "Sclerotherapy"[Mesh] OR "Ligation"[Mesh] OR "Laser Therapy"[Mesh] OR nonsurgical[tiab] OR "non-surgical"[tiab] OR "rubber band ligation"[tiab] OR "infrared coagulation"[tiab] OR "laser hemorrhoidoplasty"[tiab])
PubMed expanded that to: ("hemorrhoids/surgery"[MeSH Terms] OR "hemorrhoids/therapy"[MeSH Terms]) AND ("Hemorrhoidectomy"[MeSH Terms] OR "Sclerotherapy"[MeSH Terms] OR "Ligation"[MeSH Terms] OR "Laser Therapy"[MeSH Terms] OR "nonsurgical"[Title/Abstract] OR "non-surgical"[Title/Abstract] OR "rubber band ligation"[Title/Abstract] OR "infrared coagulation"[Title/Abstract] OR "laser hemorrhoidoplasty"[Title/Abstract])
What came back
1452 records found · 200 read · 89 answered the question
Included
  • Human, animal or laboratory studies reporting an outcome relevant to the question
Excluded
  • Records about a different condition or intervention
  • Records reporting no outcome
  • Retracted publications, which are listed but excluded from every count
Limits
  • Details were read from abstracts, not full papers, so anything reported only in a paper's methods section is not captured here.
  • Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured.
  • Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.

Automated evidence review — PubMed, ClinicalTrials.gov, Crossref. Search strategy, grading rules and the checks that must pass before anything publishes were written by Allen Kamrava, MD, MBA, FACS, FASCRS, colon & rectal surgery, Beverly Hills. The pages themselves are compiled by software running that method and are not read one by one before publication — saying otherwise would be the one claim here that could not be checked.

How we grade evidence →

  1. 1452records came back from the search
  2. 200were read
  3. 89actually answered the question
Risks and safetyReported side effects and who should be careful.
  • Rubber band ligation has been reported, in case reports, to cause delayed, heavy rectal bleeding days after the procedure, occasionally needing emergency treatment to stop it.
  • Laser hemorrhoidoplasty has been reported, in a single case, to cause rectal perforation leading to sepsis, multi-organ failure, and emergency surgery with a colostomy.
  • Conventional open excisional hemorrhoidectomy had higher rates of urinary retention and wound problems than less invasive surgical options such as LigaSure hemorrhoidectomy or stapled hemorrhoidopexy in several trials.
  • Office-based banding frequently causes acute pain afterward; about half of patients in one study had slow pain relief over the following days.
  • Stapled hemorrhoidopexy showed a higher long-term recurrence rate, particularly of prolapse, compared with conventional excisional surgery.
Why people askWhat brings people to this question.
  • Surgery sounds frightening, so people hope a quick in-office procedure will be enough.
  • Recovering from surgery can mean time off work, so less invasive options feel more practical.
  • Online marketing makes laser treatment sound like a modern, pain-free fix.
  • People want to avoid the embarrassment and discomfort of a hospital procedure.
Common questionsShort answers, drawn from the same studies.
Can hemorrhoids be treated without surgery?
Yes, for milder (grade I-III) hemorrhoids, office procedures like rubber band ligation, sclerotherapy, or infrared coagulation relieved symptoms in trials, and one clinical guideline recommends trying these before surgery. For grade IV hemorrhoids, or ones that keep coming back, trials found surgery works better long-term.
Is rubber band ligation as good as surgery?
In a trial of grade III hemorrhoids, banding relieved symptoms for many people but came back far more often than surgery over one year (about 48% vs 6%). For milder grades, one study found similar cure rates between banding and surgery.
Does laser treatment for hemorrhoids avoid the need for surgery?
Laser hemorrhoidoplasty is a minimally invasive option, not traditional open surgery. Trials found it causes less pain and a faster return to activity than excisional surgery, but recurrence was sometimes similar or higher, especially for more severe hemorrhoids.
Should I stop trying non-surgical treatments if they're not working?
If bleeding, prolapse, or pain keep returning after banding or sclerotherapy, trials suggest surgery gives a better chance of lasting relief, particularly for grade III-IV disease. Talk with your doctor about moving to surgery rather than repeating a treatment that has already failed.
What's the recovery time difference between surgery and office procedures?
Office procedures like banding generally involve little to no downtime. Surgical hemorrhoidectomy has a longer recovery, though newer surgical techniques and laser treatment can shorten that recovery somewhat compared with traditional surgery.
What has changedEvery re-check, and whether it changed the answer.

  1. 2026-10-22

    Re-reviewed under a revised method. 8 new studies · 34 no longer retrieved · evidence strength moderate → high · conclusion signal of harm → not applicable.

    How certain we are changed. The conclusion changed.

This is information, not advice

This page summarises published research. It cannot tell you what is happening in your own body, and evidence changes. If something is bleeding, painful, or new, it is worth being looked at — that is a different question from the one on this page, and a better one to bring to a consultation.

Contact the office

Automated evidence review — PubMed, ClinicalTrials.gov, Crossref. Search strategy, grading rules and the checks that must pass before anything publishes were written by Allen Kamrava, MD, MBA, FACS, FASCRS, colon & rectal surgery, Beverly Hills. The pages themselves are compiled by software running that method and are not read one by one before publication — saying otherwise would be the one claim here that could not be checked.

CallBook