How do you get rid of a prolapsed hemorrhoid?

Studies compare several approaches: conservative care (fiber, fluids, less straining), office procedures (rubber band ligation, sclerotherapy, infrared coagulation), and surgery (stapled hemorrhoidopexy or excisional hemorrhoidectomy). Milder prolapse often improves with conservative or office treatment; more severe or recurring prolapse is more reliably fixed by surgery, according to the studies reviewed here.

Prolapsed hemorrhoids vs external hemorrhoids — what's the difference?

Internal hemorrhoids form higher up inside the rectum and can prolapse, meaning they stretch and bulge out through the anus. External hemorrhoids form under the skin right at the anal opening and don't prolapse the same way, though they can swell, clot, or form skin tags. The studies here are about prolapsing internal hemorrhoids specifically.

Do I need surgery for a prolapsed hemorrhoid?

Not always. Guidelines reviewed here say grade III prolapse can often be tried with office procedures like banding first, but grade IV internal hemorrhoids, or grade III that doesn't respond to office treatment, are usually referred for surgery.

Can a prolapsed hemorrhoid go back in on its own?

In one small study, gently pushing a prolapsed hemorrhoid back in by hand and repeating this reduced pain and swelling within 10 days, and most people avoided surgery. This hasn't been tested in larger controlled trials, so it should be discussed with a doctor rather than relied on alone.

What is a prolapsed hemorrhoid, and how do you treat it?

Name: What is a prolapsed hemorrhoid, and how do you treat it?
Published: 2026-10-26
Keywords: what is a prolapsed hemorrhoid, how to get rid of prolapsed hemorrhoids, prolapsed hemorrhoids vs external hemorrhoids

In adults with internal hemorrhoids that protrude through the anus (grade III–IV prolapse), what is the condition and which treatments (conservative care, rubber band ligation, sclerotherapy, infrared coagulation, stapled hemorrhoidopexy, excisional hemorrhoidectomy) reduce symptoms, resolve prolapse, and prevent recurrence?

How people search for this, in their own words

“what is a prolapsed hemorrhoid”
“how to get rid of prolapsed hemorrhoids”
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Evidence review in plain language · compiled 2026-10-26 · checked 2026-10-26 · next 2026-11-26 · automated review, how it works

Bottom line

There is no single "best" treatment for a prolapsed hemorrhoid — the right choice depends on how severe the prolapse is, and each option trades off recovery time against how likely it is to come back.

In the studies reviewed, office procedures such as rubber band ligation, sclerotherapy, and infrared coagulation worked well for milder (grade I-II) prolapse but were progressively less effective as prolapse became more severe, and some patients needed repeat treatment or surgery. In one uncontrolled study, fiber and toilet-habit changes alone helped many people with grade III-IV prolapse avoid surgery, though this was not compared against other treatments. Surgery — especially conventional excisional hemorrhoidectomy — more reliably prevents prolapse from returning, including in grade IV disease, but causes more pain and a longer recovery than office procedures; stapled hemorrhoidopexy trades a faster, less painful recovery for a higher chance of recurrence than traditional surgery.

How well studied

Well studied

8 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: 44answer it directly
studies found: 161studies found
randomised trials: 32randomised trials
people studied: 61,486people studied
reviews of trials: 12reviews of trials
years covered: 2014–2026years covered
finished, never published: 2finished, never published

What the research shows

Prolapse resolved or reduced
Conservative fiber-based care improved or stopped worsening of prolapse in most people in one study of patients already referred for surgery. Rubber band ligation and sclerotherapy also reduced prolapse in office-procedure studies, though less reliably as the grade got more severe.[1,2,3]
Found in studies
Symptom score (pain, bleeding, itching)
Across conservative care, office procedures, and surgery, studies report lower symptom scores after treatment, but by different amounts and with different trade-offs in pain during recovery.[1,2,3,4]
Found in studies
Recurrence at 6-12 months
Surgical removal (hemorrhoidectomy) has lower recurrence than stapled hemorrhoidopexy or office procedures in comparative studies, but recurrence after sclerotherapy specifically keeps rising over years rather than stabilizing.[1,2,3,4]
Some evidence
Time to healing / return to activity
Stapled surgery and office procedures let people recover and return to normal activity faster than traditional excisional hemorrhoidectomy in comparative trials.[1,2,3]
Found in studies
Complication rate
Surgical options (excisional hemorrhoidectomy, stapled hemorrhoidopexy) had the lowest recurrence rates in a large network meta-analysis, but also caused more pain, bleeding, urinary retention, and bowel incontinence than less invasive office procedures. Specific complications can be substantial: in one study, stapled hemorrhoidopexy (PPH) caused anal stenosis more often than conventional hemorrhoidectomy, and in another, new bowel control problems (about 15% incontinence, 28% urgency, 9% outlet obstruction) were reported years after stapled hemorrhoidopexy. Office procedures generally caused fewer serious complications but gave less durable results for more severe prolapse.[1,2,3]
Some evidence

What the studies found

Simple conservative measures (fiber, fluids, reduced straining) improved or stopped progression of prolapse in most patients in one study of people already referred for surgery, letting the large majority avoid an operation.[1]
In adults with advanced (grade III-IV) prolapsed hemorrhoids who had been referred for surgery, conservative care — fiber supplements plus counseling on toilet habits — improved prolapse in 57% of patients and kept it from getting worse in another 26%, and 87% avoided needing surgery, in one study with no comparison group.[1]
Rubber band ligation stopped bleeding in up to 90% of patients and improved grade III prolapse in most people, in a review pooling office-procedure studies.[1]
Sclerotherapy injections resolved prolapse in the large majority of grade II hemorrhoids and gave good short-term results in grade III hemorrhoids in case series, though it has not been tested head-to-head against other options in controlled trials for this question.[1]
Infrared coagulation is described as a safe in-office treatment, but its effectiveness drops sharply as hemorrhoids become more severe: in one review, improvement occurred in 78% of grade I, 51% of grade II, and only 22% of grade III prolapse.[1,2]
Stapled hemorrhoidopexy led to a shorter operating time, shorter hospital stay, and quicker return to normal activity than traditional (Milligan-Morgan) surgical removal in randomised trials, though recurrence after one year was more common with the stapled procedure.[1,2]
Excisional hemorrhoidectomy (traditional surgical removal) gives the most durable results and the lowest long-term recurrence among studied options, particularly for grade III-IV prolapse.[1,2]

Important limitations

Several of the comparisons between surgical options, such as stapled hemorrhoidopexy versus traditional hemorrhoidectomy, come from retrospective or prospective observational studies rather than randomised trials, so which treatment a patient received may reflect their individual case rather than random assignment.[1,2,3]
Studies define 'success' inconsistently — some count any symptom improvement, others require prolapse to fully disappear — making it hard to compare recurrence rates directly across different treatments.[1,2]
Follow-up for office procedures (banding, sclerotherapy, infrared coagulation) is usually just months, while prolapse can return years later, as shown by long-term sclerotherapy and stapling data.[1,2,3]
Some rubber band ligation studies include lower-grade (grade I-II) hemorrhoids that do not prolapse, or specifically exclude patients with prolapse, so their findings may not apply to grade III-IV prolapsed hemorrhoids.[1,2]

What kind of studies

Retrospective42 · 26%
Randomised trial32 · 20%
Case series24 · 15%
Prospective cohort24 · 15%
Narrative review21 · 13%
Meta-analysis8 · 5%
Guideline6 · 4%
Systematic review4 · 2%

The key studies

Qureshi et al. 2026
AGA Clinical Practice Update on Diagnosis and Treatment of Hemorrhoids: Expert Review
Banding favored for prolapse; surgery for grade 4.GuidelineVery low quality
size not given2026
Rubber band ligation and infrared coagulation are both safe and effective in-office treatments, with banding giving longer-term benefit for prolapsing hemorrhoids and recurrent bleeding; grade 4 internal hemorrhoids require surgical hemorrhoidectomy; grade 3 hemorrhoids that fail banding or have associated external hemorrhoids should be referred to a surgeon.
Who was studied
adults with hemorrhoids, including prolapsing grade 3-4 internal hemorrhoids
Main outcome
best practice advice on diagnosis and treatment of hemorrhoid disease
Quality
This is an expert consensus practice update based on literature review and opinion, not a systematic review, so its statements carry no formal evidence grading.
Limitations
The authors state that systematic reviews were not performed and the best practice advice statements do not carry formal ratings regarding quality of evidence or strength of recommendations.
Taken word for word from the abstract
- population The diagnosis and grading of hemorrhoids is easily made by taking a history from the patient and examining the patient.
- primaryOutcome provide best practice advice (BPA) covering the diagnosis and treatment of hemorrhoid disease
- result Rubber band ligation has longer-term benefits for treatment of prolapsing hemorrhoids and recurrent bleeding.
- result Grade 4 internal hemorrhoids require surgical hemorrhoidectomy.
- result Consultation with a surgeon should be offered to patients with grade 3 internal hemorrhoids who fail banding procedures or have associated external hemorrhoids.
- qualityWhy 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 ↗
Jin et al. 2021
Interventional treatments for prolapsing haemorrhoids: network meta-analysis
Surgery means less recurrence, more pain/risks.Meta-analysisModerate quality
9,232 peoplea minimum follow-up of 6 weeks
Surgical options (open and closed haemorrhoidectomy, stapled haemorrhoidopexy) had the lowest rates of symptom recurrence but caused more pain, bleeding, urinary retention, and bowel incontinence than less invasive office procedures like rubber band ligation, DG-HAL with mucopexy, and infrared coagulation.
Who was studied
adults with grade II-III internal haemorrhoids that prolapse
Main outcome
symptom recurrence, pain after the procedure, and complications such as bleeding, urinary retention, and bowel incontinence
Quality
It pools a huge number of trials and patients, but most of the original studies were judged at high risk of bias, which weakens confidence in the exact numbers.
Limitations
59 of 79 RCTs (73%) were judged high risk of bias, with notable heterogeneity in how recurrence and pain were measured across studies.
Taken word for word from the abstract
- n Seventy-nine RCTs were identified, including 9232 patients.
- population compare the relative clinical outcomes and effectiveness of interventional treatments for grade II-III haemorrhoids
- primaryOutcome Primary outcomes of interest were: symptom recurrence at a minimum follow-up of 6 weeks, postprocedural pain measured on a visual analogue scale (VAS) on day 1, and postprocedural complications (bleeding, urinary retention, and bowel incontinence).
- result Open and closed haemorrhoidectomy, and stapled haemorrhoidopexy were associated with worse pain, and more postprocedural bleeding, urinary retention, and bowel incontinence, but had the lowest rates of symptom recurrence.
- followUp symptom recurrence at a minimum follow-up of 6 weeks
- qualityWhy there were 59 RCTs (73 per cent) judged as being at high risk of bias
BJS Open · PMID 34633439 · Read it on PubMed ↗
De Schepper et al. 2021
Belgian consensus guideline on the management of hemorrhoidal disease
Fiber first, banding next, surgery for severe prolapse.GuidelineModerate quality
size not given2021
For low-grade hemorrhoids, conservative treatment (fiber supplements, sometimes short course of venotropics) is recommended; instrumental treatment (infrared coagulation or rubber band ligation) can be added when prolapse is more prominent; for prolapsing hemorrhoids, surgery is indicated for refractory cases; conventional hemorrhoidectomy is described as the most effective option for all grades and the only choice for non-reducible prolapsing hemorrhoids
Who was studied
Adults with hemorrhoidal disease, including prolapsing internal hemorrhoids
Main outcome
Best management approach for hemorrhoidal disease across conservative, office-based, and surgical options
Quality
This is a consensus guideline built from a Delphi process reviewing existing literature rather than new patient data, so it reflects expert synthesis rather than a single controlled study.
Limitations
Based on a Delphi consensus process reconciling expert statements rather than new original research; no patient numbers or individual study details are given in this abstract.
Taken word for word from the abstract
- population Hemorrhoidal disease is a common problem that arises when hemorrhoidal structures become engorged and/or prolapse through the anal canal.
- primaryOutcome Every treatment for symptomatic hemorrhoids should be tailored to patient profile and expectations.
- result For low-grade hemorrhoids, conservative treatment should consist of fiber supplements and can include a short course of venotropics. Instrumental treatment can be added case by case : infrared coagulation or rubber band ligation when prolapse is more prominent. For prolapsing hemorrhoids, surgery can be indicated for refractory cases. Conventional hemorrhoidectomy is the most efficacious intervention for all grades of hemorrhoids and is the only choice for non-reducible prolapsing hemorrhoids.
Acta Gastroenterol Belg · PMID 33639701 · Read it on PubMed ↗
Zhang et al. 2020
Network meta-analysis of randomized controlled trials comparing the procedure for prolapse and hemorrhoids, Milligan-Morgan hemorrhoidectomy and tissue-selecting therapy stapler in the treatment of grade III and IV internal hemorrhoids(Meta-analysis)
Stapler technique (TST) had fewer complicationsMeta-analysisModerate quality
3,511 people2020
TST had the lowest rates of urinary retention and fecal incontinence, and fewer cases of anal narrowing than PPH or MMH; PPH was the least effective at preventing hemorrhoids from coming back
Who was studied
adults with grade III and IV internal hemorrhoids
What they received
three surgical techniques for prolapsed hemorrhoids: PPH (stapled procedure), MMH (traditional hemorrhoidectomy), and TST (tissue-selecting stapler)
Main outcome
adverse events (urinary retention, fecal incontinence, anal stenosis) and recurrence rates after surgery
Quality
it pools many randomized trials with over 3500 patients, but it's a network meta-analysis making indirect comparisons and the authors themselves say larger, higher-quality trials are still needed
Limitations
authors state high-quality large sample RCTs are still expected, indicating current evidence base has gaps
Taken word for word from the abstract
- population grade III and IV internal hemorrhoids
- n Twenty-two RCTs that recruited 3511 patients were identified.
- intervention the procedure for prolapse and hemorrhoids (PPH), Milligan-Morgan hemorrhoidectomy (MMH) and tissue-selecting therapy stapler (TST) in the treatment of grade III and IV internal hemorrhoids
- primaryOutcome In terms of adverse events, TST presented the lowest urinary retention rates and fecal incontinence rates.
- result TST exhibited fewer incidences of anal stenosis than PPH and MMH. Importantly, PPH showed the weakest effects on reducing recurrence rates in hemorrhoid patients.
- limitations However, high-quality large sample RCTs are still expected.
Int J Surg · PMID 31887419 · Read it on PubMed ↗
Cocorullo et al. 2017
The non-surgical management for hemorrhoidal disease. A systematic review
Office treatments help mild cases, recurrence common.Systematic reviewLow quality
size not giventhree months
Rubber band ligation stopped bleeding in up to 90% and improved grade III hemorrhoids in 78-83.8%, with bleeding/pain complications in 8-80%; infrared coagulation improved 78% of grade I, 51% of grade II, and 22% of grade III cases, with pain in 15-100%, bleeding in 15-44%, and 13% recurrence at 3 months; sclerotherapy resolved prolapse in 90-100% of grade II and gave good results for grade III (from case series), with post-procedural pain in 36-49% and bleeding rare.
Who was studied
adults with internal hemorrhoids that prolapse, mostly early-stage (grade I-III) disease
What they received
non-surgical office treatments: rubber band ligation, injection sclerotherapy, and infrared coagulation
Main outcome
resolution of prolapse/bleeding, recurrence, and complication rates
Quality
although based on 21 RCTs, the review reports widely varying outcome ranges across studies without pooling results, and some findings (sclerotherapy for grade III) come only from case series.
Limitations
Results pooled narratively rather than statistically; wide variation in reported outcome rates; some evidence for sclerotherapy based only on case series; authors call the evidence 'not definitive.'
Taken word for word from the abstract
- population The non-surgical treatments for hemorrhoids are cost and time-saving techniques usually performed in patients suffering early hemorrhoidal disease.
- intervention The most used are rubber band ligation (RBL), injection sclerotherapy (IS), and infrared coagulation (IRC).
- primaryOutcome do these procedures really help to avoid further more aggressive treatments? What are the common harms? What are the rare harms? How many recurrences there are?
- result In RBL bleeding stops in up to 90% and III degree hemorrhoids improves in 78%-83.8%.
- result IRC related improvement is 78%, 51% and 22% for I, II and III degree.
- result Recurrence rate is 13% at a three months follow-up.
- result IS brings to the resolution of prolapse in 90%-100% of II degree and allows good results for III degree even if reported only by case series.
- n A total of 21 RCTs were included in this review: 12 on RBL, 4 on IRC and 5 on IS.
G Chir · PMID 28460197 · Read it on PubMed ↗
Garg et al. 2017
Adequate dietary fiber supplement and TONE can help avoid surgery in most patients with advanced hemorrhoids
Fiber plus toilet habit changes cut need for surgeryProspective cohortLow quality
102 people40 (12-96) months
Prolapse improved in 56.5% and did not worsen in another 25.9%; bleeding episodes fell from 71.8% to 29.4%; most patients (87.1%) avoided needing surgery; 68.2% were highly satisfied
Who was studied
adults with advanced (grade III and IV) prolapsed hemorrhoids who had been referred for surgery
What they received
fiber supplement (psyllium husk) plus counseling on toilet habits using the TONE method
Main outcome
improvement in prolapse, bleeding episodes, and patient satisfaction
Quality
this was a single-arm study of patients already referred for surgery, with no comparison group and 17 of 102 patients lost to follow-up, so the fiber/TONE benefit can't be separated from natural improvement over time.
Limitations
No control or comparator group, 17 of 102 patients lost to follow-up, and outcomes were based on patient-reported satisfaction and symptoms rather than objective grading.
Taken word for word from the abstract
- population Patients with advanced hemorrhoids (grades III and IV) who were referred for surgery
- intervention prescribed fiber supplement and were counseled to follow TONE
- n A total of 102 patients (75 males and 10 females, mean age 46.0±13.5 years, 17 lost to follow-up) with advanced hemorrhoids
- primaryOutcome The outcome parameters evaluated were improvement in prolapse, bleeding episodes, satisfaction levels.
- result Prolapse improved in 56.5% (48/85), did not progress over time in 25.9 (22/85) and continued to progress in 4.7% (4/85) patients. 12.9% (11/85) underwent operation for hemorrhoids. Bleeding episodes decreased from 71.8% (61/85) to 29.4% (25/85) (P<0.0001).
- result 68.2% (58/85) patients were highly satisfied, 12.9% (11/85) were moderately satisfied and 18.9% (16/85) were not satisfied with treatment
Minerva Gastroenterol Dietol · PMID 28150480 · Read it on PubMed ↗
Brown et al. 2016
Comments to 'Rubber band ligation versus excisional haemorrhoidectomy for haemorrhoids'
Surgery cures more but hurts moreMeta-analysisVery low quality
202 people2016
Surgery (excisional hemorrhoidectomy) gave better long-term cure than rubber band ligation, especially for grade III prolapsing hemorrhoids, and fewer people needed re-treatment, but surgery caused more post-operative pain and more delayed complications; for grade II hemorrhoids the two treatments were similarly effective.
Who was studied
adults with symptomatic hemorrhoids
What they received
rubber band ligation
Compared with
excisional hemorrhoidectomy (surgery)
Main outcome
complete symptom remission, need for re-treatment, pain, and complications
Quality
The conclusions rest on only three small trials that the authors themselves call 'poor methodological quality,' with high statistical heterogeneity between them.
Limitations
Three trials (of poor methodological quality) met the inclusion criteria. There was a significant heterogeneity between the studies (I2 = 90.5 %; P = 0.0001).
Taken word for word from the abstract
- n three studies, 202 patients
- population symptomatic haemorrhoids in adult human patients
- intervention rubber band ligation
- comparator excisional haemorrhoidectomy (EH)
- primaryOutcome Complete remission of haemorrhoidal symptom was better with EH
- result revealed the superiority of EH over RBL for grade III haemorrhoids (prolapse that needs manual reduction) (two trials, 116 patients, RR 1.23, CI 1.04-1.45; P = 0.01)
- result Patients undergoing EH were at significantly higher risk of post-operative pain (three trials, fixed effect; 212 patients, RR 1.94, 95 % CI 1.62-2.33, P < 0.00001) and of delayed complications (three trials, 204 patients, RR 6.32, CI 1.15-34.89; P = 0.03)
- result no significant difference was noticed in grade II haemorrhoids (prolapse that reduces spontaneously on cessation of straining) (one trial, 32 patients, RR 1.07, CI 0.94-1.21; P = 0.32)
Tech Coloproctol · PMID 27023348 · Read it on PubMed ↗
He et al. 2015
[Meta-analysis of randomized controlled trials comparing procedure for prolapse and hemorrhoids with Milligan-Morgan hemorrhoidectomy in the treatment of prolapsed hemorrhoids]
Stapled surgery heals faster but recurs more.Meta-analysisModerate quality
1,411 people1 year
Stapled hemorrhoidopexy had shorter surgery and recovery times and less pain, but a higher rate of disease recurrence after 1 year compared to traditional hemorrhoidectomy
Who was studied
adults with prolapsed hemorrhoids undergoing surgery
What they received
stapled hemorrhoidopexy (procedure for prolapse and hemorrhoids, PPH)
Compared with
Milligan-Morgan hemorrhoidectomy (traditional surgical removal)
Main outcome
safety and efficacy, including operating time, pain, healing, complications, and recurrence
Quality
This pooled 16 randomized trials with over 1400 patients, which is a solid base, but the abstract does not describe how consistent or high-quality the individual trials were.
Limitations
The abstract does not report on non-surgical or office-based treatments, only compares two surgical techniques; quality and heterogeneity of included trials not detailed.
Taken word for word from the abstract
- population the treatment of prolapsed hemorrhoids
- intervention procedure for prolapse and hemorrhoids (PPH)
- comparator Milligan-Morgan hemorrhoidectomy (MMH)
- primaryOutcome To compare the safety and efficacy of procedure for prolapse and hemorrhoids (PPH) with Milligan-Morgan hemorrhoidectomy (MMH) in the treatment of prolapsed hemorrhoids.
- n Sixteen RCTs recruiting 1411 patients were identified.
- result Meta-analysis showed that as compared to MMH, PPH had shorter operating time(WMD=-12.34, 95% CI:-17.87 to -6.80, P=0.000], shorter hospital stay (WMD=-1.48, 95% CI: -1.81 to -1.14, P=0.000) and shorter time to recover normal activity (WMD=-14.11, 95% CI: -24.51 to -3.70, P=0.008).
- result but higher ratio of recurrent disease after 1 year (RR=2.54, 95% CI: 1.21 to 5.31, P=0.010).
Zhonghua Wei Chang Wai Ke Za Zhi · PMID 26704004 · Read it on PubMed ↗

What actually helps, on this site

Treatments Dr. Kamrava performs for this:

All 161 studiesEvery study that answered the question, with its design, size and result.

The other 153 studiesEverything else the search returned, including anything retracted.

Gravante et al. 2026
Polidocanol foam sclerotherapy for patients with Goligher grade IV hemorrhoidal disease unwilling to undergo surgery: preliminary outcomes from a retrospective study with 6-month follow-up
Symptoms improved, but some still needed surgery.RetrospectiveVery low quality
15 people6-month
Symptom scores improved significantly at all follow-up points up to 6 months; two-thirds of patients wanted no further treatment, but 1 patient (6.7%) still needed surgery and 4 patients (26.7%) needed a repeat sclerotherapy session
Who was studied
Adults with grade IV internal hemorrhoids (most severe, prolapsed) who refused surgery
What they received
Polidocanol foam sclerotherapy (an injection treatment)
Main outcome
Change in patient-reported symptom scores (pain, bleeding, prolapse) over time
Quality
This was a small retrospective study of only 15 patients with no comparison group and short follow-up, so it cannot reliably show how sclerotherapy compares to other treatments for this severe grade of hemorrhoids.
Limitations
Retrospective design, very small sample size (15 patients), no control group, short 6-month follow-up, and patients were a selected group who had already declined surgery.
Taken word for word from the abstract
- population patients with Goligher grade IV HD that declined hemorrhoidectomy after appropriate counseling
- intervention underwent 3% PF sclerotherapy
- primaryOutcome Primary outcome was the change in scores over time.
- result At 6 months, 66.7% of patients requested no further hemorrhoidal treatment. Significant improvements were observed in both scores across all follow-up timepoints (p < 0.05). Pain, bleeding, and prolapse showed the most consistent reductions. One patient (6.7%) required hemorrhoidectomy within 30 days, four patients (26.7%) a second sclerotherapy session.
- n Fifteen patients were included
Int J Colorectal Dis · PMID 42909517 · 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
Conservative care healed one severe, infected case.Case seriesVery low qualityRelated question
1 people30 days
after 30 days of treatment the patient's fever resolved and the eroded hemorrhoid fully healed without surgery
Who was studied
51-year-old woman with breast cancer undergoing chemotherapy, severely immunocompromised, who developed sepsis from eroded prolapsed hemorrhoids
What they received
conservative multimodal treatment: antibiotics, blood/growth factor support, and local wound care including infrared therapy, growth factor gel, zinc oxide, and a traditional Chinese medicine paste
Compared with
no comparator (single patient, surgery considered too risky)
Main outcome
resolution of sepsis and healing of the eroded hemorrhoid
Quality
this is a single case report in an atypical, severely immunocompromised cancer patient, so it cannot show what works for typical people with prolapsed hemorrhoids.
Limitations
single patient; highly atypical population (severe chemotherapy-induced immunosuppression and sepsis); no comparison group; treatment included unconventional, non-standard components (traditional Chinese medicine paste) not part of usual hemorrhoid care.
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 severe bone marrow suppression and constipation, which led to the manual reduction of prolapsed hemorrhoids, resulting in an eroded, inflamed perianal mass
- intervention a conservative strategy was implemented. This included 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 Given the high risk of surgery due to critical thrombocytopenia and neutropenia, a conservative strategy was implemented.
- 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 ↗
Gallo et al. 2026
Use of mesoglycan in the acute phase of hemorrhoidal disease, the aCute HaemORrhoidal MEsoglycan Study (CHORMES): A double-blind, randomized controlled trial
Fewer hemorrhoid symptoms with oral pill.Randomised trialModerate qualityRelated question
52 people30-day telephone follow-up after 40 days of treatment
mesoglycan reduced hemorrhoid symptom score more than placebo, with improvements in itching, pain and swelling/prolapse, and sustained pain relief
Who was studied
adults with symptomatic grade II to III hemorrhoid disease
What they received
oral mesoglycan tablets for 40 days
Compared with
placebo tablets for 40 days
Main outcome
change in Hemorrhoidal Disease Symptom Score from baseline to day 40
Quality
it was a well-designed double-blind randomized trial but very small (52 patients) and phase 2, so results need confirmation in larger studies.
Limitations
small sample size, included grade II hemorrhoids that do not prolapse, short 40-day treatment with only 30-day follow-up, and tested an oral medication rather than the procedural or surgical options usually considered for prolapsed hemorrhoids
Taken word for word from the abstract
- population enrolled adults with symptomatic grade II to III hemorrhoidal disease
- intervention receive oral mesoglycan or placebo for 40 days
- comparator receive oral mesoglycan or placebo for 40 days
- primaryOutcome The primary endpoint was the change in the Hemorrhoidal Disease Symptom Score from baseline to day 40.
- result mesoglycan resulted in a significantly greater reduction in Hemorrhoidal Disease Symptom Score compared with placebo (-7.5 ± 5.9 vs -3.9 ± 5.4; P = .027)
- n Fifty-two patients were randomized (26 mesoglycan, 26 placebo), and 48 completed the study.
Surgery · PMID 42442141 · 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
Helped bleeding more than prolapseRetrospectiveLow quality
82 people24 months
85.4% overall symptom improvement; bleeding improved in 96.3% but prolapse improved in only 58.2%; bleeding came back in 25.3% of patients by 24 months; no serious complications
Who was studied
adults with bleeding-predominant grade III internal hemorrhoids (hemorrhoids that prolapse and need manual reduction)
What they received
cap-assisted endoscopic sclerotherapy (injection of polidocanol via a long needle)
Compared with
none (single-arm study, no comparison group)
Main outcome
improvement in hemorrhoid symptom severity (bleeding and prolapse) at 3 months, and bleeding recurrence over follow-up
Quality
this was a single-arm retrospective study with no comparison group, so it cannot show whether sclerotherapy works better than other treatments or no treatment.
Limitations
single-arm design with no control group, retrospective, from a single procedure type and setting, so results may not generalize.
Taken word for word from the abstract
- population 82 patients with bleeding-predominant grade III internal HDs
- intervention Cap-assisted endoscopic sclerotherapy (CAES) via a long needle
- intervention underwent a single CAES procedure by the injection of liquid polidocanol via a long needle
- comparator This single-arm retrospective observational study
- 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) and the score of the intensity dimension of the bleeding symptom.
- primaryOutcome Bleeding recurrence was monitored during follow-ups.
- 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 included 82 patients with bleeding-predominant grade III internal HDs
Tech Coloproctol · PMID 42323500 · Read it on PubMed ↗
Long et al. 2026
Effect of preoperative anemia on postoperative outcomes in mixed hemorrhoids: a retrospective observational study
Anemia linked to more post-surgery painRetrospectiveLow qualityRelated question
127 people12 months
patients with anemia before surgery had higher pain scores and worse sleep in the first week after surgery, but no difference in bleeding, infection, swelling, urinary retention, wound healing time, or recurrence of prolapse or bleeding within 12 months
Who was studied
adults with mixed (internal and external) hemorrhoids who had Milligan-Morgan hemorrhoidectomy surgery, split into those with and without anemia before surgery
Main outcome
pain scores, sleep quality, wound healing, complications and recurrence after hemorrhoidectomy surgery, comparing patients with and without preoperative anemia
Quality
this is a retrospective study looking at a risk factor (anemia) rather than comparing treatments, with no adjustment for other factors, so it says little about which treatment approach works best for prolapsed hemorrhoids.
Limitations
retrospective observational design, exploratory analysis, no multivariable adjustment, and the authors say findings need confirmation in larger studies
Taken word for word from the abstract
- population A total of 127 patients with mixed hemorrhoids who underwent Milligan-Morgan hemorrhoidectomy at the Affiliated Hospital of Southwest Medical University from January 2021 to August 2022 participated in this study, comprising 48 patients in the preoperative anemia group and 79 patients in the preoperative non-anemia group.
- n A total of 127 patients with mixed hemorrhoids
- primaryOutcome Postoperative complications such as postoperative pain, delayed bleeding, wound infection, wound edema, urinary retention, insomnia severity index (ISI) within 7 days, wound healing time, and recurrence rates (prolapse or bleeding) within 12 months were retrospectively analyzed in the two groups.
- result preoperative anemia was associated with higher postoperative pain scores and poorer sleep quality within 7 days after Milligan-Morgan hemorrhoidectomy. However, no significant associations were observed between preoperative anemia and other postoperative complications, wound healing time, or 12-month recurrence rates.
BMC Gastroenterol · PMID 42129663 · 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
Banding as effective as surgery, less painRetrospectiveLow quality
480 people2026
Cure rates were similar between the two treatments (69.36% vs 72.65%, not statistically significant), but the banding procedure had shorter operative time and hospital stay, lower pain scores, and fewer cases of urinary retention; one patient in each group had severe bleeding.
Who was studied
adults with mixed hemorrhoids and grade II-IV internal hemorrhoid prolapse
What they received
endoscopic super-hemorrhoidal banding (ESHB)
Compared with
Milligan-Morgan hemorrhoidectomy (traditional surgery)
Main outcome
cure rate, pain scores, operative time, hospital stay, and complications
Quality
This was a retrospective study without randomization, so differences between groups could be due to how patients were selected rather than the treatments themselves.
Limitations
Retrospective design without randomization; short-term follow-up only; long-term efficacy not yet assessed.
Taken word for word from the abstract
- population patients with mixed hemorrhoids treated in our hospital
- population Grade II-IV internal hemorrhoid prolapse as the main symptom
- intervention Endoscopic Super-hemorrhoidal Banding (ESHB)
- comparator Milligan-Morgan hemorrhoidectomy (MMH) as the control group
- primaryOutcome Treatment outcomes included efficacy measurement, operative time, hospital stay, postoperative anal pain scores, and incidence of complications like bleeding and urinary retention
- n 245 patients underwent Milligan-Morgan hemorrhoidectomy (MMH) and 235 patients underwent ESHB
- result The cure rates were 69.36% in the ESHB group and 72.65% in the MMH group, with no statistically significant difference between the two groups (P > 0.05)
- result The observation group had significantly shorter operative time and hospital stay (P < 0.01), lower postoperative anal pain scores and incidence of urinary retention (P < 0.01)
- result One patient in each group had severe postoperative bleeding, which stopped after surgical suture or endoscopic titanium clip closure
BMC Surg · PMID 41987169 · Read it on PubMed ↗
Hua et al. 2025
Transverse incision with longitudinal ligation procedure: Innovation, pitfalls, and clinical perspectives
Less pain, faster healing short-term, unproven long-termNarrative reviewLow quality
size not given2025
TILL showed less pain, quicker healing, and lower risk of anal stenosis than Milligan-Morgan hemorrhoidectomy in the short term, but the underlying study had significant limitations
Who was studied
Adults with circumferential prolapsed hemorrhoids
What they received
Transverse incision with longitudinal ligation (TILL) surgical procedure
Compared with
Traditional Milligan-Morgan hemorrhoidectomy
Main outcome
Short-term results including pain, healing time, and anal stenosis risk
Quality
This is a letter commenting on a single retrospective, single-center study with a small sample size and short follow-up, so the findings are not well established.
Limitations
The study discussed was retrospective, single-center, had a small sample size, and short follow-up, limiting generalizability and ability to assess recurrence or long-term outcomes.
Taken word for word from the abstract
- population circumferential prolapsed hemorrhoids
- intervention transverse incision with longitudinal ligation (TILL) procedure
- comparator traditional Milligan-Morgan hemorrhoidectomy
- primaryOutcome better than the traditional Milligan-Morgan hemorrhoidectomy for short-term results, showing less pain, quicker healing, and lower risk of anal stenosis
- result A study by Song et al found TILL to be better than the traditional Milligan-Morgan hemorrhoidectomy for short-term results, showing less pain, quicker healing, and lower risk of anal stenosis.
- result the study's limitations, including its retrospective, single-center design, small sample size, and short follow-up, restrict the findings' generalizability and ability to assess long-term outcomes like recurrence
World J Gastroenterol · PMID 41480327 · Read it on PubMed ↗
Liao et al. 2025
Short-term and patient-reported outcomes of laser hemorrhoidoplasty plus excisional hemorrhoidectomy for the treatment of grade IV hemorrhoid
Less pain, fewer urine problems with laser methodRetrospectiveLow quality
232 peoplepostoperative week 6
Laser plus excisional hemorrhoidectomy had less urinary retention, lower pain scores on the day of and day after surgery, and needed less pain medicine; symptom scores for pain, bleeding and prolapse improved by 6 weeks after surgery
Who was studied
adults with grade IV (severely prolapsed) internal hemorrhoids undergoing surgery
What they received
laser hemorrhoidoplasty plus excisional hemorrhoidectomy
Compared with
LigaSure hemorrhoidectomy
Main outcome
surgical results and complications within 30 days after surgery
Quality
this was a retrospective comparison of two different patient groups treated in different time periods rather than a randomized trial, so differences could be due to other factors.
Limitations
retrospective design comparing patients treated in different calendar periods (historical control group), single hospital, authors state further prospective studies with larger numbers are needed
Taken word for word from the abstract
- population Patients with grade IV hemorrhoid undergoing LHP plus EH
- intervention LHP plus EH
- comparator LigaSure hemorrhoidectomy
- primaryOutcome The primary outcome was the surgical results and 30-day complications.
- result Patients who underwent LHP plus EH had a lower frequency of urinary retention than those who underwent LigaSure hemorrhoidectomy. LHP plus EH resulted in lower scores for the VAS (maximal) and VAS (mean) on the operation day and postoperative day 1 and required less acetaminophen administration on postoperative day 1.
- result Regarding patient-reported outcomes, pain, bleeding, and prolapse improved after postoperative week 6.
- n A total of 92 patients who underwent LHP plus EH and 140 who underwent LigaSure hemorrhoidectomy were included.
Sci Rep · PMID 41285870 · Read it on PubMed ↗
Xiang et al. 2025
The effect of endoscopic polidocanol carbon dioxide foam for internal hemorrhoids: a retrospective study
Same effectiveness, less pain and swelling with CO2 foamRetrospectiveLow qualityRelated question
158 people1 month
Both foam types had similar effectiveness (98.8% vs 98.0%), but the carbon dioxide foam group had significantly fewer cases of anal pain and anal swelling than the air foam group
Who was studied
adults with internal hemorrhoids treated at one center
What they received
endoscopic sclerotherapy using polidocanol carbon dioxide foam
Compared with
endoscopic sclerotherapy using polidocanol air foam
Main outcome
treatment success and complication rate one month after the procedure
Quality
This is a retrospective, non-randomized comparison of two variants of one office procedure in a single center, with modest numbers and no mention of blinding or long-term follow-up.
Limitations
Retrospective design, no randomization described, no information on hemorrhoid grade or whether prolapse was present, only 1-month follow-up reported for complications
Taken word for word from the abstract
- 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 an effective rate of 98.8%, while the control group showed a rate of 98.0%
- result The study group exhibited significantly fewer patients with anal pain and anal swelling compared to the control group (P < 0.05)
- n A retrospective analysis was conducted on 158 patients
PeerJ · PMID 41282992 · Read it on PubMed ↗
Song et al. 2025
Optimizing circumferential prolapsed hemorrhoid surgery: Transverse incision with longitudinal ligation procedure delivers superior radicality compared to Milligan-Morgan technique
New surgery technique outperformed standard hemorrhoid surgery.RetrospectiveLow quality
180 people2025
TILL gave better overall treatment effects than MMH, healed faster, and caused less pain, swelling, and anal narrowing
Who was studied
adults with severe circumferential prolapsed internal hemorrhoids needing surgery
What they received
a new surgical technique (transverse incision with longitudinal ligation, TILL)
Compared with
standard Milligan-Morgan hemorrhoidectomy (MMH)
Main outcome
overall clinical effectiveness after the wound healed
Quality
This was a retrospective comparison of two surgeries without randomization, so differences between groups could be due to other factors besides the technique.
Limitations
Retrospective design, single-country study, no mention of blinding or randomization.
Taken word for word from the abstract
- n A total of 180 patients were retrospectively reviewed in China.
- population Circumferential prolapsed hemorrhoids (CPHs) necessitate surgical intervention.
- intervention The treatment group underwent the TILL procedure
- comparator the control group underwent MMH
- primaryOutcome The main observation index was the evaluation of clinical efficacy after wound healing.
- result The TILL group showed a significant difference compared to the MMH group (P = 0.022), indicating better overall treatment effects.
- result The time for wound healing in the TILL group was shorter than that in the MMH group (P = 0.001).
- result Compared to those who underwent MMH, those who underwent TILL experienced significantly reduced postoperative pain, with lower average scores for anal edema and anal stenosis (both P < 0.05).
World J Gastroenterol · PMID 41180783 · 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 resolved, no recurrence seenCase seriesVery low qualityRelated question
10 peoplemedian: 16.0 months
Counted as a related question: This study tests a novel combined treatment (HIFU-RAL plus sclerotherapy) with no comparison group, whereas the question asks how to decide between several established approaches including conservative measures, different office procedures, and surgery.
In all patients the prolapse was visibly reduced or resolved right after the procedure, and no complications or recurrences were seen over a median follow-up of 16 months
Who was studied
Adults with prolapsed internal hemorrhoids (grade III-IV) or rectal mucosal prolapse causing discomfort
What they received
Combined HIFU rectoanal lifting (HIFU-RAL) technique plus ALTA (aluminum potassium sulfate and tannic acid) sclerotherapy, done as an office-based procedure
Compared with
None (no comparison group; outcomes compared to before treatment)
Main outcome
Whether the prolapse was reduced or resolved, and whether adverse events or recurrence occurred
Quality
This was a tiny case series of only 10 patients with no comparison group, so it cannot show whether this treatment works better than other options.
Limitations
Very small sample (10 patients), no control group, no blinding, short median follow-up relative to a chronic condition, and the technique is novel and not yet widely studied.
Taken word for word from the abstract
- 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
- comparator This case series included 10 symptomatic patients, consisting of 5 men and 5 women.
- 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.
- n This case series included 10 symptomatic patients, consisting of 5 men and 5 women.
Medicine (Baltimore) · PMID 40922264 · Read it on PubMed ↗
Campos et al. 2025
A modified stapled hemorrhoidectomy technique to optimize mucosectomy specimen and improve outcomes
New stitching method proposed, not yet testedCase seriesVery low qualityRelated question
size not given2025
The abstract describes the new suturing technique and argues it should yield a taller, more uniform strip of tissue, which the authors hypothesize may reduce prolapse recurrence; no patient outcome data, complication rates, or recurrence rates are reported, and the authors state this will be tested in a future randomized trial.
Who was studied
Adults with hemorrhoidal disease undergoing stapled hemorrhoidopexy surgery
What they received
A modified stapled hemorrhoidopexy technique using two traction points on the pursestring suture to get a larger, more even strip of rectal lining
Compared with
The classical/original stapled hemorrhoidopexy technique
Main outcome
Height and uniformity of the mucosal (rectal lining) specimen removed during surgery, thought to relate to recurrence of prolapse
Quality
This is a technical description of a surgical modification with no reported patient outcomes, no comparison group results, and no measured recurrence or complication data — the authors themselves say testing is planned for the future.
Limitations
No outcome data are given; this is a proposed technique awaiting a planned randomized study, not a report of patient results.
Taken word for word from the abstract
- population Surgical treatment of hemorrhoidal disease has undergone numerous modifications in recent decades.
- intervention we placed a circumferential submucosal suture at the 3 o'clock position in the clockwise direction. When the left lateral position (9 o'clock) was reached, a loop of 2-0 non-absorbable suture thread was passed around the continuous suture and retracted to the left.
- comparator this hypothesis will be tested in a randomized study comparing the mucosectomy height and postoperative outcomes of both technical options (classical and present).
- primaryOutcome the retrieved mucosal strip will present a greater height. These features may play a role in effectively reducing mucosal prolapse and alleviating the symptoms.
- result In the future, this hypothesis will be tested in a randomized study comparing the mucosectomy height and postoperative outcomes of both technical options (classical and present).
Sao Paulo Med J · PMID 40802349 · Read it on PubMed ↗
Pan et al. 2025
Ultrasound-guided pudendal nerve block for postoperative pain management in procedures for prolapse and hemorrhoids: a randomized, double-blinded trial
Not directly relevant: compares anesthesia methods for PPH surgery, not hemorrhoid treatment choices.Randomised trialModerate qualityRelated question
71 people48 h
the nerve block group had lower pain scores at 6, 12, and 18 hours, fewer needed extra painkillers, fewer sphincter spasms, better recovery scores, and higher satisfaction than the local anesthetic group
Who was studied
adults undergoing procedure for prolapse and hemorrhoids (PPH) surgery
What they received
ultrasound-guided pudendal nerve block for pain control after PPH surgery
Compared with
local anesthetic infiltration for pain control after PPH surgery
Main outcome
pain scores in the first 48 hours after surgery
Quality
it was a randomized, double-blinded trial but small and only looked at pain-control technique during one surgical method, not at choosing between treatments for prolapsed hemorrhoids.
Limitations
small sample (71 patients), only examines anesthesia technique during stapled hemorrhoidopexy, not a comparison of treatment approaches for prolapsed hemorrhoids
Taken word for word from the abstract
- population 78 patients undergoing procedure for prolapse and hemorrhoids (PPH) were randomly allocated
- n The trial ultimately involved 71 patients.
- intervention ultrasound-guided pudendal nerve block (PNB)
- comparator local anesthetic infiltration (LAI)
- primaryOutcome Primary outcomes were postoperative pain scores using the visual analogue scale at multiple time points within the first 48 h.
- result the PNB group had significantly lower pain scores at 6, 12, and 18 h postoperatively compared with the LAI group (all P < 0.01)
- result PNB group also had fewer patients requiring supplemental tramadol (5/36) than the LAI group (12/35) (P < 0.05)
- result QoR-15 scores at 24 h postoperatively were significantly higher in the PNB group (119.11 ± 5.87) compared with the LAI group (112.03 ± 7.04) (P < 0.05)
- result Patient satisfaction was higher in the PNB group (28/36 vs. 22/35, P < 0.05).
Int J Colorectal Dis · PMID 40676415 · Read it on PubMed ↗
Huang et al. 2025
Tissue selecting therapy stapler minimally invasive surgery to treat severe hemorrhoids
TST surgery worked better, fewer complicationsRandomised trialLow quality
141 peopleThree months after surgery
TST had a higher success rate (93.6%) than PPH (74.5%) or EPH (72.3%), shorter hospital stay, shorter operation time, less blood loss, and fewer complications (10.6% vs 27.7% and 31.9%)
Who was studied
adults with severe hemorrhoids
What they received
tissue-selecting therapy (TST) stapler surgery
Compared with
PPH stapled hemorrhoidopexy and EPH (rubber band ligation with dislocation) surgery
Main outcome
clinical effectiveness, complications, and anal muscle function after surgery
Quality
although described as randomized, the abstract gives no detail on blinding, allocation concealment, or how complications/efficacy were judged, and it is a single-center study.
Limitations
no information on blinding, dropout, or longer-term recurrence beyond three months; single hospital; randomization method only vaguely described
Taken word for word from the abstract
- population 141 patients with severe hemorrhoids
- n 141 patients with severe hemorrhoids were included into three groups
- intervention tissue-selective therapy stapler (TST) minimally invasive surgery
- comparator the pieces per hour the PPH group, and the eastern rubber band ligation and coincident of dislocation for prolapse and hemorrhoid (EPH)group
- primaryOutcome clinical efficacy of the three groups of patients, changes in hospital stay time, operation time, intraoperative blood loss, postoperative complications, and anal dynamic indicators
- 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
BMC Surg · PMID 40634906 · Read it on PubMed ↗
Schwandner 2025
[Hemorrhoidal disease and stage-dependent treatment (including anal prolapse)]
Treatment depends on hemorrhoid stage and severity.Narrative reviewLow quality
size not given2025
Early-stage disease (I-II) is treated with conservative or interventional methods like sclerotherapy and rubber band ligation, while advanced disease (III-IV) requires surgical or minimally invasive procedures; acute anal prolapse is managed conservatively and topically
Who was studied
Adults with hemorrhoidal disease, including anal prolapse, at different stages (I-IV)
What they received
Stage-based treatments: conservative/topical care, sclerotherapy, rubber band ligation, and surgical or minimally invasive procedures (hemorrhoidectomy, hemorrhoidal artery ligation, laser hemorrhoidoplasty, radiofrequency ablation)
Compared with
Comparison across treatment stages and techniques (conservative vs interventional vs surgical)
Main outcome
Symptom control and long-term absence of recurrence
Quality
This is a narrative review summarizing general treatment approaches without original data, patient numbers, or outcome statistics.
Limitations
No original data, no quantitative outcomes, no study design details, and no reported sample size; it is a general narrative 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.
- intervention 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)
- intervention "conventional" hemorrhoidectomy procedures are increasingly in competition with minimally invasive techniques (e.g. hemorrhoidal artery ligation, laser hemorrhoidoplasty, radiofrequency ablation)
- comparator In cases of acute anal prolapse, a conservative and topical approach is indicated.
- primaryOutcome The ultimate goal of all treatment strategies for hemorrhoidal disease is symptom control and long-term absence of recurrence.
- result Although conservative and interventional treatment options (including sclerotherapy, rubber band ligation) are indicated in early stages (stages I and II), surgical procedures are effective treatment options for advanced hemorrhoidal disease (stages III and IV).
Chirurgie (Heidelb) · PMID 40586790 · 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 between banding and sclerotherapyRetrospectiveLow qualityRelated question
32 people3 months
no significant difference in treatment effect, symptom relief, complication rate, psychological condition, or anorectal function between the two methods, though each had some advantages on certain sub-measures
Who was studied
adults with internal hemorrhoids
What they received
endoscopic (rubber band) ligation
Compared with
cap-assisted endoscopic sclerotherapy
Main outcome
treatment effect, symptom relief, complications, and anorectal function
Quality
Very small study (32 patients) with no mention of randomization and only 3 months of follow-up, so the findings are not very reliable.
Limitations
small sample size, no stated randomization, short 3-month follow-up, and the population is described only as having internal hemorrhoids without specifying prolapse grade
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 To evaluate 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
- followUp with a 3-month follow-up
Surg Laparosc Endosc Percutan Tech · PMID 40530787 · Read it on PubMed ↗
Grossi et al. 2025
SHAPE-skin-sparing hemorrhoidectomy and PExy: a novel technique for the surgical treatment of hemorrhoidal disease
New surgery eased symptoms short-termCase seriesLow qualityRelated question
21 people1-month follow-up
Counted as a related question: The study tests only one surgical technique (SHAPE) with no comparison group, whereas the question asks which of several different approaches to take for prolapsed internal hemorrhoids—comparing conservative care, office procedures, and surgical options.
symptom scores dropped sharply after surgery (HDSS from 16 to 0, SHS from 20 to 4), with short operative time and hospital stay, but 5 of 21 patients had complications (mostly urinary retention, one needed a repeat operation for bleeding)
Who was studied
adults with grade III to IV internal hemorrhoids that prolapse
What they received
a new surgical technique (SHAPE) combining excision of the internal hemorrhoid with stitching to reposition prolapsed tissue
Compared with
none - all patients received the same procedure, no comparison group
Main outcome
change in hemorrhoid symptom severity scores one month after surgery
Quality
this was a small, single-arm study of only 21 patients with no comparison group and just one month of follow-up, so it cannot show how this technique compares to other treatments or whether results last.
Limitations
no control group, very short follow-up (1 month), small number of patients, long-term recurrence not assessed
Taken word for word from the abstract
- population 21 consecutive patients with grade III-IV HD
- intervention SHAPE selectively excises the internal hemorrhoidal column while preserving the anoderm and incorporates mucopexy to reposition prolapsed tissue
- comparator A prospective analysis was conducted on 21 consecutive patients with grade III-IV HD who underwent SHAPE on 3 hemorrhoidal columns
- primaryOutcome At 1-month follow-up, patients experienced a significant reduction in symptoms, with the Hemorrhoidal Disease Severity Score (HDSS) decreasing from a median of 16 to 0 (p < 0.001) and the Short Health Scale (SHS) from 20 to 4 (p < 0.001).
- result Complications occurred in five patients (four cases of urinary retention, one bleeding requiring revision). No persistent pain was reported.
- n 21 consecutive patients with grade III-IV HD
Updates Surg · PMID 40399727 · Read it on PubMed ↗
Xu et al. 2025
Clinical Efficacy of Automatic Ruiyun Procedure for Hemorrhoids and Procedure for Prolapse and Hemorrhoids in the Treatment of Mixed Hemorrhoids: A Comparative Study
Newer device faster, less painful than stapling.RetrospectiveLow qualityRelated question
120 people12 weeks
RPH had shorter surgery time, less blood loss, less pain, shorter hospital stay and lower cost than PPH, and better quality-of-life scores at 12 weeks; no difference in continence scores; readmission was higher with PPH but not statistically significant
Who was studied
adults with mixed hemorrhoids (both internal and external) treated surgically
What they received
Automatic Ruiyun procedure for hemorrhoids (RPH), a surgical device-based technique
Compared with
Procedure for prolapse and hemorrhoids (PPH), a stapled hemorrhoidopexy-type technique
Main outcome
surgical time, blood loss, pain, hospital stay, cost, quality of life, continence, and readmission after surgery
Quality
This is a retrospective, single-center comparison of two surgical devices for mixed (not specifically prolapsed internal) hemorrhoids, so it carries limited weight for this question.
Limitations
Retrospective design, population is 'mixed hemorrhoids' rather than specifically prolapsed internal hemorrhoids, and RPH is not one of the standard approaches (band ligation, sclerotherapy, infrared coagulation, stapled hemorrhoidopexy, excisional hemorrhoidectomy) named in the question.
Taken word for word from the abstract
- population patients with mixed hemorrhoids who visited the Third Affiliated Hospital of Gansu University of Chinese Medicine
- intervention automatic Ruiyun procedure for hemorrhoids and procedure for prolapse and hemorrhoids
- comparator procedure for prolapse and hemorrhoids (PPH) group
- primaryOutcome Surgical time, intraoperative blood loss, duration of postoperative pain, length of hospital stay and hospitalization expenses between the two groups presented statistically significant differences
- result RPH outperforms PPH in the treatment of mixed hemorrhoids with a shortened surgical time.
- n 60 cases were grouped under the Ruiyun procedure for hemorrhoids (RPH) group, and the other 60 cases were categorized in the procedure for prolapse and hemorrhoids (PPH) group
Ann Ital Chir · PMID 39957120 · Read it on PubMed ↗
Sapkota Upadhya et al. 2024
Efficacy and Safety of Colonoscopic Band Ligation for Lower Gastrointestinal Bleeding due to Hemorrhoid
Band ligation eased bleeding and prolapse, but many had complications.Prospective cohortLow qualityRelated question
28 people3 months
By 3 months, irritation, discharge and pain were gone in all patients, bleeding resolved in 96.4% and prolapse in 92%; 75% returned to work the next day, but 53.5% had some post-procedure complication, and 78.6% rated the treatment 'excellent help'.
Who was studied
adults with bleeding hemorrhoids (mostly grade II) seen in a surgical outpatient clinic
What they received
rubber band ligation done during colonoscopy
Compared with
none (single group, before-and-after outcomes)
Main outcome
resolution of bleeding, prolapse, irritation, discharge and pain, plus complications and patient satisfaction
Quality
Small single-center group of only 28 selected patients with no comparison group and just 3 months of follow-up, so results may not generalize or hold up long-term.
Limitations
Only 28 of 108 patients with GI bleeding were included, there was no control group, over half had complications, and follow-up was short (3 months); the study focuses on grade II hemorrhoids with bleeding rather than prolapsed grade III/IV hemorrhoids.
Taken word for word from the abstract
- population We included 28 among 108 patients presenting to the surgical outpatient department with Lower gastrointestinal bleeding.
- population feasible, safe and efficient for the treatment of symptomatic grade II hemorrhoids
- intervention Colonoscopic Rubber band ligation
- 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.
- result 78.6% of patients rated Colonoscopic Rubber band ligation treatment as "excellent help".
- n We included 28 among 108 patients presenting to the surgical outpatient department with Lower gastrointestinal bleeding.
J Nepal Health Res Counc · PMID 39923169 · Read it on PubMed ↗
Mou et al. 2024
Endoscopic polidocanol foam sclerobanding for treatment of internal hemorrhoids: A novel outpatient procedure
New foam-banding technique looks promising, unconfirmed.Narrative reviewVery low quality
size not givenone-year follow-up
The commentary reports that a trial found EFSB to be a promising new therapy compared with rubber band ligation, but says larger studies with longer follow-up are needed before conclusions can be confirmed
Who was studied
Adults with grade II and III internal hemorrhoids that prolapse
What they received
Endoscopic polidocanol foam sclerobanding (EFSB), a new office procedure combining banding with a foam sclerosant injection
Compared with
Standard endoscopic rubber band ligation (ERBL)
Main outcome
Reduction in prolapse recurrence and post-procedure pain
Quality
This is an editorial commentary discussing another study rather than presenting its own data, with no sample size, methods, or statistics given here.
Limitations
No numeric results, patient numbers, or statistical data are given in this commentary; the authors themselves call for larger, longer-term studies to confirm findings.
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 that could lift the mucosa for easy ligation and promote increased scarring in the submucosal tissue
- 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.
- followUp one-year follow-up
World J Gastroenterol · PMID 39563748 · Read it on PubMed ↗
Zhou et al. 2024
[Clinical analysis of percutaneous superselective superior rectal artery embolization for grades Ⅱ-Ⅲ internal hemorrhoids]
Symptom scores improved after artery embolizationRetrospectiveLow qualityRelated question
22 people12 months
all three scores (bleeding, quality of life, prolapse) significantly improved 12 months after the procedure
Who was studied
adults with grade II-III internal hemorrhoids
What they received
percutaneous superselective superior rectal artery embolization (a blood-vessel blocking procedure)
Compared with
none - scores compared before and after treatment in the same patients
Main outcome
bleeding score, quality of life score, and prolapse score
Quality
small retrospective single-center case series of only 22 patients with no comparison group, so it cannot show whether embolization works better than other treatments.
Limitations
retrospective design, no control group, small sample, includes grade II hemorrhoids which are not the prolapse-through-the-anus population this question focuses on, and tests a procedure (artery embolization) not among the standard approaches being compared
Taken word for word from the abstract
- population 22 patients with grades Ⅱ-Ⅲ internal hemorrhoids
- intervention percutaneous superselective superior rectal artery embolization
- comparator The clinical scores before and after treatment were compared by the nonparametric rank sum test
- primaryOutcome French bleeding score,quality of life score,prolapse score
- result Compared with those prior to operation, the French bleeding score,quality of life score,and prolapse score were significantly improved (all P<0.05)
- n 22 patients with grades Ⅱ-Ⅲ internal hemorrhoids who underwent superselective superior rectal artery embolization
Zhonghua Nei Ke Za Zhi · PMID 39183158 · 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-plus-sclerotherapy beat banding alone.Randomised trialModerate qualityRelated question
195 people12 months
Combined sclerotherapy-plus-banding gave lower severity scores at 8 weeks and 12 months, lower prolapse recurrence at 12 months (11.2% vs 21.6%), and less pain 24 hours after the procedure compared with banding alone.
Who was studied
adults with grade II-III internal hemorrhoids
What they received
endoscopic polidocanol foam sclerotherapy combined with rubber band ligation (EFSB)
Compared with
endoscopic rubber band ligation alone (ERBL)
Main outcome
hemorrhoid severity score, prolapse recurrence, and pain after the procedure
Quality
It is a multicenter randomized trial with 12-month follow-up, but it only compares two office-based procedures against each other and includes less-severe grade II hemorrhoids that may not prolapse.
Limitations
Compares two specific office procedures rather than the full range of approaches (conservative care, other office procedures, surgery); includes grade II hemorrhoids which may not involve prolapse.
Taken word for word from the abstract
- population A total of 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 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 HSS was lower in the EFSB group than in the ERBL group at 8 weeks [4.0 (3.0-5.0) vs 5.0 (4.0-6.0), P = 0.003] and 12-month [2.0 (1.0-3.0) vs 3.0 (2.0-3.0), P < 0.001] of follow-up. The prolapse recurrence rate was lower in the EFSB group at 12 months (11.2% vs 21.6%, P = 0.038).
- n One hundred and ninety-five patients were enrolled, with 98 in the EFSB group.
World J Gastroenterol · PMID 39086750 · Read it on PubMed ↗
Marik et al. 2024
Effectiveness and tolerability of rectal ointment and suppositories containing sucralfate for hemorrhoidal symptoms: a prospective, observational study
Topical sucralfate eased mild hemorrhoid symptoms.Prospective cohortLow qualityRelated question
60 people4 weeks
Symptom scores improved significantly from baseline in both the ointment and suppository groups, with high patient satisfaction and good tolerability
Who was studied
Adults with mild-to-moderate symptomatic hemorrhoids that were not bleeding (not specifically described as prolapsed or high-grade)
What they received
Rectal ointment or suppositories containing sucralfate, applied twice daily for 1-4 weeks
Compared with
None - single-arm study comparing symptoms before and after treatment (ointment vs suppository were compared to each other, not to a different treatment or placebo)
Main outcome
Patient-rated change in hemorrhoid symptom severity score
Quality
This was a small, open-label study with no comparison group, so improvement could reflect natural symptom resolution rather than the treatment itself.
Limitations
No control or comparator group, short follow-up (up to 4 weeks), and the population was mild-to-moderate non-bleeding hemorrhoids rather than specifically prolapsed grade III/IV hemorrhoids.
Taken word for word from the abstract
- population Adult patients with diagnosed, mild-to-moderate, symptomatic non-bleeding hemorrhoids treated with rectal ointment or suppositories containing sucralfate were enrolled.
- intervention Patients were administered treatment twice per day for at least 1 week until symptom resolution and/or for a maximum of 4 weeks.
- n Five investigators enrolled 60 patients
- primaryOutcome The primary endpoint was patient-assessed effectiveness on a modified Symptom Severity Score (mSSS, range 0 to 14).
- result Mean patient-assessed mSSS at baseline was 6.6 ± 1.9 and was significantly improved overall and in the ointment and suppository groups individually by -4.6 ± 2.0, -4.4 ± 1.8, and -4.8 ± 2.2, respectively (p < 0.0001).
- comparator Patient-assessed mSSS at baseline was 6.6 ± 1.9 and was significantly improved overall and in the ointment and suppository groups individually
Int J Colorectal Dis · PMID 38750150 · Read it on PubMed ↗
Togo et al. 2024
Anal disorders in pregnant and postpartum women: epidemiological, diagnostic and therapeutic aspects in 10 maternities of Bamako in Mali
Only conservative care described, no comparisonsProspective cohortLow qualityRelated question
1,422 people6 weeks after delivery
Hemorrhoidal disease was found in 13% of women; treatment consisted of hygiene and diet counseling, laxatives, local topical treatments, analgesics and perineal rehabilitation, with no comparison between treatment approaches reported
Who was studied
Pregnant women followed from first trimester through 6 weeks after delivery in Bamako, Mali
Main outcome
Epidemiology, diagnosis and treatment of anal pathologies (including hemorrhoidal disease) during pregnancy and postpartum
Quality
This is an observational study in pregnant/postpartum women describing general care given, not a comparison of treatments for prolapsed hemorrhoids specifically.
Limitations
Study population is pregnant and postpartum women rather than the general adult population with grade III/IV prolapsed hemorrhoids; no distinction made for prolapse severity; no comparative treatment data (e.g., banding, sclerotherapy, surgery) reported, only general conservative measures described.
Taken word for word from the abstract
- population we enrolled all first-trimester pregnant women admitted to the hospitals and who were followed up through the postpartum
- n we followed up 1,422 pregnant women
- primaryOutcome The objective of this work was to study the epidemiology, diagnosis, and treatment of anal pathologies during pregnancy and 6 weeks after delivery.
- result The treatment was based on counseling on hygiene and diet, the use of laxatives, local topicals, and analgesics along perineal rehabilitation.
- result hemorrhoidal diseases in 13% (192)
Pan Afr Med J · PMID 38681103 · Read it on PubMed ↗
Fathallah et al. 2024
Hemorrhoidal disease: Epidemiological study and analysis of predictive factors for surgical management
Surgery worked best but rarely needed.Prospective cohortLow qualityRelated question
472 people2024
Bleeding and prolapse scores improved with treatment overall, but improvement and satisfaction were greater after surgery (73% very good satisfaction) than other treatments (54%), though surgery was needed in fewer than 20% of patients and had more complex recovery
Who was studied
adults presenting with hemorrhoidal disease (bleeding, prolapse, pain) at a single French center
What they received
surgical treatment for hemorrhoids
Compared with
medical and instrumental (office) treatments for hemorrhoids
Main outcome
change in bleeding and prolapse scores, and patient satisfaction after treatment
Quality
This is a single-center observational study where patients were not randomly assigned to treatment, so the better results seen with surgery could partly reflect which patients were chosen for surgery rather than the treatment itself.
Limitations
Single-center, non-randomized comparison of treatment groups; patients self-selected or were selected for surgery based on severity, so outcomes are not a fair head-to-head comparison; population includes general hemorrhoidal disease, not specifically grade III/IV prolapse.
Taken word for word from the abstract
- n Prospective single-center study from July to December 2021 including 472 patients.
- population Bleeding, prolapse and pain were the main reasons for consultation.
- intervention Treatment modalities were medical (44%),±instrumental (72%), and 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)
- 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 ↗
Wen et al. 2024
Anatomical Anal Stenosis after PPH: Insights from a Retrospective Study and Rat Model
Less pain but more stenosis than surgery.RetrospectiveLow quality
size not given2024
PPH reduced postoperative pain compared with hemorrhoidectomy, but caused more complications, including anal stenosis
Who was studied
adults with high-grade hemorrhoids who underwent PPH surgery
What they received
PPH (procedure for prolapse and hemorrhoids, a circular stapling device)
Compared with
conventional hemorrhoidectomy surgery
Main outcome
postoperative pain and surgical complications, including anal stenosis
Quality
The clinical part is a retrospective review without randomization, and the mechanistic findings come from a rat model, so the evidence about stenosis risk is not strong.
Limitations
Retrospective design, no patient numbers given, and key mechanistic findings are based on an animal model rather than humans.
Taken word for word from the abstract
- population High-grade hemorrhoids are usually recommended to receive operational treatments.
- intervention A procedure for prolapse and hemorrhoids (PPH), a circular staple device, has been developed to improve short-term outcomes, including reducing the severity of postoperative pain.
- comparator PPH, compared to conventional surgery, has been associated with the incidence of anatomical anal stenosis.
- primaryOutcome Our clinical data showed that PPH significantly improved postoperative pain, but that it resulted in higher incidences of complications, including anal stenosis, than hemorrhoidectomy.
- result Our clinical data showed that PPH significantly improved postoperative pain, but that it resulted in higher incidences of complications, including anal stenosis, than hemorrhoidectomy.
Int J Mol Sci · PMID 38542515 · Read it on PubMed ↗
Elshazly et al. 2024
Randomized Controlled Trial to Compare Stapled Hemorrhoidopexy Plus Ligation Anopexy With Stapled Hemorrhoidopexy for Managing Grade III and IV Hemorrhoidal Disease
Adding a ligation step reduced recurrence after stapled surgeryRandomised trialModerate qualityRelated question
124 peoplemean 36 months (range 24-47)
Adding ligation anopexy to stapled hemorrhoidopexy led to less recurrence (5% vs 16%) and fewer redo surgeries, and better long-term patient satisfaction, with similar short-term outcomes between groups
Who was studied
Adults with grade III and IV hemorrhoids
What they received
Stapled hemorrhoidopexy plus ligation anopexy
Compared with
Stapled hemorrhoidopexy alone
Main outcome
Recurrence of hemorrhoids and patient satisfaction after at least 2 years
Quality
This was a randomized trial with a reasonable sample size and long follow-up, but it came from a single center and compared two surgical approaches rather than the full range of treatment options for prolapsed hemorrhoids.
Limitations
Single-center experience, so longer follow-up was needed
Taken word for word from the abstract
- population 124 patients with grade III and IV hemorrhoids at Alexandria Main University Hospital
- intervention stapled hemorrhoidopexy plus ligation anopexy (group II)
- comparator stapled hemorrhoidopexy (group I)
- primaryOutcome Recurrence of hemorrhoids and patient satisfaction after a follow-up period of at least 2 years.
- result in group I, 10 patients (16%) reported recurrent external swelling and/or prolapse compared to 3 patients (5%) in group II ( p = 0.0368). Five patients in group I required redo surgery, whereas no patients required redo surgery in group II. Long-term patient satisfaction was significantly better in group II.
- n 124 patients with grade III and IV hemorrhoids
- followUp a mean follow-up of 36 months (interval, 24-47)
Dis Colon Rectum · PMID 38380816 · Read it on PubMed ↗
Nada et al. 2024
Comparison between stapled hemorrhoidopexy and harmonic scalpel hemorrhoidectomy in the management of third- and fourth-degree piles: a randomized clinical trial
Fewer recurrences with harmonic scalpel method.Randomised trialModerate quality
70 people1 year
SH was quicker and caused less pain at first, but had more postoperative bleeding and a much higher 1-year recurrence rate than HSH, which also gave higher patient satisfaction.
Who was studied
Adults with grade III and IV internal hemorrhoids (prolapsing piles)
What they received
Stapled hemorrhoidopexy (SH)
Compared with
Harmonic scalpel hemorrhoidectomy (HSH)
Main outcome
Procedure time, postoperative pain, satisfaction, wound infection, bleeding, incontinence, and recurrence within 1 year
Quality
It was a randomized trial with reasonable numbers in each arm, but it was single-center and only single-blind, which limits how far the results can be trusted.
Limitations
Single-center, single-blind design; some reported incontinence cases were later reclassified as urgency rather than true incontinence, suggesting possible measurement imprecision.
Taken word for word from the abstract
- population 50 (68.75%) male and 20 (31.25%) female patients with third- and fourth-degree piles
- intervention Group I underwent SH
- comparator group II underwent HSH
- primaryOutcome regarding the time of the procedure, postoperative pain, patient satisfaction, wound infection, bleeding, incontinence, and recurrence within 1 year
- result Postoperative bleeding occurred in 4 (11.4%) patients in group I in the form of spotting after defecation only during the first postoperative month; no bleeding was detected in group II (p = 0.039).
- result There were 7 (20%) cases of recurrence at the 1‑year follow-up in group I and 1 (2.9%) case in group II (p = 0.024).
- n 50 (68.75%) male and 20 (31.25%) female patients with third- and fourth-degree piles
Chirurgie (Heidelb) · PMID 38157069 · 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)]
Consensus guidance on injection therapyGuidelineLow qualityRelated question
size not given2023
This is an expert consensus statement reviewing evidence and making recommendations on types and application methods of injectable preparations for hemorrhoid treatment; it does not report a comparative trial result between treatment approaches
Who was studied
Adults with hemorrhoids, usually aged 25-65, with bleeding, swelling, prolapse, pain, itching
What they received
Injection (sclerotherapy) treatment for hemorrhoids
Main outcome
Expert recommendations on drug and dosage form selection for injection therapy
Quality
This is an expert consensus document based on literature review and GRADE assessment, not a primary study comparing treatments, so it cannot by itself establish which treatment works best.
Limitations
No original patient data, no sample size, no direct comparison across conservative, office-procedure, and surgical options for prolapsed hemorrhoids; focuses narrowly on injection therapy and general hemorrhoid population rather than specifically grade III/IV prolapsing hemorrhoids
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, clinical bleeding, swelling, prolapse, pain, itching and anal discomfort
- intervention Injection therapy with a history of more than 150 years is simple to operate, easy to popularize and apply in grass-roots units, causes less intraoperative bleeding and fewer complications, and has reliable efficacy.
- 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
- result This paper attempts to make detailed recommendations on the types and application methods of the preparations commonly used in the injection treatment of hemorrhoids at home and abroad, and form the Chinese Expert Consensus on the Treatment of hemorrhoids by anal injection (2023 edition)
Zhonghua Wei Chang Wai Ke Za Zhi · PMID 38110270 · Read it on PubMed ↗
He et al. 2023
Clinical efficacy of ultrasound doppler-guided hemorrhoidal artery ligation combined with procedure for prolapse and hemorrhoids in treatment of severe hemorrhoids
Combined artery ligation plus stapling beat stapling alone.RetrospectiveLow quality
size not given2023
The combined DG-HAL plus PPH approach had higher treatment success (90.0% vs 75.0%), lower pain scores, faster healing, shorter hospital stay, and fewer complications (3.3% vs 17.9%) than PPH alone
Who was studied
Adults aged 18-65 with grade III or grade IV internal hemorrhoids
What they received
Doppler-guided hemorrhoidal artery ligation combined with Procedure for Prolapse and Hemorrhoids (PPH) surgery
Compared with
Standard PPH surgery alone
Main outcome
Therapeutic efficacy, postoperative pain (VAS), wound healing time, hospital stay, and complication rates
Quality
This was a retrospective study comparing two surgical techniques without reported randomization or blinding, and it does not state how many patients were enrolled, which limits confidence in the findings.
Limitations
Retrospective design, no mention of randomization, no participant numbers reported, single comparison group, and the abstract itself notes long-term efficacy needs further observation.
Taken word for word from the abstract
- population patients aged 18-65 with confirmed diagnosis of Grade III or Grade IV hemorrhoids
- intervention the observation group received DG-HAL followed by PPH
- comparator The control group underwent standard PPH
- primaryOutcome Efficacy was evaluated using a hierarchical scale and a visual analog scale (VAS) for postoperative pain.
- result The overall therapeutic efficacy in the observation group was 90.0%, which was higher than that of the control group (75.0%; P = .025).
- result A marked decrease in complication rates was observed in the observation group (3.3%) compared with that in the control group (17.9%) (P < .05).
Medicine (Baltimore) · PMID 38013354 · 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
High success, low pain long-termRetrospectiveLow qualityRelated question
size not givenfive years
Counted as a related question: This study tests a single novel combination treatment (ALTA sclerotherapy with mucopexy) rather than comparing multiple treatment approaches for prolapsed internal hemorrhoids; the question asks which of several approaches to take, requiring comparative evidence across conservative, office procedure, and surgical options.
High cumulative success (96.5% at 1 year, 85.3% at 3 and 5 years), low pain scores, few complications (5.3%), and high satisfaction over mid-term follow-up
Who was studied
Adults with grade III internal hemorrhoids that prolapse
What they received
ALTA (aluminum potassium sulfate and tannic acid) sclerotherapy combined with rectal mucopexy surgery
Main outcome
Success rate of treatment, postoperative pain, complications, and patient satisfaction
Quality
This was a single-center study with no comparison group, relying on retrospective analysis of one surgeon's cases, so it cannot show how this approach compares to other hemorrhoid treatments.
Limitations
No control or comparator group, single institution, retrospective design, and the primary outcome was not clearly pre-specified among several measures reported.
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
- result Cumulative success rates at one, three, and five years were 96.5%, 85.3%, and 85.3%, respectively.
- result Six patients (5.3%) showed postoperative complications
- primaryOutcome Cumulative success rates, postoperative symptoms, including pain scores, analgesic requirements, and postoperative complications, and patient satisfaction were assessed.
Tech Coloproctol · PMID 37848640 · Read it on PubMed ↗
Long et al. 2023
Milligan-Morgan hemorrhoidectomy combined with non-doppler hemorrhoidal artery ligation for the treatment of grade III/IV hemorrhoids: a single centre retrospective study
Combined surgery: less pain, fewer complicationsRetrospectiveLow qualityRelated question
115 people12 months
Counted as a related question: This study compares two surgical techniques (combination surgery versus single surgery) rather than surveying multiple treatment approaches ranging from conservative care through office procedures to surgical options for prolapsed internal hemorrhoids.
Combined MMH + ND-HAL surgery caused less pain, less bleeding, fewer complications, lower recurrence, and higher satisfaction than MMH alone at 12 months
Who was studied
Adults with grade III/IV internal hemorrhoids
What they received
Milligan-Morgan hemorrhoidectomy combined with non-Doppler hemorrhoidal artery ligation (MMH + ND-HAL)
Compared with
Milligan-Morgan hemorrhoidectomy (MMH) alone
Main outcome
Postoperative pain, bleeding, complications, recurrence, and patient satisfaction
Quality
This is a retrospective, single-centre study comparing two surgical groups without randomization, so differences could be due to other factors rather than the treatment itself.
Limitations
Retrospective design, single centre, no randomization, follow-up partly by telephone
Taken word for word from the abstract
- population 115 patients with grade III/IV hemorrhoids
- intervention MMH combined with non-Doppler hemorrhoidal artery ligation (MMH + ND-HAL)
- comparator the remaining 62 patients received MMH
- primaryOutcome postoperative visual analog scale (VAS) for pain, analgesic consumption, postoperative bleeding, perianal incision edema, urinary retention, anal stenosis, anal incontinence incidence, recurrence rate (prolapse or bleeding), and patient satisfaction
- result the recurrence rate (prolapse or bleeding) was lower in the MMH + ND-HAL group than in the MMH group (P < 0.05), and satisfaction was higher in the MMH + ND-HAL group than in the MMH group (P < 0.05)
- n We conducted a retrospective analysis of 115 patients with grade III/IV hemorrhoids
- followUp At follow-up by telephone or outpatient 12 months after surgery
BMC Gastroenterol · PMID 37653473 · Read it on PubMed ↗
Yuan et al. 2023
Comparison of the efficacy and safety of different surgical procedures for patients with hemorrhoids: a network meta-analysis
No single best surgery; trade-offs differMeta-analysisModerate qualityRelated question
3,573 people2023
Each surgical technique performed best on a different outcome: Ligasure had shortest operating time and least blood loss but most anal stenosis; STARR had longest operating time but least recurrence; PPH had most blood loss, most recurrence and most pain but least anal stenosis; Ferguson had least pain after 24 hours; TST had shortest time to first bowel movement; T-S had shortest hospital stay.
Who was studied
adults with hemorrhoids treated surgically
What they received
various surgical procedures for hemorrhoids (Ligasure, Milligan-Morgan, Ferguson, Harmonic variants, PPH, TST, T-S, STARR)
Compared with
the other surgical procedures compared against each other
Main outcome
operating time, length of hospital stay, blood loss, time to first bowel movement, recurrence, anal stenosis, and pain after surgery
Quality
It pools 23 randomized trials with over 3500 patients, but it compares many different surgical techniques without stating hemorrhoid grade or comparing against non-surgical options, so the applicability to a specific patient is uncertain.
Limitations
The abstract does not specify hemorrhoid grade (e.g., III or IV), does not include conservative or office-based treatments for comparison, and only compares surgical techniques against each other.
Taken word for word from the abstract
- n involved 3573 patients
- population patients with hemorrhoids
- intervention L (Ligasure), M-M (Milligan-Morgan), F (Ferguson), H (Harmonic), OH (open Harmonic), CH (closed Harmonic), PPH (procedure for prolapse and hemorrhoids), TST (tissue selecting technique), T-S (TST STARE+; tissue selection therapy stapled transanal rectal resection plus), and STARR (stapled transanal rectal resection)
- comparator 10 interventions
- primaryOutcome shortest mean operating time and STARR has the longest mean operating time, F and H have the longest length of hospitalization and T-S has the shortest length of hospitalization, PPH has the most intraoperative blood loss and L has the least intraoperative blood loss, TST has the shortest time to first defecation and M-M has the longest time to first defecation, STARR had the least recurrence and PPH had the most recurrence, PPH had the least anal stenosis and L had the most anal stenosis, and F had the least postoperative pain after 24 h and PPH had the most postoperative pain after 24 h
- result L is best at reducing mean operative time and intraoperative bleeding, T-S is best at reducing mean length of stay, TST has the shortest time to first defecation, STARR is best at reducing recurrence rates, PPH is best at reducing postoperative anal stricture, and F is best at reducing postoperative pain after 24 h
Tech Coloproctol · PMID 37634164 · Read it on PubMed ↗
Huang et al. 2023
The efficiency and safety of modified tissue-selecting therapy stapler combined with complete anal canal epithelial preservation operation in circumferential mixed hemorrhoids: a randomized controlled trial
New stapler surgery beat standard stapling.Randomised trialModerate qualityRelated question
306 people12 months
The modified stapler technique had a higher cure rate, lower recurrence, less incontinence, and less anal narrowing than standard stapled hemorrhoidopexy
Who was studied
Adults with circumferential mixed hemorrhoids (hemorrhoids that are both internal and external and go all the way around the anus)
What they received
A modified surgical stapling technique (M-TST-CACP) that preserves anal skin lining
Compared with
Standard stapled hemorrhoidopexy (PPH) surgery
Main outcome
Cure rate, recurrence, anal incontinence, and anal narrowing after surgery
Quality
It was a randomized trial with a reasonable number of patients, but it came from a single hospital and only the person doing the statistics (not patients or surgeons) was kept unaware of group assignment.
Limitations
Single-center study; only the statistical analyst was blinded, not patients or surgeons; population was specifically circumferential mixed hemorrhoids rather than the broader grade III/IV internal prolapsing hemorrhoids population, and it compares two specific surgical variants rather than the full range of treatment options.
Taken word for word from the abstract
- population in the treatment of circumferential mixed hemorrhoids
- intervention modified tissue-selecting therapy stapler combined with complete anal canal epithelial preservation operation (M-TST-CACP)
- comparator procedure for prolapse and hemorrhoids (PPH) group
- primaryOutcome The efficiency (efficacy, recurrence, anal smoothness, quality of life, and wound healing time) and safety (anal incontinence, pain level, anal stenosis, urinary retention, perianal edema, and postoperative bleeding) were evaluated
- result M-TST-CACP group showed a higher cure rate (6 months: 74.51% vs. 64.71%, P = 0.044), lower recurrence (6 months: 0% vs. 4.58%, P = 0.015; 12 months: 0.65% vs. 5.88%, P = 0.010), lower anal incontinence score (1 month: 1.29 ± 1.17 vs. 1.93 ± 1.33; 3 months: 1.07 ± 0.87 vs. 1.59 ± 1.01; 6 months: 0.58 ± 0.61 vs. 1.00 ± 0.90; all P < 0.001), and lower rate of anal stenosis (1 month: 0% vs. 7.84%; 3 months: 0% vs. 9.80%; both P < 0.001) than the PPH group
- n A total of 306 patients were finally included for analysis
Langenbecks Arch Surg · PMID 37620667 · Read it on PubMed ↗
De Gregorio et al. 2023
Catheter-directed hemorrhoidal embolization for rectal bleeding due to hemorrhoids (Goligher grade I-III): prospective outcomes from a Spanish emborrhoid registry
Fewer bleeding episodes, but not about prolapse.Prospective cohortLow qualityRelated question
80 people12 months
Fifty-five (68.7%) participants had the absence of rectal bleeding after 12 months of embolization, but 31.3% had bleeding recur and some needed repeat embolization or surgery.
Who was studied
adults with bleeding internal hemorrhoids graded I-III (mild to moderate, most grade II, none grade IV)
What they received
catheter-directed hemorrhoidal embolization (microcoil blocking of the artery feeding the hemorrhoids)
Main outcome
whether rectal bleeding stopped after treatment
Quality
This was a single-arm study with no comparison group, and it focused on bleeding in mild-to-moderate hemorrhoids rather than on prolapse or grade IV disease.
Limitations
No comparator group; population is mostly grade II hemorrhoids with no grade IV, so results may not generalize to prolapsed (grade III-IV) disease; outcome tracked is bleeding, not prolapse resolution.
Taken word for word from the abstract
- population Eighty patients (62.5% males) with a mean age of 48 ± 9 years were recruited prospectively
- population All patients had symptomatic bleeding hemorrhoids.
- population grade I (13.7%), grade II (71.1%), grade III (15%), and no grade IV were recruited in this study
- intervention catheter-directed hemorrhoidal embolization (CDHE) by microcoil embolization
- intervention microcoils were used to embolize the superior rectal artery(SRA), and microspheres if recurrence of bleeding occurred
- primaryOutcome To evaluate the safety and efficacy of catheter-directed hemorrhoidal embolization (CDHE) by microcoil embolization for rectal bleeding due to hemorrhoids
- result Fifty-five (68.7%) participants had the absence of rectal bleeding after 12 months of embolization.
- result A total of 25/80 (31.3%) had a recurrence in rectal bleeding.
- n Eighty patients (62.5% males) with a mean age of 48 ± 9 years were recruited prospectively
Eur Radiol · PMID 37458757 · Read it on PubMed ↗
Liu et al. 2024
Role of antibiotics in Milligan-Morgan hemorrhoidectomy for Grade III to IV Hemorrhoids: A randomized clinical trial
Antibiotics didn't improve hemorrhoidectomy recovery or pain.Randomised trialModerate qualityRelated question
150 people1 year
No significant difference between antibiotic and no-antibiotic groups in pain scores, bowel movement timing, wound swelling, bleeding, or urinary retention; inflammatory markers rose similarly after surgery regardless of antibiotic use; recurrence was 1.4% at one year across the study.
Who was studied
adults with grade III to IV prolapsed hemorrhoids undergoing Milligan-Morgan hemorrhoidectomy surgery
What they received
IV antibiotics (Cefoxitin) given before surgery, or before and after surgery
Compared with
no antibiotics given around surgery
Main outcome
pain scores, bleeding, swelling, urinary retention, infection markers, and hemorrhoid recurrence after surgery
Quality
It was a randomized trial, but it was conducted at a single hospital, tested only the add-on question of antibiotic use rather than comparing different hemorrhoid treatment approaches, and did not report blinding of assessors.
Limitations
Single-center study; focuses only on antibiotic prophylaxis during one surgical technique (Milligan-Morgan hemorrhoidectomy), not on comparing different treatment approaches (conservative care, office procedures, or other surgical options) for prolapsed hemorrhoids.
Taken word for word from the abstract
- population A total of 150 consecutive patients undergoing Milligan Morgan hemorrhoidectomy (MMH) in a tertiary hospital for grade III/IV hemorrhoids from January 2020 to August 2022 were enrolled.
- intervention group B received 2 g I/V Cefoxitin Sodium before the induction of anesthesia, and group C received 2 g I/V Cefoxitin Sodium before the induction of anesthesia and 6 h after operation.
- comparator Group A did not receive any prophylactic antibiotic
- primaryOutcome There was no significant difference in measured VAS values on the 1st day,3rd day and 7th day after surgery (p> 0.05).
- result There was no significant difference in measured VAS values on the 1st day,3rd day and 7th day after surgery (p> 0.05).
- result there was no significant difference among the first defecation time, wound edema, bleeding, urinary retention after surgery (p> 0.05).
- result the rate of recurrence of hemorrhoids follow-up for 1 year was 1.4%.
- n A total of 150 consecutive patients undergoing Milligan Morgan hemorrhoidectomy (MMH) in a tertiary hospital for grade III/IV hemorrhoids from January 2020 to August 2022 were enrolled.
Asian J Surg · PMID 37451888 · Read it on PubMed ↗
Zhang et al. 2023
Establishment and validation of clinical prediction model for hemorrhoid recurrence after procedure for prolapse and hemorrhoids
RetrospectiveLow qualityRelated question
415 people5-year recurrence rate
a prediction model using factors like birth history, anal pressure, nutrition, BMI, and hemorrhoid grade could estimate recurrence risk, with good-to-moderate accuracy
Who was studied
adults who had stapled hemorrhoid surgery (procedure for prolapse and hemorrhoids)
Main outcome
predicting which patients' hemorrhoids come back after surgery
Quality
this is a single-center retrospective study building a prediction model, not a trial comparing treatments, so it cannot show which treatment works best.
Limitations
retrospective data from one hospital, only examined one surgical technique (stapled hemorrhoidopexy), and does not compare different treatment approaches to each other.
Taken word for word from the abstract
- population patients who underwent stapler hemorrhoidal mucosal circumcision in Shanxi Bethune Hospital from April 2014 to June 2017
- n Finally, 415 patients were included, which were divided into training group (n = 290) and verification group (n = 125).
- primaryOutcome This study aimed to establish a clinical model to predict the risk of hemorrhoid recurrence after procedure for prolapse and hemorrhoids.
- result The area under the curve of the prediction model was 0.813 and 0.679, respectively, in the training and verification groups, and 0.839 and 0.746, respectively, for the 5-year recurrence rate.
- result Birth history, muscle attachment, postoperative anal urgency, anal resting pressure, postoperative nutritional index, body mass index, Wexner score, and hemorrhoid grading were included in the nomogram.
Medicine (Baltimore) · PMID 37390253 · Read it on PubMed ↗
Gachabayov et al. 2023
Transanal Hemorrhoidal Dearterialization With Mucopexy Versus Ferguson Hemorrhoidectomy for Prolapsed Internal Hemorrhoids: A Multicenter Prospective Study
Less early pain, similar recurrence ratesProspective cohortModerate quality
197 people3.1 (1.0-5.5) years
No significant difference in recurrence between THD and Ferguson hemorrhoidectomy, but THD patients had less pain in the first two weeks and higher satisfaction up to 3 months
Who was studied
Adults with prolapsed internal hemorrhoids affecting at least 3 columns
What they received
Transanal hemorrhoidal dearterialization (THD) with mucopexy
Compared with
Ferguson hemorrhoidectomy
Main outcome
Rate of hemorrhoid prolapse recurrence
Quality
This was a well-conducted multicenter study with video review and long follow-up, but surgeons chose which procedure to perform based on their own expertise rather than random assignment, so differences between surgeons could affect results.
Limitations
Not randomized; each surgeon performed the operation they were most experienced with rather than patients being randomly assigned to a procedure.
Taken word for word from the abstract
- population Patients with prolapsed internal hemorrhoids in at least 3 columns were eligible.
- intervention transanal hemorrhoidal dearterialization (THD) with mucopexy
- comparator Ferguson hemorrhoidectomy
- primaryOutcome The primary endpoint was recurrence rates defined as prolapsing internal hemorrhoids.
- result Recurrence rates did not differ between the study arms (5.9% vs 2.4%, P =0.253).
- result THD patients had lower Visual pain scores at postoperative day (POD) 1 (6.2 vs 8.3, P =0.047), POD7 (4.5 vs 7.7, P =0.021), POD14 (2.8 vs 5.3, P <0.001), and medication use at POD14 (23% vs 58%, 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).
- n Twenty surgeons enrolled 197 patients.
- followUp Median follow-up was 3.1 (1.0-5.5) years.
- limitations Participating surgeons performed the operation they knew best enrolling 10 patients each.
Ann Surg · PMID 37325897 · Read it on PubMed ↗
Wei et al. 2023
Prevention of Rectal Stenosis After Procedure for Prolapse and Hemorrhoids by Anastomotic Thread-Drawing and Anal Enlargement
Fewer narrowed anastomoses with added surgical stepsRandomised trialLow qualityRelated question
400 people1-3 years
No rectal stenosis occurred in the group that had both thread-drawing and anal enlargement, compared to 14% stenosis in the group that had PPH alone; thread-drawing alone gave 11% and anal enlargement alone gave 7%
Who was studied
Adults with severe mixed hemorrhoids (internal and external) undergoing stapled hemorrhoidopexy (PPH) surgery
What they received
Multipoint thread-drawing during surgery plus anal enlargement after PPH surgery
Compared with
PPH surgery alone (standard stapled hemorrhoidopexy without added techniques)
Main outcome
Rate of rectal narrowing (stenosis) at the surgical join after surgery
Quality
This is a single-hospital trial of an add-on surgical technique for one complication of one specific surgery, so it says little about choosing between the main treatment options for prolapsed hemorrhoids overall.
Limitations
Single hospital, all patients had 'severe mixed hemorrhoids' rather than a clearly staged prolapse grade, no blinding described, and the study tests technical modifications of one surgical method (stapled hemorrhoidopexy) rather than comparing the major treatment categories (conservative care, office procedures, surgery) for prolapsed hemorrhoids.
Taken word for word from the abstract
- population A total of 400 patients with severe mixed hemorrhoids hospitalized in the [anonymous hospital] from January 2018 to February 2022
- intervention Experimental group: Thread-drawing during operation and anal enlargement after PPH.
- comparator Group C: PPH alone.
- primaryOutcome The anastomotic sites of the 4 groups were observed for 1-2 months and followed up for 1-3 years.
- result There was no rectal stenosis in the experimental group, 11% in group A, 7% in group B, and 14% in group C.
- n A total of 400 patients with severe mixed hemorrhoids hospitalized in the [anonymous hospital] from January 2018 to February 2022 were randomly divided into the experimental group and control group A, B, and C, with 100 patients in each group.
Am Surg · PMID 37257493 · Read it on PubMed ↗
Tian et al. 2023
Efficacy of two endoscopic rubber band ligation methods for symptomatic hemorrhoids: a randomized controlled trial
Similar results; combined banding hurts moreRandomised trialModerate qualityRelated question
70 people12 months
no significant difference in success, recurrence, or symptom relief between the two ligation methods, but the combined method caused more postoperative pain
Who was studied
adults with symptomatic grade I to III hemorrhoids
What they received
endoscopic rubber band ligation of the hemorrhoid alone
Compared with
combined ligation of the hemorrhoid plus nearby normal rectal lining
Main outcome
overall therapeutic success rate (complete or partial symptom resolution)
Quality
it was a randomized trial but small, open-label, and compared two technique variants rather than different overall approaches, with some patients lost to follow-up.
Limitations
open-label design, small sample (70 randomized, 62 completed follow-up), includes grade I-II hemorrhoids that are not prolapsed, and compares two rubber-band techniques rather than different treatment categories (conservative, office procedure, or surgery)
Taken word for word from the abstract
- population Seventy patients with symptomatic grade I to III hemorrhoids were randomly assigned to the hemorrhoid and combined ligation groups
- n Seventy patients with symptomatic grade I to III hemorrhoids were randomly assigned to the hemorrhoid and combined ligation groups (35 in each group).
- 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 ↗
Ding et al. 2023
Rubber band ligation versus coagulation for the treatment of haemorrhoids: a meta-analysis of randomised controlled trials
Similar results; banding hurts more, bleeds less.Meta-analysisModerate qualityRelated question
size not given2023
No difference in efficacy, prolapse recurrence or urine retention; banding caused more pain but less bleeding than coagulation
Who was studied
adults with haemorrhoids (grade not specified)
What they received
rubber band ligation
Compared with
coagulation (infrared or non-infrared)
Main outcome
efficacy rate, postoperative pain, bleeding, prolapse, recurrence and urine retention
Quality
It pools nine randomised trials but all were rated only moderate quality, and the abstract does not specify hemorrhoid grade or confirm patients had prolapse.
Limitations
All included trials were of moderate methodological quality only; population not specified as prolapsing grade III/IV hemorrhoids.
Taken word for word from the abstract
- population randomised clinical trials that compare rubber band ligation and coagulation treatments for haemorrhoids
- intervention Rubber band ligation and coagulation are two kinds of non-surgical therapies.
- comparator coagulation
- 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. Patients undergoing rubber band ligation had higher postoperative pain rate and lower postoperative bleeding rate than patients undergoing coagulation.
- qualityWhy All trials were of moderate methodological quality.
Postgrad Med J · PMID 37117040 · Read it on PubMed ↗
Devi et al. 2023
Hemorrhoid Disease: A Review on Treatment, Clinical Research and Patent Data
General review, no specific findings reportedNarrative reviewVery low qualityRelated question
size not given2023
The review summarizes that new drug molecules are needed and discusses past studies on hemorrhoid management, but does not report specific comparative findings for prolapsed hemorrhoid treatments
Who was studied
People with hemorrhoid disease in general (not specifically defined as prolapsing grade III/IV hemorrhoids)
Main outcome
Overview of treatment development and clinical research for hemorrhoids
Quality
This is a general narrative review summarizing patents and drug development literature, without systematic methodology, specific patient data, or direct comparison of treatments for prolapsed hemorrhoids.
Limitations
The abstract does not describe a systematic review methodology, does not specify grade of hemorrhoids studied, does not report on conservative care, banding, sclerotherapy, infrared coagulation, stapled hemorrhoidopexy, or hemorrhoidectomy specifically, and focuses broadly on drug molecules and patents rather than clinical treatment approaches for prolapse.
Taken word for word from the abstract
- population Hemorrhoid disease (HD) is an anal-rectal ailment that is commonly painful or may be painless and causes rectal bleeding with or without prolapsing anal tissue.
- result This review article mainly focuses on the newer molecules to overcome hemorrhoids and also emphasizes various studies carried out in the past.
- primaryOutcome To highlight the recent developments in terms of safety, clinical efficacy, and marketed formulation for the effective management of hemorrhoids.
Infect Disord Drug Targets · PMID 37106517 · Read it on PubMed ↗
Shen et al. 2023
Electroacupuncture at Baliao point alleviates post-operative pain and anal distension after procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy): a prospective randomized clinical trial
Acupuncture add-on eased post-surgery painRandomised trialLow qualityRelated question
124 people72 hours after operation
Electroacupuncture plus surgery gave lower pain and anal distension scores at multiple time points, needed fewer painkillers, and had less urinary retention than surgery alone
Who was studied
Adults with mixed hemorrhoids having stapled hemorrhoidopexy (PPH) surgery
What they received
Electroacupuncture at Baliao point added to PPH surgery
Compared with
PPH surgery alone
Main outcome
Post-operative anal pain and anal swelling/distension after PPH surgery
Quality
Single randomized trial of an adjunct therapy to one specific surgical technique, with no mention of blinding, so it only weakly informs the broader question of which hemorrhoid treatment approach to choose.
Limitations
Only examines an acupuncture add-on to stapled hemorrhoidopexy, not a comparison between treatment approaches (conservative, office procedures, or surgery) for prolapsed hemorrhoids; no blinding described; short follow-up window.
Taken word for word from the abstract
- population patients with mixed hemorrhoids
- n A total of 124 eligible patients undergoing PPH surgery were included in this study
- intervention patients in the EA group receiving PPH surgery and EA at Baliao point
- comparator patients in the control group receiving only PPH surgery
- primaryOutcome short-term complications, such as anal pain and swelling, after procedure for prolapse and hemorrhoids (PPH)
- result The visual analogue scale (VAS) scores of EA group at 8, 24, 48, and 72 h after operation were significantly lower than those of control group.
- result The incidence of urinary retention and tenesmus in EA group was significantly lower than that in control group within the first day after surgery.
Int J Colorectal Dis · PMID 37074488 · Read it on PubMed ↗
Laurain et al. 2023
French multicentre prospective evaluation of radiofrequency ablation in the management of haemorrhoidal disease
Less pain, better quality of lifeProspective cohortLow qualityRelated question
129 people1 year's follow-up
quality-of-life score improved significantly and symptoms such as bleeding and prolapse decreased, but some patients needed repeat surgery or had complications
Who was studied
adults with grade II-III internal hemorrhoids
What they received
radiofrequency ablation (RFA) of hemorrhoids
Compared with
none (single-arm study, before-and-after comparison)
Main outcome
change in hemorrhoid-related quality-of-life score at 3 months
Quality
this was a single-arm study with no comparison group, so it can't show whether RFA works better than other treatments, only that patients improved after it.
Limitations
no control group; grades II-III rather than the more severe grade III-IV prolapse; some patients needed reoperation or had complications
Taken word for word from the abstract
- population outpatients with grade II-III haemorrhoids
- intervention RFA (Rafaelo©)
- comparator This prospective multicentre study assessed RFA (Rafaelo©) in outpatients
- 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.
- result Seven patients (5.4%) were reoperated on by haemorrhoidectomy for relapse, and three for complications.
- n A total of 129 patients (69% men, median age 49 years) were operated on in 16 French centres.
Tech Coloproctol · PMID 37005961 · Read it on PubMed ↗
Mascagni et al. 2023
Perirectal hematoma after stapled surgery for hemorrhoidal prolapse and obstructed defecation syndrome: case series management to avoid panic-guided treatment
Rare bleeding complication, usually resolves without major surgery.RetrospectiveLow qualityRelated question
3,058 people2023
Most hematoma cases (12 of 14) were stable and resolved with conservative treatment (antibiotics, monitoring) via self-drainage; 2 progressive cases were treated with embolization; no patients needed major abdominal surgery
Who was studied
Adults who had stapling surgery for hemorrhoids or obstructed defecation with internal prolapse
What they received
Management of perirectal hematoma (a bleeding complication) after stapled surgery - either conservative monitoring or embolization
Compared with
Conservative monitoring versus embolization for bleeding, within the same complication
Main outcome
Whether the hematoma resolved without needing major abdominal surgery
Quality
This is a retrospective case series of a rare complication in a small subgroup (14 of 3058 patients), not a comparison of treatments for prolapsed hemorrhoids themselves.
Limitations
Retrospective design, very small number of actual complication cases (14), and this reports on managing a surgical complication rather than comparing treatment approaches for prolapsed hemorrhoids.
Taken word for word from the abstract
- n In all, 3058 patients underwent stapling procedures for hemorrhoidal disease or obstructed defecation syndrome with internal prolapse.
- population 3058 patients underwent stapling procedures for hemorrhoidal disease or obstructed defecation syndrome with internal prolapse
- intervention 14 (0.46%) large PH cases were reported, and 12 of these hematomas were stable and treated conservatively (antibiotics and CT/laboratory test monitoring)
- comparator Two patients with progressive PH (signs of active bleeding and peritonism) were submitted to CT and arteriography to evaluate the source of bleeding, which was subsequently closed by embolization.
- primaryOutcome The aim of this study was to analyze a homogenous case series of PH and to define a treatment algorithm for huge postoperative PHs.
- result This approach helped ensure that no patients with PH were referred for major abdominal surgery. Most PH cases are stable and treatable with a conservative approach, evolving with self-drainage.
Updates Surg · PMID 36899291 · Read it on PubMed ↗
Frigerio et al. 2023
Surgical management of rectovaginal fistula after stapled transanal rectal resection for prolapsed hemorrhoids
Stapled surgery caused a fistula; repair worked.Case seriesVery low qualityRelated question
1 people6 months
The repair succeeded with no surgical complications; the bowel diversion was reversed after 2 months, and the patient was symptom-free with no recurrence at 6 months
Who was studied
A woman who developed a rectovaginal fistula after having a stapled procedure (STARR) for prolapsed hemorrhoids
What they received
Surgical repair of the fistula via a vaginal-approach layered repair plus a temporary bowel diversion (colostomy)
Main outcome
Successful closure of the fistula and relief of symptoms
Quality
This is a single patient's case report, so it cannot show how often this complication occurs or how this repair compares to other options.
Limitations
Single case, no comparison group, short follow-up, describes treatment of a complication of one hemorrhoid procedure rather than comparing treatments for prolapsed hemorrhoids themselves
Taken word for word from the abstract
- population A 38-year-old woman was referred to our division for continuous fecal discharge through her vagina that developed a few days after she had a STARR for prolapsed hemorrhoids.
- intervention the patient was admitted to transvaginal layered repair and temporary laparoscopic bowel diversion
- primaryOutcome We aimed to present a case of iatrogenic rectovaginal fistula after STARR that was successfully treated with a transvaginal primary layered repair and bowel diversion.
- result No surgical complications were observed. The patient was successfully discharged home on postoperative day 3. Bowel diversion was reversed after 2 months. At the current follow-up (6 months), the patient is asymptomatic and without recurrence.
- n A 38-year-old woman was referred to our division
- harm Rectovaginal fistula after stapled transanal rectal resection (STARR) may be challenging to treat, due to the extensive scarring, the local ischemia, and the risk of rectal stenosis.
Int Urogynecol J · PMID 36811636 · Read it on PubMed ↗
Falsarella et al. 2023
Embolization of the Superior Rectal Arteries versus Closed Hemorrhoidectomy (Ferguson Technique) in the Treatment of Hemorrhoidal Disease: A Randomized Clinical Trial
Less pain than surgery, similar resultsRandomised trialLow qualityRelated question
29 people12 months
Embolization caused much less pain and required far fewer pain medication doses than surgery; by 12 months the frequency of symptoms was similar between the two groups
Who was studied
Adults with symptomatic hemorrhoidal disease, grades 2 and 3
What they received
Embolization of the superior rectal arteries (artery-blocking procedure)
Compared with
Ferguson closed surgical hemorrhoidectomy
Main outcome
Pain after the procedure, use of pain medication, and recurrence of symptoms (bleeding, pain, prolapse, itching) over 12 months
Quality
Very small trial (under 30 patients analyzed) with some patients excluded from the final analysis, limiting confidence in the results.
Limitations
Small sample size, four patients excluded from analysis, includes Grade 2 hemorrhoids which do not necessarily prolapse, and tests embolization rather than the conservative/office/surgical options the question is about
Taken word for word from the abstract
- population 33 patients with symptomatic hemorrhoidal disease Grades 2 and 3
- intervention superior rectal artery embolization group (n = 15)
- comparator Ferguson closed hemorrhoidectomy surgical group (n = 14)
- primaryOutcome Pain using the visual analog scale and the use of analgesics were evaluated 3 times daily during the first 7 days of the postoperative period. Recurrent symptoms and satisfaction with treatment were also evaluated in the subsequent first, third, sixth, and twelfth months.
- result The mean pain during the first bowel movement after the procedure was 6.08 ± 4.41 in the surgery group and 0 in the embolization group (P = .001).
- result The frequency of symptoms (bleeding, pain, prolapse, and pruritus) was similar between the groups at 12 months (P = .691).
- n Four patients were excluded from the analysis.
J Vasc Interv Radiol · PMID 36736690 · Read it on PubMed ↗
Felsenreich et al. 2023
Bandwagons in colorectal surgery
Stapled hemorrhoidopexy called an unproven trendNarrative reviewVery low qualityRelated question
size not given2023
The article identifies stapled hemorrhoidopexy (PPH) as one of five current "bandwagons" in colorectal surgery—treatments adopted based on popular acceptance rather than strong evidence
Who was studied
Not specifically described; general reference to colorectal surgery patients
Main outcome
Whether certain surgical treatments are supported by evidence or driven by unproven trends ("bandwagons")
Quality
This is an opinion/commentary piece with no original patient data, trial results, or systematic evidence review—it is the author's argument about trends in surgical practice.
Limitations
No patient outcomes, no comparative data, no methodology—this is a narrative opinion piece about trends in surgical adoption, not a study of treatment efficacy for prolapsed hemorrhoids
Taken word for word from the abstract
- intervention stapled hemorrhoidopexy, also known as procedure for prolapse and hemorrhoids (PPH)
- result there are at least five currently ongoing bandwagons: 1) laparoscopic lavage of perforated colon; 2) laparoscopic ventral rectopexy; 3) stapled hemorrhoidopexy, also known as procedure for prolapse and hemorrhoids (PPH)
- primaryOutcome some trends can actually be traced back to 1979. Cohen and Rothschild stated that even when medical progress is extraordinary, the path has too often been driven by overwhelming acceptance of popular albeit unproven ideas
- population In the specific case of colorectal surgery
Minerva Surg · PMID 36511316 · Read it on PubMed ↗
Zhongguo Zhong Yao Za Zhi 2022
[Expert consensus on clinical application of Fufang Jingjie for Fumigation and Washing]
Consensus on using one herbal wash, not a treatment comparison.GuidelineVery low qualityRelated question
size not given2022
This is an expert consensus statement compiling clinical experience and literature to guide use of the product; it does not report a comparative trial result for treating prolapsed hemorrhoids specifically.
Who was studied
adults with various anal and perianal conditions (external hemorrhoids, mixed hemorrhoids, prolapsed/incarcerated internal hemorrhoids, anal fissures, perianal abscess, anal fistula, perianal eczema)
What they received
Fufang Jingjie for Fumigation and Washing (a traditional Chinese medicine topical wash/fumigation product)
Main outcome
expert consensus on function, usage, dosage, adverse reactions and precautions for this product (not a measured clinical outcome)
Quality
This is an expert consensus/opinion document summarizing usage guidance rather than original comparative research data, so it cannot establish how well treatments work.
Limitations
No original trial data, no control group, no specific outcome data isolated for prolapsed hemorrhoids among the many anal conditions discussed; it is a consensus on use of one specific herbal product rather than a comparison of treatment approaches for prolapsed hemorrhoids.
Taken word for word from the abstract
- population widely used for the treatment of external hemorrhoids, mixed hemorrhoids, internal hemorrhoids prolapse and incarceration, anal fissures, perianal abscess, anal fistula acute attack, perianal eczema and other diseases
- intervention Fufang Jingjie for Fumigation and Washing is one of the commonly used and effective drugs for external fumigation and washing of traditional Chinese medicine
- primaryOutcome the function, usage, dosage, adverse reactions and points for attention were discussed of Fufang Jingjie for Fumigation and Washing
- result This consensus was formed to provide reference for the clinical application of Fufang Jingjie for Fumigation and Washing.
Zhongguo Zhong Yao Za Zhi · PMID 36472015 · Read it on PubMed ↗
Lohsiriwat et al. 2023
Recurrence Rates and Pharmacological Treatment for Hemorrhoidal Disease: A Systematic Review
Recurrence common; limited treatment comparison dataSystematic reviewLow qualityRelated question
44 people2023
Across 23 real-world studies and one meta-analysis, recurrence after surgery or phlebotonics ranged from 0% to 56.5%, with most studies (19 of them) reporting 20% or less; micronized purified flavonoid fractions improved main symptoms more than other pharmacological treatments, but no real-world studies reported recurrence specifically after systemic or topical treatments.
Who was studied
Adults with hemorrhoidal disease (HD), not specifically limited to prolapsed grade III/IV hemorrhoids
What they received
Various treatments for hemorrhoidal disease, including surgery, phlebotonics, and other pharmacological (systemic or topical) treatments
Compared with
Other pharmacological treatments and different studies' comparators (not a single fixed comparator)
Main outcome
Recurrence of hemorrhoidal disease and improvement in symptoms after treatment
Quality
The review pooled very different real-world studies with inconsistent data collection and found major gaps in recurrence reporting, so its conclusions are not strongly reliable.
Limitations
The abstract notes a lack of consistent epidemiology and recurrence data, differences in data collection across studies, and no real-world studies on recurrence after medical treatment; it is not specific to prolapsed (grade III/IV) hemorrhoids or to office/surgical procedure comparisons.
Taken word for word from the abstract
- population Hemorrhoidal disease (HD) is characterized by prolapse of the inflamed and bleeding vascular tissues of the anal canal.
- intervention SLRs including a meta-analytic component reporting on the efficacy of systemic or topical pharmacological treatments for adults with HD
- comparator micronized purified flavonoid fractions significantly improved the main symptoms of HD compared to other pharmacological treatments
- primaryOutcome a systematic literature review (SLR) was conducted to summarize evidence on epidemiology, recurrence, and efficacy of interventions in HD
- result Twenty-three RWE studies and one meta-analysis reported HD recurrence rates ranging from 0 to 56.5% following surgery or phlebotonics, with most (n = 19) reporting rates of 20% or less.
- result micronized purified flavonoid fractions significantly improved the main symptoms of HD compared to other pharmacological treatments.
- n The SLR identified 44 eligible publications.
Adv Ther · PMID 36331754 · Read it on PubMed ↗
Huang et al. 2023
Tissue-selecting-technique mega-window stapler combined with anal canal epithelial preservation operation in prolapsed hemorrhoids
Newer stapler technique gave better continence, satisfaction.Randomised trialModerate quality
204 people2023
The TST-MS plus epithelial preservation surgery gave lower anal incontinence scores, higher patient satisfaction, and fewer leftover skin tags, but took longer to perform and removed more rectal mucosa by volume; there was no difference between the two surgeries in recurrence, blood loss, anal pain, bleeding, urinary retention, swelling, or anal narrowing.
Who was studied
Adults with prolapsed internal hemorrhoids undergoing surgery
What they received
Tissue selecting technique with mega-window stapler (TST-MS) combined with anal canal epithelial preservation operation
Compared with
Stapled hemorrhoidopexy (PPH) combined with external hemorrhoidectomy and inferior internal hemorrhoid ligation
Main outcome
Anal function (continence score), recurrence, operative complications and patient satisfaction after surgery
Quality
It was a randomized trial with a reasonable number of patients, but it was done at one center, patients and surgeons could not be blinded to which operation they had, and no length of follow-up is reported.
Limitations
Single-center study; only the outcome assessors (not patients or surgeons) were blinded; no stated duration of follow-up after surgery.
Taken word for word from the abstract
- population prolapsed hemorrhoids
- n A total of 204 participants were randomly divided into the two groups.
- intervention tissue selecting technique with mega-window stapler (TST-MS) combined with anal canal epithelial preservation operation
- comparator prolapse and hemorrhoids (PPH) combined with the external hemorrhoidectomy and inferior internal hemorrhoid ligation
- primaryOutcome The anal function, reoccurrence, intraoperative variables, and operative complications were assessed.
- result TST-MS combined with anal canal epithelial preservation operation had lower Wexner score of anal incontinence (Z = 3.062, P = 0.002), higher patients' satisfaction degree (t = 7.32, P < 0.001), less residual skin tags (χ2 = 18.141, P < 0.001), longer operative time (Z = -2.281, P = 0.023), and bigger volume of excised rectal mucosa (t = 2.35, P = 0.020). There was no significant difference between the two groups in the anal canal circumference, recurrence, intraoperative blood loss, weight of excised rectal mucosa, anal pain, bleeding, urinary retention, anal edge edema, and anatomical anal stenosis (all P > 0.05).
Asian J Surg · PMID 35961908 · Read it on PubMed ↗
Yu et al. 2022
Modified rubber band ligation for treatment of grade II/III hemorrhoids: clinical efficacy and safety evaluation-a retrospective study
Modified banding: less bleeding, lower recurrence.RetrospectiveLow qualityRelated question
274 people3 months
Modified banding had fewer cases of delayed bleeding (0 vs 5) and lower recurrence within 3 months (5.4% vs 13.6%); pain, edema and sensation of prolapse were similar between groups at 3 and 7 days
Who was studied
Adults with grade II or III internal hemorrhoids
What they received
Modified rubber band ligation technique
Compared with
Conventional (standard) rubber band ligation
Main outcome
Complications after banding, including delayed bleeding, recurrence of prolapse, pain and swelling
Quality
This was a retrospective, non-randomized comparison at one hospital, so differences could be due to other factors rather than the banding technique itself.
Limitations
Retrospective design without randomization; single center; compares two technique variants of the same office procedure rather than comparing across the main treatment categories (conservative, other office procedures, or surgery); includes grade II hemorrhoids which do not necessarily prolapse.
Taken word for word from the abstract
- population patients with grade II or III internal hemorrhoids treated with RBL
- n A total of 274 patients were enrolled, including 149 patients treated with modified RBL and 125 treated with conventional RBL.
- intervention modified RBL
- comparator conventional RBL
- primaryOutcome Postoperative minor complications such as pain, swelling, anal edema, prolapse recurrence and major complications like DB were retrospectively reviewed.
- result Five cases of postoperative DB have been observed in the conventional RBL group, compared to none in the modified ones, with a significant difference (P < 0.05).
- result 8 cases in the modified RBL group experienced a recurrence rate of 5.4%, whereas 17 patients in the conventional RBL group experienced a recurrence rate of 13.6%. The difference was statistically significant (P < 0.05).
- result The VAS score, edema, and incidence of sensation of prolapse between the two groups were not significantly different at 3 and 7 days after surgery (P < 0.05).
BMC Surg · PMID 35725452 · Read it on PubMed ↗
Yang et al. 2022
Modified ligation procedure for prolapsed haemorrhoids versus stapled haemorrhoidectomy for the management of symptomatic haemorrhoids (MoLish): randomized clinical trial
Ligation less painful, cheaper, similar cure.Randomised trialModerate quality
133 people6 months
MLPPH took longer to perform but caused less pain in the first two weeks, better continence scores at 1 and 3 months (similar by 6 months), lower symptom severity scores and a higher cure rate at 6 months, and lower treatment costs, with no significant difference in overall cost-effectiveness analysis effectiveness score.
Who was studied
patients with symptomatic haemorrhoids treated in Shanghai
What they received
modified ligation procedure for prolapsed haemorrhoids (MLPPH)
Compared with
stapled haemorrhoidectomy (SH)
Main outcome
efficacy at 6 months after the intervention
Quality
It was a randomized trial with reasonable numbers, but it was done at a single centre in one city with only 6-month follow-up, so longer-term and generalizability questions remain.
Limitations
Single-centre study, short follow-up of only 6 months, and two patients were lost to follow-up.
Taken word for word from the abstract
- n 133 patients were randomized (67 for MLPPH and 66 for SH)
- population patients with symptomatic haemorrhoids treated in Shanghai from May 2018 to September 2021
- intervention the modified ligation procedure for prolapsed haemorrhoids (MLPPH)
- comparator stapled haemorrhoidectomy (SH)
- primaryOutcome The primary outcome was the assessment of efficacy at 6 months after the intervention.
- result The mean operating time was longer in MLPPH than in SH (57.42 min versus 30.68 min; P < 0.001).
- result The median pain score was higher in SH than in MLPPH at postoperative day 3 (P = 0.018), day 7(P = 0.013), and day 14 (P = 0.003).
- result The median Wexner incontinence score was higher in SH than in MLPPH at postoperative month 1 (P = 0.036) and month 3 (P = 0.035), but was similar in the two groups at month 6.
- result the median HSS score was lower in MLPPH than in SH 6 months after surgery (P = 0.003).
- result The 6-month cure rate was higher in MLPPH than in SH (P = 0.003).
- result CEA showed lower mean costs in MLPPH than in SH (EUR 1080.24 versus EUR 1657.97; P < 0.001) but there was no significant difference in effectiveness (P = 0.181).
- followUp The primary outcome was the assessment of efficacy at 6 months after the intervention.
BJS Open · PMID 35552375 · Read it on PubMed ↗
Nguyenhuy et al. 2022
Clinical Outcomes Following Rectal Artery Embolisation for the Treatment of Internal Haemorrhoids: A Systematic Review and Meta-Analysis
Symptoms improved, but prolapse itself did not.Meta-analysisLow qualityRelated question
381 people2022
Bleeding, pain and quality-of-life scores improved, but the grade of prolapse actually increased slightly; technical success was almost universal (99%) while clinical success was lower (82%), and no major complications occurred
Who was studied
adults with haemorrhoidal disease (internal haemorrhoids)
What they received
rectal artery embolisation (a radiology procedure blocking blood flow to haemorrhoids)
Main outcome
bleeding score, pain score, quality of life, and prolapse grade
Quality
This pools only 381 patients from 13 small, mostly uncontrolled studies with no comparison group, so it cannot show how embolisation stacks up against standard treatments.
Limitations
No comparator arm, high heterogeneity in procedural details, and prolapse grade worsened despite symptom improvement, so overall clinical meaning is uncertain.
Taken word for word from the abstract
- population Haemorrhoidal disease (HD) is a common anorectal disorder which can substantially impair quality of life.
- intervention Rectal artery embolisation (RAE) is a recently described technique for the management of HD
- n Thirteen eligible studies were identified including 381 patients.
- primaryOutcome Primary outcomes were: French bleeding score (FBS), Visual analogue scale (VAS) for pain, general quality of life (QoL) score, and the Goligher prolapse score (GPS).
- result Rectal artery embolisation was associated with improvements in the FBS (mean difference [MD] 2.66; 95% confidence interval [CI] 2.10-3.23), VAS (MD 1.92; 95% CI 1.58-2.27) and QoL (MD 1.41; 95% CI 1.20-3.80), although the grade of internal haemerrhoids increased with uncertain clinical significance (MD 0.30; 95% CI 0.23-0.36).
- result Technical success was achieved in almost all procedures (99%; 95% CI 94-100%) however clinical efficacy was lower (82%; 95% CI 73-89%). Procedural duration and radiation exposure were heterogeneous. No major complications occurred.
Cardiovasc Intervent Radiol · PMID 35551442 · Read it on PubMed ↗
Zhang et al. 2022
Comparison of the outcomes of hemorrhoidectomy and PPH in the treatment of grades III and IV hemorrhoids
Similar recurrence, fewer complications with staplingRetrospectiveLow quality
1,003 peoplemore than 12months
No significant difference in 1-year recurrence between the two groups; PPH group had less postoperative anal pain, less bleeding, easier urination, lower resting anal pressure, less blood loss, shorter operative time, faster wound healing, and lower wound infection rate compared with traditional hemorrhoidectomy
Who was studied
Adults with grade III and IV internal hemorrhoids
What they received
Stapled hemorrhoidopexy (PPH procedure)
Compared with
Traditional surgical hemorrhoidectomy
Main outcome
Recurrence within 1 year and postoperative/surgery-related complications
Quality
This was a retrospective, single-hospital study without randomization, so differences between groups could be due to factors other than the surgery itself.
Limitations
Single-hospital retrospective study; authors state randomized controlled trials are needed to confirm findings
Taken word for word from the abstract
- n We retrospectively reviewed 1003 grades III and IV hemorrhoid patients who presented to our hospital.
- population grades III and IV hemorrhoid patients who presented to our hospital
- intervention A total of 585 patients underwent PPH
- comparator 418 patients underwent hemorrhoidectomy
- primaryOutcome The outcomes were 1-year recurrence, postoperative complications, surgery-related complications, and indicators.
- result No significant difference between the 2 treatment groups in 1-year recurrence. PPH can markedly improve anal pain, postoperative bleeding, difficult urination, and postoperative resting anal pressure. The operative blood loss, operative time, wound healing time, and wound infection rates were decreased significantly in the PPH group compared with the traditional hemorrhoidectomy group.
- followUp All patients underwent more than 12months of postoperative follow-up.
- limitations this was a single-hospital retrospective study. Therefore, well-designed, multicenter, randomized controlled trials are needed to evaluate the value of PPH for grades III and IV hemorrhoids.
Medicine (Baltimore) · PMID 35356944 · Read it on PubMed ↗
Luo et al. 2022
Analgesic Effect of Ropivacaine Combined with Hydromorphone following Surgery for Mixed Hemorrhoids: A Pilot Study
Compares anesthesia drugs, not hemorrhoid treatments.Randomised trialLow qualityRelated question
80 people24 hours
Pain relief was similar between the two anesthesia combinations, but the hydromorphone group had less itching than the morphine group
Who was studied
Adults with mixed hemorrhoids undergoing surgery (procedure for prolapse and hemorrhoids plus external hemorrhoidectomy)
What they received
Spinal anesthesia with ropivacaine and hydromorphone
Compared with
Spinal anesthesia with ropivacaine and morphine
Main outcome
Pain scores, itching, vomiting, and length of hospital stay after surgery
Quality
This is a small single-center pilot study comparing two anesthesia drug combinations, not a treatment approach for prolapsed hemorrhoids itself, so it doesn't inform the treatment-choice question directly.
Limitations
Small pilot study at a single center; compares two spinal anesthesia regimens rather than treatment approaches for prolapsed hemorrhoids; does not address which procedure (banding, stapling, hemorrhoidectomy, etc.) to choose.
Taken word for word from the abstract
- population This single-center, double-blind pilot study included patients with mixed hemorrhoids who underwent a procedure for prolapse and hemorrhoids (PPH) and external hemorrhoidectomy under spinal anesthesia
- intervention spinal anesthesia with 0.5% ropivacaine and 75 μg hydromorphone
- comparator spinal anesthesia with 0.5% ropivacaine and 150 μg morphine
- primaryOutcome Pain scores (numerical rating scale), incidences of vomiting and itching, and length of hospital stay (LoS) were recorded at 6, 12, 18, and 24 hours after surgery.
- result spinal anesthesia with ropivacaine/hydromorphone has a comparable analgesic effect and a lower incidence of pruritus during the first 24 hours after surgery than spinal anesthesia with ropivacaine/morphine
- n The analysis included 40 patients in each group.
Pain Res Manag · PMID 35154550 · Read it on PubMed ↗
Zhang et al. 2022
LigaSure hemorrhoidectomy versus the procedure for prolapse and hemorrhoids: A meta-analysis of randomized controlled trials
LigaSure: less recurrence, faster surgery, similar pain.Meta-analysisModerate qualityRelated question
397 people2022
LigaSure had lower recurrence and shorter operating time than PPH; no difference in pain, time off work, or complications
Who was studied
Adults with symptomatic hemorrhoids undergoing surgery
What they received
LigaSure hemorrhoidectomy (a surgical device-based excisional technique)
Compared with
Procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy)
Main outcome
Recurrence rate, operating time, postoperative pain, and time off work
Quality
This pools 5 randomized trials, but the total number of patients is small and the abstract notes the findings need confirmation in larger, longer-term trials.
Limitations
Small total sample size (397 participants) across only 5 trials, short-term follow-up, no long-term outcomes reported.
Taken word for word from the abstract
- n A total of 5 studies involving 397 participants were included in this review.
- intervention LigaSure hemorrhoidectomy
- comparator the procedure for prolapse and hemorrhoids (PPH)
- primaryOutcome significantly lower recurrence rate [relative risk (RR) = 0.21, 95% confidence interval (CI): 0.06 to 0.72, P = .01] and significantly shorter operating time
- result the LigaSure procedure was associated with significantly lower recurrence rate [relative risk (RR) = 0.21, 95% confidence interval (CI): 0.06 to 0.72, P = .01] and significantly shorter operating time [mean difference (MD) = -6.39, 95% CI: -7.68 to -5.10, P < .001]. The analysis showed no significant difference in postoperative pain between the two techniques (MD = 0.55, 95% CI: -0.15 to 1.25, P = .12] or in time off work or away from normal activity
- population LigaSure hemorrhoidectomy and the procedure for prolapse and hemorrhoids (PPH) are both relatively new treatments for managing symptomatic hemorrhoids.
Medicine (Baltimore) · PMID 35060505 · Read it on PubMed ↗
Abe et al. 2022
Long-term Outcomes of Aluminum Potassium Sulfate and Tannic Acid Sclerotherapy for Prolapsed Hemorrhoids: A Single-Center, Observational Study
Recurrence increases over years after sclerotherapyRetrospectiveLow quality
1,180 people3, 6, and 9 years
Recurrence rose over time (7.4% at 3 years, 27.2% at 6 years, 47.5% at 9 years); complications were uncommon, including fever (1.4%), rectal ulcer (0.9%), rectal stricture (0.4%), and perianal abscess (0.3%)
Who was studied
Adults with grade II to IV hemorrhoids
What they received
Sclerotherapy injection using aluminum potassium sulfate and tannic acid
Compared with
None (single-group observational follow-up)
Main outcome
Long-term recurrence rate and complications after sclerotherapy
Quality
This was a retrospective, single-center study without a comparison group, and follow-up visits became optional and declined after 3 years, weakening confidence in the long-term recurrence figures.
Limitations
Retrospective, nonrandomized, single-center design; follow-up after 3 years was optional and participation declined over time, so later recurrence estimates are based on fewer patients.
Taken word for word from the abstract
- population 1180 patients with grade II to IV hemorrhoids treated with injection sclerotherapy were enrolled
- intervention Sclerotherapy using aluminum potassium sulfate and tannic acid
- comparator This was a retrospective review of a single-institution experience.
- primaryOutcome Efficacy measures included cumulative recurrence rates and postoperative complications.
- result Recurrence rates at 3, 6, and 9 years were 7.4%, 27.2%, and 47.5%.
- result Postoperative complications included fever ≥38°C in 16 (1.4%) patients, rectal ulcer in 10 (0.9%) patients, rectal stricture in 5 (0.4%) patients, and perianal abscess in 4 (0.3%) patients.
- n In total, 1180 patients with grade II to IV hemorrhoids treated with injection sclerotherapy were enrolled.
Dis Colon Rectum · PMID 34990425 · Read it on PubMed ↗
Chivate et al. 2022
Transanal Suture Mucopexy for Hemorrhoids
Low pain, low recurrence with suturingRetrospectiveLow qualityRelated question
5,634 peoplemean follow-up of 7 ± 6 years
Most patients had minimal pain and a low recurrence rate (1.3%) with few complications over a mean follow-up of 7 years
Who was studied
Adults with symptomatic grade II to IV hemorrhoids
What they received
Transanal suture mucopexy (suturing the hemorrhoids back to the rectal wall)
Main outcome
Pain level and hemorrhoid recurrence
Quality
This is a large but retrospective, single-arm study with no comparison group, so it cannot show how this procedure compares to other treatments.
Limitations
Requires special proctoscopic equipment; no control group; retrospective design over 13 years from medical records.
Taken word for word from the abstract
- population This study includes 5634 patients who had grade II to IV symptomatic hemorrhoids.
- intervention The reduced hemorrhoids were fixed to the muscles of the rectal wall using sutures.
- primaryOutcome Pain assessed using the visual analog scale and hemorrhoid recurrence served as outcome measures.
- result Effective treatment without complications occurred for 5541 patients (98.65%). A recurrence rate of 1.3% was recorded in 5634 cases with a mean follow-up of 7 ± 6 years.
- n This study includes 5634 patients who had grade II to IV symptomatic hemorrhoids.
Dis Colon Rectum · PMID 34958048 · Read it on PubMed ↗
Popovtsev et al. 2021
[Hemorrhoidal artery ligation without Doppler navigation in surgical treatment of hemorrhoidal disease]
Doppler guidance added no extra benefit.Randomised trialModerate qualityRelated question
120 people8.3±2.1 and 8.1±1.9 months
no significant difference between the two techniques in prolapse recurrence, bleeding, pain or complications
Who was studied
adults with grade II-III hemorrhoid disease having surgery
What they received
hemorrhoidal artery ligation guided by feel (palpation) alone, without Doppler ultrasound
Compared with
hemorrhoidal artery ligation guided by Doppler ultrasound to find the arteries
Main outcome
return of hemorrhoid prolapse, bleeding, pain and complications after surgery
Quality
it was a randomized trial but single-center, modest size, and followed patients for only about 8 months.
Limitations
single-center study, relatively short follow-up of about 8 months, and it compares two ways of doing the same ligation procedure rather than comparing different treatment approaches for prolapsed hemorrhoids
Taken word for word from the abstract
- n The study included 120 patients: group A - Doppler-guided ligation (n=60) and group B - ligation without ultrasound (n=60).
- population surgical treatment of hemorrhoidal disease (GD) stage II-III
- intervention ligation without ultrasound
- comparator Doppler-guided ligation
- primaryOutcome Relapse of all preoperative symptoms was registered in 1 patient (1.6%) in the group A. Intermittent bleeding was observed in 5 (8.3%) and 3 (5%) patients, respectively (p=0.71). Periodic hemorrhoid prolapse (GP) occurred in 6 (10%) and 4 (6.6%) respondents, respectively (p=0.74).
- result There are no significant advantages of Doppler-guided HA ligation compared to palpation regarding incidence of hemorrhoid prolapse (p=0.74) and hemorrhoidal bleeding (p=0.71).
- followUp Mean follow-up period was 8.3±2.1 and 8.1±1.9 months, respectively (p=0.96).
Khirurgiia (Mosk) · PMID 34941209 · Read it on PubMed ↗
Song et al. 2022
Outcome of a modified Park's submucosal hemorrhoidectomy versus Milligan-Morgan for grade III-IV circumferential prolapsed hemorrhoids
Park's technique: less day-7 pain, fewer recurrencesRandomised trialModerate quality
186 people24 months
MPSH took longer to perform but caused less pain on day 7, had similar bleeding and anal stenosis rates, and had a higher rate of staying recurrence-free over 24 months compared to MMH
Who was studied
adults with grade III or IV circumferential prolapsed hemorrhoids
What they received
modified Park's submucosal hemorrhoidectomy (MPSH)
Compared with
Milligan-Morgan hemorrhoidectomy (MMH)
Main outcome
operative time, postoperative pain, complications, and recurrence of prolapsed hemorrhoids
Quality
it is a randomized trial with a reasonable number of patients and long follow-up, but it compares two surgical techniques rather than testing against conservative care or placebo, and is a single study.
Limitations
Study only compares two specific surgical techniques; authors state additional clinical studies are needed to validate the conclusions.
Taken word for word from the abstract
- population grade III and IV circumferential prolapsed hemorrhoids (CPH)
- intervention modified Park's submucosal over Milligan-Morgan hemorrhoidectomy (MMH)
- comparator Milligan-Morgan hemorrhoidectomy (MMH)
- n A total of 186 consecutive patients with grade III or IV CPH were enrolled.
- primaryOutcome Patient data included demographics, clinical characteristics, surgical parameters, underlying or arising complications, and CPH recurrence.
- result MPSH took significantly longer operative time (P < 0.05).
- result pain at day 7 was significantly more frequent and severe in the MMH group (P < 0.05)
- result There were no significant group differences in postoperative bleeding, intraoperative blood loss, or development of anal stenosis (P > 0.05).
- result the cumulative relapse-free rate was substantially higher in the MPSH group (P < 0.05)
- followUp closely followed up for at least 24 months
Asian J Surg · PMID 34840045 · Read it on PubMed ↗
Chen et al. 2021
Surgical Outcomes of LigaSure Hemorrhoidectomy in the Elderly Population: A retrospective cohort study
Surgery equally safe in older and younger patients.RetrospectiveLow qualityRelated question
1,238 people2021
No significant difference between age groups in operation time, hospital stay, pain, complications, re-admission, or reoperation rates
Who was studied
Adults with symptomatic prolapsed hemorrhoids who underwent LigaSure hemorrhoidectomy, compared by age group (under 65 vs 65 or older)
Main outcome
Surgical outcomes and complication rates after LigaSure hemorrhoidectomy, compared between older and younger patients
Quality
This is a retrospective database review comparing age groups for one surgical technique, not a comparison of different treatment approaches for prolapsed hemorrhoids, so it cannot inform which approach to choose.
Limitations
Retrospective design; compares age groups rather than different treatment approaches; only looks at one surgical technique (LigaSure hemorrhoidectomy) with no comparator treatment.
Taken word for word from the abstract
- population consecutive patients whose symptomatic prolapsed hemorrhoids managed by the LigaSure hemorrhoidectomy
- n Among 1238 patients, 1075 were under 65 years old (group 1), and 163 were 65 years old or older (group 2).
- primaryOutcome Both groups were compared regarding baseline characteristics and surgical outcomes.
- result There was no significant difference between these two groups regarding sex, hemorrhoids grade, operation time, duration of hospital stays, postoperative pain score, analgesic consumption, total postoperative complications, re-admission rate, reoperation rate and follow-up times.
BMC Gastroenterol · PMID 34715801 · Read it on PubMed ↗
Stecca et al. 2021
Superior Rectal Artery Embolization for Symptomatic Grades 2 and 3 Hemorrhoidal Disease: 6-Month Follow-up among 43 Patients
Less bleeding, better quality of lifeProspective cohortLow qualityRelated question
43 people6 months
Bleeding score improved significantly in Grade 3 patients, quality of life improved significantly in both groups, and no serious complications occurred
Who was studied
Adults with symptomatic Grade 2 or Grade 3 prolapsing internal hemorrhoids
What they received
Superior rectal artery embolization (a non-surgical procedure blocking blood flow to hemorrhoids)
Main outcome
Change in bleeding score, prolapse grade, pain, and quality of life after 6 months
Quality
This was a small study of only 43 patients with no comparison group, so it cannot show whether embolization works better than other treatments.
Limitations
No control group, short 6-month follow-up, and the studied treatment (artery embolization) is not one of the standard conservative, office-based, or surgical approaches being compared.
Taken word for word from the abstract
- population 43 patients (24 men and 19 women; mean age, 52 years [18-77 years]) with symptomatic hemorrhoidal disease
- population 25 patients had Grade 2 prolapse and 18 patients had Grade 3 prolapse
- intervention superior rectal artery embolization in the treatment of symptomatic Grades 2 and 3 hemorrhoidal disease
- primaryOutcome anamnestic questionnaire and disease scores, including French bleeding, Goligher prolapse, visual analog scale for pain, and quality of life
- result The reduction in the French bleeding score (global and single entity) in Grade 3 prolapse was statistically significant (P = .001). Improvement in the quality of life was significant in both groups (P < .05). No serious complications were registered.
- n 43 patients (24 men and 19 women; mean age, 52 years [18-77 years])
J Vasc Interv Radiol · PMID 34166805 · Read it on PubMed ↗
Yu et al. 2021
Efficacy of Ruiyun procedure for hemorrhoids combined simplified Milligan-Morgan hemorrhoidectomy with dentate line-sparing in treating grade III/IV hemorrhoids: a retrospective study
Combined surgery: less pain, faster healing, fewer complications.RetrospectiveLow quality
452 people12 months
No difference in cure rate between the two surgeries, but the combined RPH+sMMH approach had a lower 12-month recurrence rate (3.0% vs 7.8%), shorter wound healing time, faster return to work, less postoperative pain, and fewer complications (8.6% vs 16.3%) compared with standard MMH.
Who was studied
adults with grade III or IV internal hemorrhoids (prolapsing)
What they received
combined surgery: Ruiyun procedure for hemorrhoids plus simplified Milligan-Morgan hemorrhoidectomy with dentate line-sparing (RPH + sMMH)
Compared with
standard Milligan-Morgan hemorrhoidectomy (MMH)
Main outcome
cure rate at 3 months after surgery and recurrence rate within 12 months
Quality
This was a retrospective chart review comparing two surgical groups rather than a randomized trial, so differences between patients who received each operation could explain some of the results.
Limitations
Retrospective design without randomization, from a single hospital, so selection bias and unmeasured differences between groups cannot be ruled out.
Taken word for word from the abstract
- n Total 452 patients with hemorrhoids of grade III/IV were retrospectively reviewed in China-Japan Friendship Hospital, 244 cases were assigned to RPH + sMMH group, and 208 cases in MMH group.
- population patients with hemorrhoids of grade III/IV
- intervention Ruiyun procedure for hemorrhoids combined simplified Milligan-Morgan hemorrhoidectomy with dentate line-sparing (RPH + sMMH)
- comparator 208 cases in MMH group
- primaryOutcome The primary efficacy outcome was rate of curative at 3 month after operation, and the recurrence rate within 12 months post operation.
- result There was no statistically significant difference between the two groups in the curative rate. The recurrence rate after 12 months post operation in the RPH + sMMH (3.0%) was significantly lower than the sMMH group (7.8%) (P = 0.032).
- result The total rate of patients with postoperative complications in the RPH + sMMH group (8.6%) was significant lower than the MMH group (16.3%) (P = 0.012).
BMC Surg · PMID 34016101 · Read it on PubMed ↗
Sobrado et al. 2021
A NEW APPROACH FOR HEMORRHOID DISEASE: SELECTIVE DEARTERIALIZATION AND MUCOPEXY WITHOUT DOPPLER GUIDANCE
Controlled prolapse and bleeding, no recurrenceCase seriesLow quality
20 peoplemean follow-up of 13 months
All 20 patients achieved control of prolapse and bleeding; some had tenesmus, external hemorrhoidal thrombosis, or urinary retention; no recurrences after a mean follow-up of 13 months
Who was studied
Adults with grade II and III internal hemorrhoids that prolapse
What they received
Selective dearterialization and mucopexy of the symptomatic hemorrhoid only, without Doppler guidance
Main outcome
Control of prolapse and bleeding, postoperative complications, and recurrence
Quality
This was a small, single-arm study of only 20 patients with no comparison group, so it cannot show how this technique compares to other treatments.
Limitations
Small sample size, no control or comparator group, single-center, short follow-up period.
Taken word for word from the abstract
- n Twenty consecutive patients with grade II and III hemorrhoids were treated with this new approach
- population Twenty consecutive patients with grade II and III hemorrhoids were treated with this new approach
- intervention selective dearterialization and mucopexy at the symptomatic hemorrhoid only, without Doppler guidance
- primaryOutcome evaluate if selective dearterialization and mucopexy at the symptomatic hemorrhoid only, without Doppler guidance, achieves adequate control of the prolapse and bleeding and if postoperative morbidity is reduced with this technique
- result Control of prolapse and bleeding was achieved in all patients (n=20). Postoperative complications were tenesmus (n=2), external hemorrhoidal thrombosis (n=2) and urinary retention (n=2). After a mean follow-up of 13 months no recurrences were diagnosed.
Arq Bras Cir Dig · PMID 34008704 · Read it on PubMed ↗
Landolfi et al. 2022
Long-Term Outcomes of Sectorial Longitudinal Augmented Prolapsectomy for Asymmetric Muco-hemorrhoidal Prolapse: An Observational Study of 433 Consecutive Patients
Low recurrence, some bleeding/incontinence risk.RetrospectiveLow qualityRelated question
433 people2022
recurrence was uncommon, no major surgery-time complications, but some patients needed emergency reoperation for bleeding and some developed fecal incontinence
Who was studied
adults with grade III-IV hemorrhoids with uneven (asymmetric) mucosal prolapse
What they received
a surgical technique called sectorial longitudinal augmented prolapsectomy (SLAP), done on one or two hemorrhoidal columns
Main outcome
return of symptoms, return of prolapse, and narrowing of the anal or rectal canal after surgery
Quality
this was a retrospective review of patients having one type of surgery with no comparison group, so it cannot show whether SLAP works better or worse than other treatments.
Limitations
retrospective design, no comparator group, and the surgery was specifically for a particular asymmetric-prolapse subtype rather than hemorrhoids generally
Taken word for word from the abstract
- population Patients affected by III-IV-degree symptomatic HD with asymmetric mucosal prolapse
- intervention the sectorial longitudinal augmented prolapsectomy (SLAP), a technique dedicated to asymmetric prolapse
- n We enrolled 433 patients (277 SLAP1 and 156 SLAP2).
- primaryOutcome Mean outcome was evaluation of medium-long-term outcomes as the occurrence of recurrence and anal or rectal stenosis.
- result Hemorrhoidal symptoms recurrence was reported in 9 patients undergone SLAP1 and 4 patients undergone SLAP2, while prolapse recurrence occurred, respectively, in 4 and 2 patients. No major intraoperative complications occurred. An emergency reintervention for postoperative bleeding occurred in 13 cases undergone SLAP1 and in 5 patients treated with SLAP2. Fecal incontinence occurred in 8 and 4 cases of patients treated with SLAP1 and SLAP2.
- design undergone SLAP of 1 or 2 hemorrhoidal columns (SLAP1 or SLAP2) were retrospectively assessed
Surg Innov · PMID 33830810 · Read it on PubMed ↗
Yu et al. 2021
Clinical study of use of large C suture in procedure for prolapse and hemorrhoids for treatment of mixed hemorrhoids
Few complications with modified stapling surgeryRetrospectiveLow quality
126 people6 months
No patients developed anastomotic stenosis; two patients had secondary anastomotic bleeding
Who was studied
Adults with mixed (grade III or IV) hemorrhoids, including internal and external components
What they received
Stapled hemorrhoidopexy (PPH) using a modified 'large C suture' technique
Main outcome
Rate of anastomotic stenosis and anastomotic (post-operative) bleeding
Quality
This was a retrospective single-center case series with no comparison group, so it cannot show whether this technique is better or worse than other treatments.
Limitations
Retrospective design, no control or comparator group, single hospital, and only 6 months of follow-up.
Taken word for word from the abstract
- population Patients with mixed hemorrhoids (grade III or IV) who underwent treatment with a large C suture during PPH
- intervention treatment with a large C suture during PPH
- primaryOutcome The incidences of anastomotic stenosis and anastomotic hemorrhage after the operation were observed.
- result None of the patients with mixed hemorrhoids developed anastomotic stenosis, although two patients developed secondary anastomotic bleeding.
- n The study population comprised 126 patients
J Int Med Res · PMID 33682485 · Read it on PubMed ↗
Puia et al. 2021
Stapled Hemorrhoidopexy: Technique and Long Term Results
Safe surgery, good long-term resultsRetrospectiveLow quality
35 people6 (1-9) years
Low complication rate (one reoperation for bleeding, two internal hemorrhoid thromboses, one small recurrence at 3 months), short hospital stay, few painkillers needed, and 94% patient satisfaction over a mean follow-up of 6 years
Who was studied
adults with symptomatic second- and third-degree (prolapsing) hemorrhoids
What they received
stapled hemorrhoidopexy (Longo operation) surgery
Main outcome
long-term recurrence/prolapse, complications, and patient satisfaction after surgery
Quality
This is a small, retrospective, single-center study with no comparison group, so it can only describe outcomes of this surgery, not how it compares to other treatments.
Limitations
Retrospective design, small sample (35 patients), single surgical technique only, no control or comparison group, single institution.
Taken word for word from the abstract
- population The data of 35 patients with symptomatic second- and third-degree hemorrhoids who had stapled hemorrhoidopexy using a PPH03 stapler
- intervention stapled hemorrhoidopexy using a PPH03 stapler
- n The data of 35 patients with symptomatic second- and third-degree hemorrhoids who had stapled hemorrhoidopexy
- primaryOutcome The follow-up consisted in a rectal exam and evaluated anatomical recurrence or prolapse.
- result A single patient needed reoperation for a staple line bleeding, two patients had a thrombosis of internal hemorrhoids and in one patient a small prolapse was diagnosed at 3 months follow-up.
- result Global satisfaction rate was 94%.
- followUp Patients were followed-up for 6 (1-9) years.
Chirurgia (Bucur) · PMID 33638331 · Read it on PubMed ↗
Zhai et al. 2022
Evaluation of clinical efficacy of suture-fixation mucopexy in the treatment of prolapsed hemorrhoid
Similar results, less pain, better anal function.Randomised trialModerate quality
123 people2022
no difference in overall effectiveness, but less pain and better anal function with suture-fixation mucopexy
Who was studied
adults with grade II, III, and IV hemorrhoids
What they received
suture-fixation mucopexy
Compared with
Milligan-Morgan hemorrhoidectomy
Main outcome
clinical efficacy, pain, and anal function after surgery
Quality
it was a randomized trial but came from a single hospital with no mention of blinding or long-term follow-up details.
Limitations
single-center study; no blinding described; follow-up duration not specified
Taken word for word from the abstract
- population A total of 123 patients with grade II, III, and IV hemorrhoids were admitted to The TCM Hospital of Pu Dong New District between 2018 and 2019.
- intervention suture-fixation mucopexy
- comparator Milligan-Morgan hemorrhoidectomy
- n the suture-fixation group (SF, N.=60) and the Milligan-Morgan hemorrhoidectomy group (MM, N.=63)
- primaryOutcome Clinical efficacy, postoperative pain, average operation time, hospital stay, complications, and patient satisfaction were prospectively evaluated.
- result No significant differences were identified in clinical efficacy; operation time and hospital stay between the two groups (P>0.05). However, VAS Score in the SF group was lower than that in the MM group. And the SF group was also more advantageous in anal function protection (P<0.05).
Minerva Surg · PMID 33433071 · Read it on PubMed ↗
Giamundo et al. 2022
Doppler-guided hemorrhoidal dearterialization with laser (HeLP): indications and clinical outcome in the long-term. Results of a multicenter trial
90% symptom relief, worse for high-grade hemorrhoidsProspective cohortModerate qualityRelated question
284 people2-year follow-up
89.9% of patients had symptom resolution at 2-year follow-up, but patients with constipation or grade III-IV hemorrhoids had significantly higher failure rates
Who was studied
adults with hemorrhoids, including some with grade III-IV (prolapsing) disease
What they received
Doppler-guided laser treatment that seals off the artery feeding the hemorrhoid (HeLP procedure)
Main outcome
resolution of hemorrhoid symptoms (bleeding, pain, prolapse) at 2 years
Quality
it followed a fairly large group of patients for two years but had no comparison group, so it can't show how this procedure stacks up against other treatments.
Limitations
single-arm study with no comparator group, 8 of 284 patients lost to follow-up, and the procedure is a specific laser dearterialization technique not one of the standard listed treatments
Taken word for word from the abstract
- population Two-hundred-eighty-four patients (183 males, 101 females; mean age: 47.5 years) were included in the trial
- intervention Doppler-guided hemorrhoidal laser procedure consists of sutureless closure of terminal branches of the superior hemorrhoidal artery by laser energy
- n Two-hundred-eighty-four patients (183 males, 101 females; mean age: 47.5 years) were included in the trial
- primaryOutcome Primary endpoint was resolution of symptoms
- result Analysis of 276 patients who completed the 2-year follow-up showed an overall resolution of symptoms in 89.9% (248/276) of patients.
- result Constipation and III-IV grade hemorrhoids were associated with statistically significant higher failure rates (p = 0.046 and 0.012, respectively).
Surg Endosc · PMID 33415419 · Read it on PubMed ↗
Professional Committee of Colorectal Diseases, Chinese Society of Integrated Chinese and Western Medicine 2020
[Consensus of Chinese experts on treatment of prolapsed hemorrhoids with transanal stapler]
Expert guidance on stapler surgeryGuidelineVery low quality
size not given2020
The committee reached consensus recommendations on when to use transanal stapler surgery, how to perform it, and how to manage complications, but no outcome data (such as cure or recurrence rates) are reported
Who was studied
Adults with prolapsed hemorrhoids
What they received
Treatment of prolapsed hemorrhoids using a transanal stapler (stapled procedure)
Main outcome
Expert consensus on indications, contraindications, surgical technique and perioperative management (not a measured clinical outcome)
Quality
This is a group of experts agreeing on best practice by discussion, not a study that measured results in patients, so it carries much less weight than actual trial evidence.
Limitations
No patients, outcomes, or comparative data are reported; it is an opinion-based consensus document rather than a study.
Taken word for word from the abstract
- population Prolapsed hemorrhoids is a common clinical disease
- intervention The transanal stapler has the advantages of simple operation and less trauma in treating prolapsed hemorrhoids.
- primaryOutcome concerning the indications, contraindications, operating specifications and perioperative management of prolapsed hemorrhoids
- result A consensus was consequently formed, aiming to provide a guideline for the clinical practice.
Zhonghua Wei Chang Wai Ke Za Zhi · PMID 33353265 · Read it on PubMed ↗
Didelot et al. 2021
Radiofrequency thermocoagulation of haemorrhoidal bundles, an alternative technique for the management of internal haemorrhoids
Less bleeding and prolapse after RF treatmentProspective cohortLow qualityRelated question
42 people15 months
Counted as a related question: Tests radiofrequency thermocoagulation (Rafaelo procedure), a single treatment approach not mentioned among the standard approaches being compared (conservative measures, rubber band ligation, sclerotherapy, infrared coagulation, stapled hemorrhoidopexy, or excisional hemorrhoidectomy)—and uses a before-and-after design rather than comparing multiple treatment options.
Bleeding dropped from 7/10 to 1/10, prolapse grade fell from 3 to 2, and quality-of-life scores improved markedly after RFT treatment
Who was studied
Adults with internal hemorrhoids, mostly grade III prolapse, treated as outpatients
What they received
Radiofrequency thermocoagulation (RFT) of hemorrhoidal tissue using the Rafaelo procedure
Compared with
None — before-and-after comparison within the same patients
Main outcome
Change in bleeding, prolapse grade (Goligher scale), and quality of life after treatment
Quality
This was a small single-center study with no comparison group, so it can't show whether RFT works better than other treatments, only that patients improved after it.
Limitations
No control group, single-center design, follow-up based on only 39 of 42 treated patients, and outcomes partly self-reported via satisfaction scales
Taken word for word from the abstract
- population 42 outpatients were operated for internal haemorrhoids using RFT
- intervention treated by using the Rafaelo® procedure, using the HPR45i probe (F-Care-Systems) under general anaesthesia
- comparator Assessment was performed prior to the intervention and during follow-up
- primaryOutcome bleeding, improvement, and satisfaction using a verbal analogical scale; and the burden of haemorrhoidal disease using the HEMO-FISS-QoL questionnaire
- result bleeding drastically decreased from 7/10 to 1/10 (p < 0.0001)
- result Prolapse significantly reduced from grade 3 to 2 (p < 0.0001)
- result HEMO-FISS-QoL score significantly improved, dropping from 24.91 to 5.94 (p < 0.001)
- n 42 outpatients were operated for internal haemorrhoids using RFT
Int J Colorectal Dis · PMID 33111967 · Read it on PubMed ↗
Stratta et al. 2021
Conservative Treatment of Hemorrhoidal Disease
Diet and topical care ease early symptomsNarrative reviewLow qualityRelated question
size not given2021
conservative treatment helps manage symptoms in early-stage hemorrhoidal disease, but evidence is largely from uncontrolled case series rather than randomized trials
Who was studied
adults with hemorrhoidal disease, mostly early-stage
What they received
conservative treatments (diet/lifestyle changes, oral phlebotonic drugs, topical medications)
Main outcome
symptom control and disease management
Quality
this is a narrative review that itself states few randomized controlled trials exist and most supporting studies are uncontrolled case series
Limitations
narrative review (not systematic/meta-analysis), focuses on early-stage disease rather than prolapsed grade III/IV hemorrhoids, authors note lack of RCTs and reliance on uncontrolled case series
Taken word for word from the abstract
- population Hemorrhoids are vascular cushions underlying the distal rectal mucosa
- intervention Dietary and lifestyle modifications are the first therapeutic step necessary to achieve a regular defecation with soft stool whereas oral phlebotonic drugs can help to control symptoms.
- primaryOutcome Conservative treatment is effective in managing the majority of patients complaining of early stages of the disease.
- result very few randomized controlled trials have been carried out and most of the studies are uncontrolled case series
Rev Recent Clin Trials · PMID 33087033 · Read it on PubMed ↗
Sobrado et al. 2020
TRANSANAL HAEMORRHOIDAL DEARTERIALIZATION WITH MUCOPEXY (THD-M) FOR TREATMENT OF HEMORRHOIDS: IS IT APPLICABLE IN ALL GRADES? BRAZILIAN MULTICENTER STUDY
Works well for grades II-III, not grade IVProspective cohortModerate quality
705 peopleAverage follow-up was 21 months (12-48)
THD-M was safe with low surgical complication rates for grade II and III hemorrhoids, but grade IV patients had much higher recurrence of prolapse (26.54% vs 2.31% and 2.5%) and bleeding (7.96% vs 0.92% and 1.25%) compared with grades III and II
Who was studied
Adults with grade II, III, or IV symptomatic internal hemorrhoids
What they received
Transanal hemorrhoidal dearterialization with mucopexy (THD-M), a surgical procedure
Compared with
Outcomes compared across hemorrhoid grades (II vs III vs IV) rather than against a different treatment
Main outcome
Complication rates and recurrence of prolapse and bleeding after surgery
Quality
It is a large multicenter study with meaningful follow-up, but it has no comparison group and relies on consecutive case series data rather than a randomized design.
Limitations
No control group or randomization; outcomes depended on surgeon experience across five centers; follow-up duration varied (12-48 months).
Taken word for word from the abstract
- n Seven hundred and five consecutive patients with Goligher's grade II, III or IV symptomatic haemorrhoids underwent surgical treatment using the THD-M method in five participating centres.
- population patients with Goligher's grade II, III or IV symptomatic haemorrhoids
- intervention Transanal haemorrhoidal dearterialization with mucopexy (THD-M)
- comparator to compare the immediate and late results in different grades
- primaryOutcome To evaluate the effectiveness of THD-M technique for treating hemorrhoidal disease and to compare the immediate and late results in different grades.
- result The recurrence of prolapse and bleeding was greater in patients with grade IV haemorrhoidal disease than in those with grade III and II (26.54% and 7.96% vs. 2.31% and 0.92% vs. 2.5% and 1.25%), respectively.
- result The THD-M method is safe and effective for haemorrhoidal disease grades II and III with low rates of surgical complications.
- followUp Average follow-up was 21 months (12-48).
Arq Bras Cir Dig · PMID 32844877 · Read it on PubMed ↗
Hussain et al. 2020
Experience with Haemorrhoidal artery ligation under direct vision at a tertiary care hospital: A case series
Mostly pain-free, few recurrencesCase seriesLow qualityRelated question
70 people6 months
All patients were pain-free at 1 month, 10% had post-operative bleeding not needing further surgery, most returned to work within 1-2 weeks, satisfaction rose from 64% at 3 months to 75% at 6 months, and prolapse recurred in 1 patient (1.42%) by 6 months, treated with band ligation
Who was studied
adults with symptomatic haemorrhoids (grade not specified)
What they received
Haemorrhoidal Artery Ligation (HAL) done under direct vision plus Recto Anal Repair (RAR)
Main outcome
pain, bleeding, return to activity, patient satisfaction and hemorrhoid recurrence after surgery
Quality
This is a small, single-arm case series from one hospital with no comparison group and only 6 months of follow-up, so it cannot show how this procedure compares to other treatments.
Limitations
No control or comparison group, short follow-up, single institution, and the abstract does not specify hemorrhoid grade or confirm prolapse severity matching grade III/IV.
Taken word for word from the abstract
- n We conducted a case series of 70 patients
- population in the management of symptomatic haemorrhoids
- intervention All patients underwent Haemorrhoidal Artery Ligation (HAL) and Recto Anal Repair (RAR).
- primaryOutcome Patients were followed up postoperatively at 1, 3 and 6 months.
- result At 1 month follow up, all 70 (100%) patients were pain free. Post operative bleeding was observed in 7 (10%) patients but did not require surgical intervention.
- result 70 (100%) patients were asymptomatic and 45 (64%) highly satisfied with their surgery at 3 months. This increased to 53 (75%) at 6 months.
- result Prolapse recurrence was observed in 1(1.42%) patient 6 months post operatively which was dealt by band ligation.
J Pak Med Assoc · PMID 32810115 · Read it on PubMed ↗
Jin et al. 2020
Symptom-based scoring for haemorrhoidal disease: a systematic review
Not about treatment choiceSystematic reviewLow qualityRelated question
5 people2020
Only one of five validated scoring systems met proper measurement standards for use; this review does not compare treatments
Who was studied
adults with hemorrhoidal disease
Main outcome
finding a symptom-based scoring tool to classify severity of hemorrhoidal disease
Quality
The review is about symptom scoring tools, not about comparing treatments for prolapsed hemorrhoids, so it gives no direct evidence on which treatment works.
Limitations
Only five studies were found, and most did not follow proper standards for validating symptom scores; this is not a review of treatment effectiveness.
Taken word for word from the abstract
- population Haemorrhoidal disease can severely affect a patient's quality of life.
- n A total of 5288 articles were identified, with five articles included.
- primaryOutcome The aim of this systematic review was to determine the most appropriate instruments that classify the severity of disease according to symptoms.
- result Only one study demonstrated satisfactory valid, reliable and responsive measurement criteria.
Colorectal Dis · PMID 32639663 · Read it on PubMed ↗
De Simone et al. 2021
The Management of Hemorrhoidal Disease by Dearterialization and Mucopexy
Described as safe, low-recurrence option for prolapseNarrative reviewVery low quality
size not given2021
The review describes the technique as avoiding serious or life-threatening complications, having limited risk of recurrence, and minimal impact on anorectal function, provided careful postoperative bowel management is followed
Who was studied
Adults with hemorrhoidal disease, including those with prolapsing internal hemorrhoids
What they received
Doppler-guided hemorrhoidal dearterialization combined with mucopexy (THD procedure) to treat prolapse without removing the hemorrhoids
Main outcome
Safety and outcome of the dearterialization and mucopexy technique for treating hemorrhoidal prolapse
Quality
This is a descriptive narrative review of a surgical technique with no reported patient numbers, comparison group, or measured outcomes, so it cannot show how well the treatment actually works.
Limitations
No study data, patient numbers, or comparative results are given; claims about safety and recurrence are general statements rather than findings from a specific trial.
Taken word for word from the abstract
- population to treat hemorrhoids without any excision
- intervention a plication of the redundant and prolapsing mucosa/submucosa of the rectum (named "mucopexy") has been introduced to treat hemorrhoidal prolapse, without excision of the hemorrhoidal piles
- primaryOutcome Advantages of this surgical technique are the absence of serious and life-threatening postoperative events, chronic complications, and limited recurrence risks.
- result Advantages of this surgical technique are the absence of serious and life-threatening postoperative events, chronic complications, and limited recurrence risks. The impact of the procedure on the anorectal physiology is negligible.
Rev Recent Clin Trials · PMID 32370723 · Read it on PubMed ↗
Giamundo 2021
Hemorrhoidal Laser Procedure (HeLP) and Hemorrhoidal Laser Procedure + Mucopexy (HeLPexx) and Other Emerging Technologies
Describes laser technique, no outcome dataNarrative reviewVery low qualityRelated question
size not given2021
The abstract describes which patients each procedure is suited for, without reporting comparative outcome data
Who was studied
Adults with symptomatic hemorrhoids, including some with mucosal prolapse
What they received
Laser dearterialization (HeLP), sometimes combined with suture mucopexy (HeLPexx), and artery embolization (Emborrhoid)
Quality
This is a descriptive narrative piece about new laser and embolization techniques with no patient numbers, no comparison group, and no measured outcomes.
Limitations
No original data, no sample size, no outcome measurements, and the laser procedure alone is explicitly outside the scope of this prolapse treatment question
Taken word for word from the abstract
- population patients suffering from symptomatic hemorrhoids
- intervention 'HeLP' (Hemorrhoids Laser Procedure) is a novel form of dearterialization to treat patients suffering from symptomatic hemorrhoids.
- intervention In the case of concomitant severe mucosal prolapse, laser treatment can be combined with suture mucopexy.
- result 'HeLP' is indicated in patients with symptomatic hemorrhoids where conservative treatment failed and when mucosal prolapse is scarce or not symptomatic.
- result The addition of mucopexy to laser treatment (HeLPexx) contributes to the overall resolution of symptoms when mucosal prolapse is an issue.
Rev Recent Clin Trials · PMID 32250230 · Read it on PubMed ↗
Sena et al. 2021
Excisional Haemorrhoidectomy: Where Are We?
Surgery works best for severe prolapse.Narrative reviewLow qualityRelated question
size not given2021
Excisional hemorrhoidectomy techniques are described as the most effective treatment for grade III and IV hemorrhoidal disease, despite improvements in conservative treatments
Who was studied
Adults with hemorrhoidal disease, particularly grade III and IV (prolapsing) hemorrhoids
What they received
Excisional hemorrhoidectomy techniques (Milligan and Morgan, Parks, Ferguson, Whitehead)
Compared with
Conservative treatments
Main outcome
Overall effectiveness of treatment for hemorrhoidal disease
Quality
This is a narrative review describing surgical techniques without reporting original data, patient numbers, or systematic comparison of outcomes.
Limitations
No original data, no patient numbers, no systematic methodology described, and no direct comparison data between conservative, office-based, and surgical approaches.
Taken word for word from the abstract
- population Haemorrhoidal disease (HD) is defined as the symptomatic enlargement and/or distal displacement of anal cushions
- intervention we describe the most common techniques such as Milligan and Morgan, Parks, Ferguson and Whitehead technique
- comparator Despite significant improvements in conservative treatments
- result excisional haemorrhoidectomy techniques are the most effective treatment for III- and IV degree
- primaryOutcome The severity of HD is based on the degree of the prolapse.
Rev Recent Clin Trials · PMID 32189597 · Read it on PubMed ↗
Sturiale et al. 2021
Stapled Surgery for Hemorrhoidal Prolapse: From the Beginning to Modern Times
Review favors stapled surgery, no new dataNarrative reviewLow qualityRelated question
size not given2021
Narrative review describing the evolution of stapled hemorrhoidopexy devices and technique; reports that stapled hemorrhoidopexy is safe and effective with quicker recovery, shorter hospital stay, less pain, bleeding, wound complications and constipation compared to conventional treatment, and that newer generation staplers outperform first generation ones
Who was studied
adults with prolapsing hemorrhoids
Main outcome
safety, effectiveness, recovery and complications of stapled hemorrhoidopexy compared with conventional surgery
Quality
This is a narrative review describing technique history and citing other studies' findings without presenting new data, methods, or numbers, so it cannot be weighted strongly.
Limitations
No original data, no study design details, no patient numbers, no statistics, and no systematic methodology described; it is a descriptive/historical overview referencing unspecified 'several studies'.
Taken word for word from the abstract
- population Hemorrhoidal disease is the most common proctologic condition in adults.
- primaryOutcome Several studies have reported that SH is a safe and effective procedure to treat hemorrhoidal prolapse.
- result It is a quicker procedure with a shorter hospital stay and earlier return to work if compared with the conventional treatment. This is due to less postoperative pain, postoperative bleeding, wound complications and constipation.
- result the first generation devices had worse outcomes if compared with those of the new generation stapler that showed lower postoperative complication rates with better anatomical and symptomatic results.
Rev Recent Clin Trials · PMID 32156241 · Read it on PubMed ↗
Giamundo et al. 2020
Hemorrhoid laser procedure with suture-pexy (HeLPexx): a novel effective procedure to treat hemorrhoidal disease
Marked symptom improvement, few recurrences.Prospective cohortLow qualityRelated question
170 people36 months (range 12-72 months)
Symptom scores dropped sharply after treatment, with low complication rates and 7% needing further treatment for recurrence
Who was studied
Adults with grade III internal hemorrhoids
What they received
HeLPexx (Doppler-guided laser treatment of hemorrhoid blood vessels plus stitching to lift the prolapse)
Main outcome
Change in hemorrhoid symptom score (bleeding, prolapse, discomfort, quality of life)
Quality
This was a single-group study with no comparison treatment, so it cannot show whether HeLPexx works better than other options.
Limitations
No control group for comparison; single-center study; severe constipation predicted treatment failure.
Taken word for word from the abstract
- population patients with grade III hemorrhoids who had HeLPexx
- n One hundred and seventy consecutive patients with grade III hemorrhoids
- intervention the hemorrhoid laser procedure with suture-pexy (HeLPexx), consisting of Doppler-guided hemorrhoidal dearterialization with laser and the addition of anal mucopexy
- primaryOutcome The sum of the score for each symptom constituted the Hemorrhoid Symptom Score.
- result The Hemorrhoid Symptom Score significantly improved from 15.83 ± 3.04 to 1.3 ± 2.4 (p ≤ 0.001) and showed a statistically significant improvement in all items.
- result Recurrent symptoms were reported in 12 patients (7%) who required further treatment.
Tech Coloproctol · PMID 31993838 · Read it on PubMed ↗
Shen et al. 2019
[Procedure for prolapse and hemorrhoids versus stapled transanal rectal resection in the treatment of grade IV hemorrhoids]
STARR had fewer relapses but higher cost and risk.RetrospectiveLow quality
263 people40 (33, 52) months
STARR took longer and cost more, but had a lower 3-year recurrence rate (0% vs 4.2%); one STARR patient developed a rectovaginal fistula
Who was studied
adults having their first surgery for grade IV internal hemorrhoids
What they received
stapled hemorrhoidopexy (PPH)
Compared with
stapled transanal rectal resection (STARR)
Main outcome
how well and how safely the surgery worked, including complications and hemorrhoid recurrence
Quality
This was a retrospective, non-randomized comparison from a single surgical team, so differences between groups could be due to factors other than the procedure itself.
Limitations
Retrospective cohort design without randomization, single center, and only two of several possible surgical options were compared.
Taken word for word from the abstract
- n 263 patients undergoing the first elective surgery for grade IV hemorrhoids
- population patients undergoing the first elective surgery for grade IV hemorrhoids by the same team of surgeons
- intervention the procedure for prolapse and hemorrhoids (PPH)
- comparator stapled transanal rectal resection (STARR)
- primaryOutcome To compare the efficacy and safety of two procedures in the treatment of hemorrhoid
- result As compared to PPH group, STAAR group had longer operation time and higher hospitalization cost with significant differences
- result The 3-year disease-relapse rate was 0 in STARR group and 4.2% in PPH group (P=0.042).
- result One case in STAAR group developed rectovaginal fistula.
Zhonghua Wei Chang Wai Ke Za Zhi · PMID 31874533 · Read it on PubMed ↗
Banai et al. 2019
[HAL-RAR for the treatment of hemorrhoids - a new, non invasive method]
Few complications, good results at 1 yearCase seriesLow qualityRelated question
45 people1 year
Counted as a related question: Tests HAL-RAR, a single new surgical technique in isolation without comparing it to other treatment approaches like conservative care, rubber band ligation, sclerotherapy, or conventional hemorrhoidectomy that the question asks about.
3 of 45 patients had complications within 30 days (proctitis, thrombosed hemorrhoid, bleeding), 2 needed reoperation; most were treated as one-day surgery; at 1 year no recurrence of bleeding or pain, but one patient had recurrence of prolapse
Who was studied
Adults with grade II or III internal hemorrhoids that prolapse
What they received
HAL-RAR (Doppler-guided ligation of hemorrhoidal arteries combined with mucopexy of prolapsed tissue)
Main outcome
Postoperative complications, pain, and recurrence after surgery
Quality
This is a small, single-arm case series without a comparison group, so it can't reliably show how HAL-RAR stacks up against other treatments.
Limitations
Small sample size (45 patients), no control or comparator group, single-center retrospective-style review of consecutive operations.
Taken word for word from the abstract
- population in the cases of grade III or - in some cases - grade II haemorrhoids
- n a total of 45 patients were operated on with the HAL-RAR procedure
- intervention Doppler-guided ligation of the haemorrhoidal arteries (HAL) is combined with a mucopexy of the prolapsed haemorrhoidal tissue (RAR = Recto Anal Repair)
- primaryOutcome Complications were seen in three patients within 30 days of surgery.
- result One patient had proctitis, one patient suffered from a thrombosed haemorrhoid, while one patient had bleeding, which occurred on the 16th postoperative day. Two of them needed re-operation.
- result Neither the bleeding, nor the pain did not re-appear after 1 year, but one patient mentioned recurrence of the prolapse.
Magy Seb · PMID 31813242 · Read it on PubMed ↗
Lightner et al. 2020
Excisional Hemorrhoidectomy: Safe in Patients With Crohn's Disease?
Surgery seemed safe in Crohn's patientsRetrospectiveLow qualityRelated question
36 people31.5 (range, 1 to 255) months
11% of patients had complications (stricture, abscess/fistula, non-healing wound, or hemorrhoid recurrence) after surgery, with no need for bowel removal reported
Who was studied
Adults with Crohn's disease who had symptomatic hemorrhoids, some with prolapse
What they received
Surgical removal of hemorrhoids (excisional hemorrhoidectomy)
Main outcome
Safety and complications after hemorrhoidectomy surgery
Quality
This is a small retrospective review of only 36 patients from two centers with no comparison group, so it can't reliably show how this compares to other treatments.
Limitations
Retrospective design, no comparator group, small sample size, specific to Crohn's disease patients rather than general hemorrhoid population
Taken word for word from the abstract
- population A total of 36 adult patients with Crohn's disease with symptomatic hemorrhoidal disease were included.
- intervention excisional hemorrhoidectomy
- primaryOutcome postoperative complications including bleeding, wound healing, and need for further therapy or surgical intervention after surgery
- result 4 patients (11%) had complications (1 developed a stricture, 1 developed a perianal abscess/fistula, 1 had a nonhealing wound, and 1 had hemorrhoidal recurrence)
- n A total of 36 adult patients with Crohn's disease with symptomatic hemorrhoidal disease were included.
Inflamm Bowel Dis · PMID 31633186 · Read it on PubMed ↗
Godeberge et al. 2020
Hemorrhoidal disease and chronic venous insufficiency: Concomitance or coincidence; results of the CHORUS study (Chronic venous and HemORrhoidal diseases evalUation and Scientific research)
Survey of treatment patterns, not outcomes.RetrospectiveLow qualityRelated question
5,617 people2020
Treatments most commonly prescribed were venoactive drugs (94.3%), dietary fiber (71.4%), topical treatment (70.3%), analgesics (26.3%), and surgery (23.5%). The presence of CVD, reported in approximately half the patients (51.2%), was strongly associated with advanced grade of HD
Who was studied
adult patients attending a consultation for hemorrhoidal complaints
Main outcome
to explore the frequency with which it coexists with chronic venous disease (CVD) and shared risk factors
Quality
This was a one-time survey of patients with no control group or randomization, so it can show associations and treatment patterns but cannot show whether any treatment actually works better than another.
Limitations
Noninterventional, cross-sectional survey design; only 36.2% of patients reported prolapse and grades were not isolated to III/IV, and no outcome data comparing treatments were collected.
Taken word for word from the abstract
- population This international, noninterventional study enrolled adult patients attending a consultation for hemorrhoidal complaints.
- n A total of 5617 patients were analyzed.
- primaryOutcome to explore the frequency with which it coexists with chronic venous disease (CVD) and shared risk factors
- result Treatments most commonly prescribed were venoactive drugs (94.3%), dietary fiber (71.4%), topical treatment (70.3%), analgesics (26.3%), and surgery (23.5%).
- result The presence of CVD, reported in approximately half the patients (51.2%), was strongly associated with advanced grade of HD (P < 0.0001).
- limitations prolapse (36.2%)
J Gastroenterol Hepatol · PMID 31512275 · Read it on PubMed ↗
Reboa et al. 2019
Integrated Treatment With Stapled Haemorrhoidopexy and Proctonorm® of Haemorrhoidal Disease
High satisfaction after surgery plus supplementRetrospectiveVery low qualityRelated question
100 peoplesix-month follow-up
Complication and pain scores were low after surgery, satisfaction was high at six months, and constipation scores were reduced compared to before surgery; there was no comparison group without the supplement
Who was studied
Adults with haemorrhoidal disease undergoing stapled haemorrhoidopexy surgery
What they received
Stapled haemorrhoidopexy followed by a post-operative supplement (Proctonorm) plus anti-inflammatory medication as needed
Main outcome
Post-operative complications, pain, patient satisfaction, and constipation scores after surgery
Quality
This is a retrospective study with no comparison group, so it cannot show whether the supplement or the surgery itself caused the outcomes seen.
Limitations
No control group (e.g., surgery alone without Proctonorm), retrospective design, and outcomes are reported only for the combined surgery-plus-supplement protocol.
Taken word for word from the abstract
- population Forty-six males and 54 females received Proctonorm
- intervention patients undergoing Stapled Haemorrhoidopexy (SH) who were post-operatively treated with Proctonorm
- n Forty-six males and 54 females received Proctonorm
- primaryOutcome assessing its effect on early and late haemorrhoidal-related symptoms
- result At six-month follow-up, a high index of patient satisfaction (VAS=9.39±0.24) was self-reported with 75% reduction in CSS (Constipation Scoring System) (1.95±2.58) compared to preoperative scores; "Late Complication Score" was 0.
- result "Early Complication Score" (0-12) two days after surgery was 2.02±1.03; pain VAS (Visual Analogue Scale) (0-10) was 1.21±0.89
In Vivo · PMID 31471422 · Read it on PubMed ↗
Schneider et al. 2019
Long-Term Results After Stapled Hemorrhoidopexy: A 15-Year Follow-Up
High long-term recurrence, but most patients satisfiedRetrospectiveLow quality
140 people15 years
Nearly half (47.4%) had at least one symptom come back, mostly more than 10 years after surgery; 15.2% needed another surgery; new bowel control problems occurred (15.5% incontinence, 28% urgency, 9.4% difficulty emptying); still, 62.3% were very satisfied overall
Who was studied
Adults with grade III internal hemorrhoids who had stapled hemorrhoidopexy surgery
What they received
Stapled hemorrhoidopexy (a stapling procedure for prolapsed hemorrhoids)
Main outcome
Long-term recurrence of hemorrhoidal symptoms, need for further treatment, bowel function problems, and patient satisfaction
Quality
This looked back at patients from a database with only about half reachable for follow-up, relied on their phone-interview memory of symptoms, and had no comparison group, so the findings are less reliable.
Limitations
Only 140 of 257 original patients had follow-up data (large loss to follow-up); based on patient-reported telephone interview rather than clinical exam; no control group for comparison.
Taken word for word from the abstract
- population All patients with a hemorrhoidal disease grade III, who underwent stapled hemorrhoidopexy from May 1999-December 2003, were included.
- intervention The stapled hemorrhoidopexy is reported to have a low recurrence while treating the major hemorrhoidal symptoms of bleeding and prolapse.
- primaryOutcome we recorded information regarding the postoperative recurrence and severity of hemorrhoidal symptoms (defined as bleeding, prolapse, burning, itching and moisture), further hemorrhoidal treatments and functional results (incontinence, fecal urgency and outlet obstruction) as well as patients' satisfaction
- n Of the 257 patients, who underwent stapled hemorrhoidopexy, follow-up data were available in 140 patients.
- result In 47.4% of the patients, a recurrence of at least one hemorrhoidal symptom was registered, whereas this recurrence was observed in 47.3% of these patients more than 10 years postoperatively. A surgical re-intervention was necessary in 15.2%. We found a postoperative new incontinence in 15.5%, a fecal urgency in 28.0% and an outlet obstruction in 9.4%. Of all patients, 62.3% were "very satisfied" with the operation.
World J Surg · PMID 31227850 · Read it on PubMed ↗
Genova et al. 2019
Transanal hemorrhoidal dearterialization versus Milligan-Morgan hemorrhoidectomy in grade III/IV hemorrhoids
THD faster recovery, but more grade IV recurrenceRandomised trialLow quality
87 peoplethree months, one year and three years
For grade III hemorrhoids, THD gave faster pain relief and recovery with similar overall results to MM. For grade IV hemorrhoids, THD also gave faster early recovery but had a 15% recurrence rate at three years, whereas MM had no recurrence at three years.
Who was studied
Adults with grade III-IV internal hemorrhoids who had not had previous surgery
What they received
Transanal hemorrhoidal dearterialization (THD)
Compared with
Milligan-Morgan hemorrhoidectomy (MM)
Main outcome
Post-operative pain, speed of recovery/return to normal life, and recurrence
Quality
Small randomized trial (87 patients split into four subgroups) at a single center using a subjective symptom questionnaire, with no detail on blinding or how randomization was concealed.
Limitations
Small sample especially in the grade IV subgroups, symptom assessment was based on a simple subjective questionnaire, and the abstract gives no detail on blinding or statistical significance testing for the recurrence difference.
Taken word for word from the abstract
- population Between January 2010 and March 2013 they were recruited 87 patients with grade III-IV hemorrhoids. All patients did not previously undergo surgical treatment.
- intervention Transanal Hemorroidal Dearterialization (THD)
- comparator The Milligan Morgan hemorrhoidectomy (MM)
- primaryOutcome It was evaluated in particular the post-operative pain recovery, the reaching the feeling of wellness (evaluated with a modified VAS scale), the presence of bleeding and soiling.
- result Grade III-IV hemorrhoids treated with THD showed a more rapid achievement of the wellness with a lower incidence of post-operative pain and faster recovery and return to work activities and social life compared to MM cases.
- result there has been an incidence of recurrence at 3 years equal to 15% of cases. In grade IV hemorrhoids treated with MM no recurrence occurred during the three-year follow-up.
- n they were recruited 87 patients with grade III-IV hemorrhoids
- followUp The patients then underwent follow-up to at three months, one year and three years.
Ann Ital Chir · PMID 31182699 · Read it on PubMed ↗
Song et al. 2019
[Effect of preoperative intervention of electroacupuncture at Baliao point on postoperative complications of procedure for prolapsed and hemorrhoids]
Less post-surgery pain with acupuncture add-onRandomised trialLow qualityRelated question
60 people24 h
the acupuncture group had lower anal pendant and pain scores at 6, 12, and 18 hours after surgery, shorter duration of anal pendant feeling and pain within 24 hours, and earlier first urination, all statistically significant
Who was studied
adults with mixed hemorrhoids undergoing stapled hemorrhoidopexy (PPH) surgery
What they received
electroacupuncture at Baliao point given 30 minutes before surgery
Compared with
surgery alone with no acupuncture
Main outcome
anal pendant sensation score, pain score, how long these lasted, and time to first urination after surgery
Quality
this is a small, single-trial study of only 60 patients looking at an add-on acupuncture treatment for post-surgical discomfort, not a comparison of treatment approaches for prolapsed hemorrhoids, and it only tracked outcomes for 24 hours.
Limitations
small sample size (30 per group), very short follow-up of only 24 hours, and the study tests a preoperative add-on to one specific surgical technique rather than comparing different treatment approaches for prolapsed hemorrhoids
Taken word for word from the abstract
- n Sixty patients with pre-mixed hemorrhoids PPH were randomly divided into a simple operation group and a preoperative electroacupuncture intervention group, 30 cases in each group.
- population patients with pre-mixed hemorrhoids PPH
- intervention Electroacupuncture (EA) was applied at Baliao point 30 min before PPH in the preoperative electroacupuncture intervention group
- comparator PPH routine treatment was given in the simple operation group.
- primaryOutcome The scores of anus pendant, pain degree and persistent time and first urination time were compared within 24 h after operation between the two groups.
- result The scores of anal pendant and pain degree in the 6 h, 12 h, 18 h, the persistent time of anal pendant and pain degree within 24 h and first urination time were better in the preoperative electroacupuncture intervention group than those in the simple operation group, and there were statistically significant differences (all P<0.05).
Zhongguo Zhen Jiu · PMID 30942010 · Read it on PubMed ↗
Qamar Naqvi et al. 2018
Haemorrhoidal Artery Ligation Operation Without Doppler Guidance
Low pain and complications after this surgery.Case seriesLow qualityRelated question
97 people6 months
Pain scores dropped from 1.76 at 1 week to 0 by 6 months; bleeding occurred in 1.03% at 1 week and 2.06% at 6 months; prolapse persisted in 4.12% of patients; 96.91% of patients were satisfied overall
Who was studied
Adults with hemorrhoids that did not respond to banding or sclerotherapy (grade II), or who had grade III or IV hemorrhoids
What they received
Surgery to tie off the blood vessels feeding the hemorrhoids (HALO), done without Doppler ultrasound guidance
Main outcome
Pain, bleeding, prolapse recurrence, and patient satisfaction after surgery
Quality
This was a single group of patients followed over time with no comparison to other treatments, so it cannot show whether this surgery works better or worse than other options.
Limitations
No control or comparison group, single center, not randomized, so results cannot be directly compared against other hemorrhoid treatments.
Taken word for word from the abstract
- population Consenting patients with second degree haemorrhoids not responding to banding or sclera-therapy and those with third and fourth degree haemorrhoids were included in the study.
- intervention Haemorrhoidal artery ligation operation (HALO) with or without Doppler guidance
- n A total of 97 patients (n=97) were included in the study.
- primaryOutcome We aimed to study the efficacy of HALO without Doppler guidance in terms of presence of postoperative complications including pain, bleeding, prolapse and overall patient satisfaction.
- result At 1 week follow up after HALO, mean pain score was 1.76, at 6 weeks it was 0.4 and at 6 months none of the patients had any pain. Postoperative bleeding was seen in 1 patient at 1 week (1.03%). None of the patients had bleeding at 6 weeks (0%), and 2 patients reported mild occasional bleeding at 6 months' post op (2.06%). Four of our patients had persistent prolapse post-operatively (4.12%) which persisted throughout follow up. Ninety-four (96.91%) patients were overall satisfied with the procedure, whereas 3 patients (3.09%) were not satisfied.
J Ayub Med Coll Abbottabad · PMID 30838827 · Read it on PubMed ↗
Ray-Offor et al. 2019
Hemorrhoidal disease: Predilection sites, pattern of presentation, and treatment
Mostly describes hemorrhoid locations, not prolapse treatmentProspective cohortLow qualityRelated question
121 people2019
Grade I, II, and III hemorrhoids were seen in 38 (31%), 31 (26%), and 21 (17%) of cases; the study concludes that Grade I hemorrhoids are effectively treated with 50% dextrose sclerotherapy, described as a cheap and physiologic agent
Who was studied
Adults diagnosed with hemorrhoids at an endoscopy centre in Nigeria, ages 15-80, including both asymptomatic and symptomatic cases
What they received
Injection sclerotherapy using 50% dextrose solution
Main outcome
Anatomical location, clinical presentation, and treatment of hemorrhoidal disease
Quality
This is a small descriptive cohort mainly cataloguing hemorrhoid location and grade, with only a brief conclusion about treating grade I disease, not a controlled comparison of treatments for prolapsed (grade III/IV) hemorrhoids.
Limitations
Not a comparative treatment study; focuses mostly on anatomic distribution; conclusion about treatment applies to grade I hemorrhoids, not specifically to prolapsed grade III/IV disease; includes external hemorrhoids without prolapse.
Taken word for word from the abstract
- n One hundred and twenty- one cases were included in study.
- population A cohort study of patients diagnosed with haemorrhoids at an Endoscopy centre in Port Harcourt, Rivers State Nigeria from February 2014- July 2017.
- intervention Goligher classification Grade 1 hemorrhoids are effectively treated by injection sclerotherapy using 50% dextrose solution; a cheap and physiologic sclerotherapy agent.
- primaryOutcome Variables studied included: demographics, anatomic variations, grade of haemorrhoids, clinical presentation and treatment.
- result Grade I, II and III haemorrhoids were seen in 38 (31%), 31(26%) and 21(17%) cases respectively.
- result Goligher classification Grade 1 hemorrhoids are effectively treated by injection sclerotherapy using 50% dextrose solution; a cheap and physiologic sclerotherapy agent.
Ann Afr Med · PMID 30729927 · Read it on PubMed ↗
Guttadauro et al. 2018
Day-surgery stapled prolassectomy: a "ten minutes job"
Stapled surgery feasible as day caseCase seriesLow qualityRelated question
50 people2018
92% of patients had complete pain control during surgery; 88% were discharged the same day; no patient needed to be switched to general anesthesia
Who was studied
Adults aged 18-65 with hemorrhoids undergoing stapled prolassectomy surgery, classified as low anesthesia risk (ASA I)
What they received
Stapled hemorrhoidopexy (stapled prolassectomy) performed under local-regional anesthesia as day surgery
Main outcome
Pain control during surgery and whether patients could be discharged the same day
Quality
This is a small, single-arm case series of 50 patients with no comparison group, so it can only show that the procedure is feasible, not how it compares to other treatments.
Limitations
No control or comparison group; small sample size; focuses on anesthesia technique and day-surgery logistics rather than comparing treatment approaches for prolapsed hemorrhoids
Taken word for word from the abstract
- n we performed 50 hemorrhoidal stapled prolassectomies
- population All patients were classified as ASA I and were aged between 18 and 65 years
- intervention we performed 50 hemorrhoidal stapled prolassectomies under local-regional anesthesia
- primaryOutcome Intraoperative pain control was found to be complete and optimal for the majority of patients (92%)
- result Forty-four of the patients (88%) were discharged on the same day of the operation
- result A conversion to general anesthesia was never required
Ann Ital Chir · PMID 30665225 · Read it on PubMed ↗
Popov et al. 2019
Doppler-guided transanal hemorrhoidal dearterilization versus conventional hemorrhoidectomy for treatment of hemorrhoids - early and long-term postoperative results
Less early pain, similar long-term resultsProspective cohortModerate qualityRelated question
287 peoplebetween 18 and 78 months (mean 46 ± 16 months)
THD caused less pain in the first week after surgery and shorter hospital stay than conventional hemorrhoidectomy; by 30 days and at 18 months, pain and satisfaction were similar between groups, and long-term recurrence rates requiring further surgery were not significantly different (about 3% in each group) after a mean follow-up of 46 months
Who was studied
Adults with hemorrhoids of various stages, including advanced (4th-degree) hemorrhoids
What they received
Doppler-guided transanal hemorrhoidal dearterialization (THD) with mucopexy
Compared with
conventional (excisional) hemorrhoidectomy
Main outcome
postoperative pain, complications, hospital stay, and long-term recurrence/satisfaction
Quality
A reasonably large comparative study with long follow-up, but it was not stated to be randomized, so differences between groups could be due to factors other than the treatment itself.
Limitations
Not described as randomized; groups differed at baseline in preoperative bleeding frequency; single-center or unspecified-center design with no blinding mentioned.
Taken word for word from the abstract
- population 287 patients who underwent CH (167 cases) or Doppler-guided THD with mycopexy (120 patients)
- intervention Doppler-guided THD with mycopexy
- comparator conventional hemorrhoidectomy (CH)
- primaryOutcome postoperative pain, patients' satisfaction and follow-up
- result The mean visual analog scale (VAS) pain scores in CH and THD groups on days 1, 2 and 7 were 7.01 vs 5.03, 5.07 vs 2.98, 2.39 vs 0,57 (p = 0,000).
- result 5 patients (2,99%) in CH group required surgery for recurrence. In THD group, 3 patients (2,5%), all with 4th-degree hemorrhoids underwent additional procedures (p 0,802).
- n 287 patients who underwent CH (167 cases) or Doppler-guided THD with mycopexy (120 patients)
- followUp The postoperative follow-up was between 18 and 78 months (mean 46 ± 16 months).
BMC Surg · PMID 30630463 · Read it on PubMed ↗
Lin et al. 2019
Partial Stapled Hemorrhoidopexy Versus Circumferential Stapled Hemorrhoidopexy for Grade III to IV Prolapsing Hemorrhoids: A Randomized, Noninferiority Trial
Similar success, fewer side effects with partial surgeryRandomised trialModerate qualityRelated question
300 peoplea median follow-up period of 5 years
Counted as a related question: This study compares two surgical techniques (partial vs. circumferential stapled hemorrhoidopexy) against each other, whereas the question asks which of several different treatment approaches (conservative care, office procedures, or surgery) should be used for prolapsed hemorrhoids.
Recurrence rates were similar between the two surgeries (9% vs 12%, not significantly different, within the noninferiority margin), but the partial procedure caused less pain, less urgency, better continence, and no cases of rectal narrowing versus 5% with the circumferential procedure.
Who was studied
Patients with grade III/IV hemorrhoids
What they received
partial stapled hemorrhoidopexy
Compared with
circumferential stapled hemorrhoidopexy
Main outcome
rate of recurrent prolapse at a median follow-up period of 5 years
Quality
It was a well-designed randomized trial with long follow-up, but it was conducted at only one hospital, which limits how well the results generalize.
Limitations
The study was limited because it was a single-center trial.
Taken word for word from the abstract
- population Patients with grade III/IV hemorrhoids between August 2011 and November 2013 were included.
- intervention partial stapled hemorrhoidopexy (group 1, n = 150)
- comparator circumferential stapled hemorrhoidopexy (group 2, n = 150)
- primaryOutcome The primary outcome was the rate of recurrent prolapse at a median follow-up period of 5 years with a predefined noninferiority margin of 3.75%.
- result The 5-year cumulative recurrence rate between group 1 (9% (95% CI, 4%-13%)) and group 2 (12% (95% CI, 7%-17%)) did not differ significantly (p = 0.137), and the difference was within the noninferiority margin (absolute difference, -3.33% (95% CI, -10.00% to 3.55%)).
- result Postoperative rectal stenosis did not develop in patients in group 1, although it occurred in 8 patients (5%) in group 2 (p = 0.004).
- result Fewer patients in group 1 experienced postoperative urgency compared with those in group 2 (p = 0.001).
- n Three hundred patients were randomly assigned to undergo either partial stapled hemorrhoidopexy (group 1, n = 150) or circumferential stapled hemorrhoidopexy (group 2, n = 150).
Dis Colon Rectum · PMID 30489326 · Read it on PubMed ↗
Sturiale et al. 2018
Long-term results after stapled hemorrhoidopexy: a survey study with mean follow-up of 12 years
Many recurrences and incontinence long-term.RetrospectiveLow quality
171 people12 ± 0.8 years (range 11-13 years)
At a mean 12-year follow-up, 40.9% of patients self-reported prolapse recurrence, 75.6% had improved symptom severity/frequency, complications occurred in 56.7% (8.7% serious), 39.1% had impaired continence, and 81.2% reported good satisfaction
Who was studied
Adults who previously had stapled hemorrhoidopexy surgery for hemorrhoidal prolapse
What they received
Stapled hemorrhoidopexy (circular stapler, PPH03 device)
Main outcome
Long-term anatomical recurrence, symptom recurrence, complications, and patient satisfaction after surgery
Quality
This was a retrospective, single-arm survey relying on patients' phone-reported memories years later, with no comparison group, so it can only describe outcomes after this one procedure, not how it compares to other treatments.
Limitations
Retrospective design, self-reported outcomes via phone questionnaire, no control group, use of older first-generation stapling devices, and reliance on patient recall over a decade later.
Taken word for word from the abstract
- population All the patients who had stapled hemorrhoidopexy using a PPH03 stapler, from January 2003 to December 2005, were retrospectively collected in a dedicated database.
- intervention stapled hemorrhoidopexy using a PPH03 stapler
- n One hundred and ninety four patients were identified and 171 completed the questionnaire.
- primaryOutcome The study evaluated anatomical recurrence, symptom recurrence and frequency, and satisfaction after surgery.
- result Anatomical self-reported prolapse recurrence was 40.9% (n = 70). In 75.6% (n = 129) of patients, the severity and frequency of symptoms improved. The overall complication rate was 56.7% (n = 40) with a serious adverse event rate of 8.7% (n = 15). The overall tenesmus rate was 38.2% (n = 65) and the overall impaired continence rate was 39.1% (n = 67).
- result Patient satisfaction rate was good (≥ 3 on a scale of 1 to 5) in 81.2% (n = 139) of cases.
Tech Coloproctol · PMID 30288629 · Read it on PubMed ↗
Zagriadskiĭ et al. 2018
Conservative Treatment of Hemorrhoids: Results of an Observational Multicenter Study
Most improved with flavonoid pills alone.Prospective cohortLow qualityRelated question
1,952 people25-30 days
76.3% of patients had their main symptoms (bleeding and prolapse) resolved with MPFF-based conservative treatment alone; 3.5% with grade IV hemorrhoids still needed invasive treatment, and 20.2% with grades I-III combined MPFF with invasive treatment
Who was studied
adults with symptomatic hemorrhoid disease, including various grades (I-IV), some with bleeding and prolapse of internal hemorrhoids
What they received
conservative oral treatment with micronized purified flavonoid fraction (MPFF, Detralex)
Main outcome
resolution of main hemorrhoid symptoms (bleeding and prolapse of internal nodes)
Quality
this was an observational study with no control group and no blinding, and it was funded by the maker of the drug being studied, so its findings are not strong evidence of what caused the improvement.
Limitations
non-interventional design with no comparator group, mixed hemorrhoid grades (I-IV) rather than isolating prolapsed grade III/IV disease, short follow-up, and industry funding by the drug manufacturer.
Taken word for word from the abstract
- population patients with complaints of hemorrhoids
- population bleeding and prolapse of internal nodes
- intervention MPFF-based conservative treatment
- n A total of 1952 patients were enrolled.
- primaryOutcome eliminating the main clinical manifestations of disease, i.e., bleeding and prolapse of internal nodes
- result MPFF-based conservative treatment was effective in 1489 (76.3%) patients in eliminating the main clinical manifestations of disease, i.e., bleeding and prolapse of internal nodes.
- result Invasive treatment was performed in 68 (3.5%) patients with grade IV hemorrhoids and was combined with MPFF conservative treatment in 395 (20.2%) patients with grades I-III hemorrhoids.
- followUp 25-30 days after enrollment
Adv Ther · PMID 30276625 · Read it on PubMed ↗
Freymond et al. 2018
[Proctological emergencies in pregnant women]
In pregnancy, conservative care preferred over surgeryNarrative reviewLow qualityRelated question
size not given2018
Hygiene and dietary measures plus conservative treatment (local anesthetics, sitz baths) are recommended first; surgery should be avoided and used only if conservative treatment fails; rectal prolapse should be manually reduced before any surgery
Who was studied
pregnant women with hemorrhoids, anal fissures, or rectal prolapse in later pregnancy
Main outcome
management approach for these conditions in pregnancy
Quality
This is a general review about pregnancy-related anorectal problems, not a study testing treatments for prolapsed internal hemorrhoids specifically, and gives no data on numbers of patients or outcomes.
Limitations
Abstract covers pregnant women only, lumps hemorrhoids together with anal fissure as 'these two entities', and does not distinguish grade III/IV internal hemorrhoid prolapse or describe office procedures like banding or sclerotherapy; it is a narrative overview with no study population or outcome data.
Taken word for word from the abstract
- population Hemorrhoids affect up to 85 % of pregnant women during the last two trimesters.
- result The treatment includes above all hygiene and dietary measures to prevent constipation and conservative measures (local anesthetics, sitz baths). Surgical procedures should be avoided and indicated only in case of failure of conservative treatment.
- result Rectal prolapse is more rare and must be reduced manually before surgery.
- primaryOutcome The treatment includes above all hygiene and dietary measures to prevent constipation and conservative measures (local anesthetics, sitz baths).
Rev Med Suisse · PMID 30091329 · Read it on PubMed ↗
Liu et al. 2018
Rectal inclusion cyst as a complication of stapled hemorrhoidopexy: A case report
Rare cyst complication after stapling surgeryCase seriesVery low qualityRelated question
1 people6 months
Counted as a related question: This case report documents a rare complication (rectal inclusion cyst) that developed after stapled hemorrhoidopexy rather than comparing different treatment approaches for prolapsed hemorrhoids themselves.
The cyst was surgically removed and the patient fully recovered with no recurrence for at least 6 months.
Who was studied
A 49-year-old woman who had stapled hemorrhoidopexy for prolapsing hemorrhoids and later developed anorectal pain and fever
What they received
Stapled hemorrhoidopexy (as the procedure linked to a later complication)
Main outcome
Diagnosis and treatment of a rare cyst complication (rectal inclusion cyst) after stapled hemorrhoidopexy
Quality
This is a single case report describing one patient's complication, so it cannot show how common this problem is or how stapled hemorrhoidopexy compares to other treatments.
Limitations
Only one patient is described, with no comparison group, so the findings cannot be generalized to typical rates of this complication.
Taken word for word from the abstract
- n A 49-year-old woman was admitted to our hospital
- population A 49-year-old woman was admitted to our hospital with a complaint of anorectal pain and fever complaints after stapled hemorrhoidopexy.
- intervention Stapled hemorrhoidopexy is gaining popularity for prolapsing hemorrhoids.
- primaryOutcome Rectal inclusion cysts are rare complications that results from the potential space in the staple line.
- result The patient had complete recovery, with no recurrence or complaints for at least 6 months after the surgery.
Medicine (Baltimore) · PMID 29851787 · Read it on PubMed ↗
Venara et al. 2018
A comparison of surgical devices for grade II and III hemorrhoidal disease. Results from the LigaLongo Trial comparing transanal Doppler-guided hemorrhoidal artery ligation with mucopexy and circular stapled hemorrhoidopexy
Device brand made little difference in outcomes.Randomised trialModerate qualityRelated question
377 people12 postoperative months
Postoperative morbidity and outcome at 1 year were similar regardless of the type of devices used, though within the stapled group one device type had more short-term anal urgency or incontinence than the other.
Who was studied
Adults with hemorrhoidal disease (grade II and III) treated surgically
What they received
Doppler-guided hemorrhoidal artery ligation with mucopexy (DGHAL), comparing two different surgical devices (THD vs HAL-RAR)
Compared with
Circular stapled hemorrhoidopexy (CSH), comparing two different stapler devices (PPH-03 vs HEM)
Main outcome
Complications after surgery and recurrence/reoperation rate at 1 year
Quality
It was a well-sized multicenter randomized trial, but it only compared device brands within two surgical techniques rather than comparing the full range of treatment approaches for prolapsed hemorrhoids.
Limitations
The study compared specific device brands within two surgical techniques (DGHAL and stapled hemorrhoidopexy) rather than comparing conservative care, office procedures, and surgery as distinct approaches; it also included grade II disease, which is milder than the grade III/IV prolapse asked about.
Taken word for word from the abstract
- n Three hundred and seventy-seven patients were randomized according to HD grade.
- population when a surgical treatment is considered for hemorrhoidal disease (HD)
- intervention In the DGHAL arm (N = 193), the procedure was done with transanal hemorrhoidal dearterialization (THD)™ (THD, Correggio, Italy) (104 patients) and with HAL-RAR™ (Agency for Medical Innovations (AMI) GmbH, Feldkirch, Austria) (89 patients).
- comparator In the CSH arm (N = 184), procedure for prolapse and hemorrhoids (PPH)-03™ (Ethicon Endo-Surgery, Cincinnati OH) and hemorrhoidopexy and prolapse (HEM)™ (Covidien, Inc.) staplers were used in respectively 106 and 78 cases.
- primaryOutcome Surgery-related morbidity at 90 postoperative days (POD) based on the Clavien-Dindo procedure-related complication score and clinical outcome in terms of recurrence and reoperation rate at 12 postoperative months (POM) was collected.
- result Postoperative morbidity and outcome at 1 year were similar regardless of the type of devices used.
Int J Colorectal Dis · PMID 29808305 · Read it on PubMed ↗
Tradi et al. 2018
Embolization of the Superior Rectal Arteries for Hemorrhoidal Disease: Prospective Results in 25 Patients
Embolization helped most, failed in some.Prospective cohortLow qualityRelated question
25 people12 months
72% of patients had symptom relief at 12 months, with improved pain, bleeding, quality of life, and prolapse scores, and no complications; 7 patients had complete treatment failure
Who was studied
Adults with grade II-III hemorrhoids that had not responded to medical treatment
What they received
Superior rectal artery embolization (a procedure blocking blood flow to hemorrhoid-feeding arteries using coils, done through a blood vessel in the groin)
Compared with
None — all patients received the embolization procedure, no comparison group
Main outcome
Relief of symptoms by 12 months, defined as a 2-point improvement in pain and bleeding scores
Quality
This was a small study of only 25 patients with no comparison group and no blinding, so it cannot show whether embolization works better than other treatments.
Limitations
Small sample size, no control/comparator group, included grade II hemorrhoids which do not prolapse, and 8 of the successful patients needed a second embolization procedure
Taken word for word from the abstract
- population 25 consecutive patients (16 men and 9 women with a mean age of 53 y [range, 30-76 y]) with grade II-III hemorrhoids refractory to medical treatment
- intervention A transfemoral superselective superior rectal artery branch embolization was performed using 2- and 3-mm diameter microcoils
- comparator This prospective study was conducted between 2014 and 2015 on 25 consecutive patients
- primaryOutcome The primary endpoint was relief of symptoms by 12 months based on a 2-point minimum improvement on VAS score and bleeding score
- result At 12 months after embolization, clinical success was obtained in 18 patients (72%), 8 of whom had 2 embolizations.
- result VAS score decreased from 4.6 to 2.3 (P < .01), and bleeding score decreased from 5.5 to 2.3 (P < .01). Quality-of-life and prolapse scores also showed improvement (P < .05), and no patients experienced any early or late complications.
- result Complete clinical failure was observed in 7 patients.
- n 25 consecutive patients
J Vasc Interv Radiol · PMID 29724519 · Read it on PubMed ↗
van Tol et al. 2018
Towards a core outcome set for hemorrhoidal disease-a systematic review of outcomes reported in literature
Doesn't test treatments; studies vary in measures.Systematic reviewLow qualityRelated question
34 people2018
found wide variation in what outcomes were measured and defined across studies, with pain, blood loss, prolapse, and incontinence most commonly reported but often undefined
Who was studied
adults with hemorrhoidal disease
Main outcome
types of outcomes reported in hemorrhoidal disease studies
Quality
this review doesn't test any treatment's effectiveness, so it can't tell you whether any approach works, only that studies measure outcomes inconsistently.
Limitations
Abstract notes a high variation in definitions of common outcomes and often no definition at all for what was measured.
Taken word for word from the abstract
- population interventional studies for adult patients with HD
- n A total of 34 randomized controlled trials and prospective observational studies were included in this study.
- primaryOutcome to systematically list the types of outcomes used in HD studies
- result The most frequently reported outcomes were pain (91%), blood loss (94%), prolapse (71%), and incontinence (56%). There was a high variation in definitions of the common outcomes. And often there was no definition at all.
- limitations There was a high variation in definitions of the common outcomes. And often there was no definition at all.
Int J Colorectal Dis · PMID 29680897 · Read it on PubMed ↗
Sandler et al. 2019
Rethinking What We Know About Hemorrhoids
More research needed, no clear answerNarrative reviewLow qualityRelated question
size not given2019
This review found that hemorrhoid causes and symptoms are poorly understood, medical therapies are largely unstudied, office procedures like rubber band ligation and infrared coagulation are widely used, and surgery works but can be painful; it calls for more research rather than giving treatment recommendations
Who was studied
Adults with hemorrhoids (general, not specifically limited to prolapsed internal hemorrhoids)
Main outcome
Understanding of hemorrhoid causes, symptoms, and treatment effectiveness
Quality
This is a narrative opinion piece pointing out gaps in evidence, not a systematic review or trial comparing treatments, so it carries little weight for deciding what works.
Limitations
The abstract explicitly states medical therapies have not been formally studied, symptoms are poorly understood, and it is a general commentary rather than a focused study on prolapsed hemorrhoids specifically or a comparison of treatment options.
Taken word for word from the abstract
- population Symptoms commonly attributed to hemorrhoids include bleeding, pain, pruritus, fecal seepage, prolapse, and mucus discharge.
- result Medical therapies for hemorrhoids have not been formally studied except for fiber where the results have been inconsistent.
- result A number of office-based interventions such as rubber band ligation and infrared coagulation are widely used and economically favorable for practitioners.
- result Surgical procedures are effective at eliminating hemorrhoids but may be painful.
- result Given the burden of disease and numerous gaps in our understanding, the time has come for targeted research to understand the cause, symptoms, and best treatment for patients with symptomatic hemorrhoids.
- primaryOutcome the time has come for targeted research to understand the cause, symptoms, and best treatment for patients with symptomatic hemorrhoids
Clin Gastroenterol Hepatol · PMID 29601902 · Read it on PubMed ↗
Bellio et al. 2018
Stapled Hemorrhoidopexy: Results at 10-Year Follow-up
High long-term recurrence, declining satisfactionRetrospectiveLow quality
86 people119.0 months
At 10 years, 39% had recurrent prolapse, 8% had gas leakage, and satisfaction was 68%; no major complications like fistula or stenosis occurred
Who was studied
Adults with grade 3 prolapsing internal hemorrhoids
What they received
Stapled hemorrhoidopexy surgery
Main outcome
Patient satisfaction and recurrence of hemorrhoid prolapse over long-term follow-up
Quality
Small single-center retrospective study with no control group, so it can't compare stapled hemorrhoidopexy to other treatments directly.
Limitations
Small sample size and lack of a control group
Taken word for word from the abstract
- population Eighty-six consecutive patients treated with stapled hemorrhoidopexy for grade 3 hemorrhoidal prolapse between January and December 2006 were included.
- intervention stapled hemorrhoidopexy
- n Eighty-six consecutive patients treated with stapled hemorrhoidopexy for grade 3 hemorrhoidal prolapse
- primaryOutcome Patients satisfaction and recurrence rates were measured.
- result 30 patients (39%) experienced a recurrent hemorrhoidal prolapse, 8 of whom needed a reoperation. Thirty-four patients (44%) reported urge to defecate with a median visual analog scale of 1 (range, 1-7). Six patients (8%) reported gas leakage at the last follow-up visit, whereas no liquid or solid stool leakage was recorded. Satisfaction rate at 10-year follow-up was 68%.
- limitations The study was limited by its small sample size and lack of a control group.
- followUp median duration of 119.0 months (range 115.4-121.8 mo)
Dis Colon Rectum · PMID 29521831 · Read it on PubMed ↗
Mott et al. 2018
Hemorrhoids: Diagnosis and Treatment Options
Step-up care: self-care, then banding, then surgeryNarrative reviewLow quality
size not given2018
Initial conservative care (stool softeners, fiber/water, sitz baths) is first-line; if unsuccessful, office-based rubber band ligation is preferred over infrared photocoagulation for grades I-III due to lower failure rate; excisional hemorrhoidectomy gives greater surgical success but more pain and longer recovery, so it is reserved for recurrent or higher-grade disease; stapled hemorrhoidopexy repositions grade III/IV hemorrhoids but has potential complications; hemorrhoidal artery ligation may cause less pain and faster recovery for grade II/III hemorrhoids; excision of thrombosed external hemorrhoids reduces pain if done early.
Who was studied
Adults with hemorrhoids, including internal hemorrhoids graded I to IV
Main outcome
Treatment success, symptom relief, pain, and recovery after different hemorrhoid treatments
Quality
This is a narrative review summarizing existing literature and expert recommendations without a described systematic search or pooled analysis, so it carries less certainty than a systematic review.
Limitations
No systematic search methodology or quantitative synthesis of studies is described; it is a general clinical review article.
Taken word for word from the abstract
- population Many Americans between 45 and 65 years of age experience hemorrhoids.
- population Internal hemorrhoids are traditionally graded from I to IV based on the extent of prolapse.
- primaryOutcome Other factors such as degree of discomfort, bleeding, comorbidities, and patient preference should help determine the order in which treatments are pursued.
- result Medical management (e.g., stool softeners, topical over-the-counter preparations, topical nitroglycerine), dietary modifications (e.g., increased fiber and water intake), and behavioral therapies (sitz baths) are the mainstays of initial therapy.
- result If these are unsuccessful, office-based treatment of grades I to III internal hemorrhoids with rubber band ligation is the preferred next step because it has a lower failure rate than infrared photocoagulation.
- result Open or closed (conventional) excisional hemorrhoidectomy leads to greater surgical success rates but also incurs more pain and a prolonged recovery than office-based procedures; therefore, hemorrhoidectomy should be reserved for recurrent or higher-grade disease.
- result Stapled hemorrhoidopexy elevates grade III or IV hemorrhoids to their normal anatomic position by removing a band of proximal mucosal tissue; however, this procedure has several potential postoperative complications.
- result Hemorrhoidal artery ligation may be useful in grade II or III hemorrhoids because patients may experience less pain and recover more quickly.
- result Excision of thrombosed external hemorrhoids can greatly reduce pain if performed within the first two to three days of symptoms.
Am Fam Physician · PMID 29431977 · Read it on PubMed ↗
Ratto et al. 2017
Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: a single-center study on 1000 consecutive cases and a review of the literature
Low recurrence, few complications with THD.RetrospectiveLow qualityRelated question
1,000 people44 ± 29 months
9.5% of patients had symptoms return (recurrence) during an average follow-up of about 44 months, and by final follow-up 95.7% of patients showed no hemorrhoid disease on exam after accounting for repeat procedures; early complications included bleeding in 1.4%, pain in 3.1%, and urinary retention in 2.3%
Who was studied
adults with grade 2, 3, or 4 hemorrhoid disease
What they received
transanal hemorrhoidal dearterialization (THD) Doppler procedure, with added mucopexy stitching when prolapse was present
Main outcome
change in symptoms and hemorrhoid grade from before treatment to last follow-up, including recurrence rate
Quality
This was a single-center case series of one procedure without a comparison group, so it cannot show how this treatment stacks up against other options.
Limitations
No comparator group, retrospective design, and the procedure (THD) is not one of the standard approaches (banding, sclerotherapy, infrared, stapling, or excisional surgery) being compared for this question.
Taken word for word from the abstract
- n There were 1000 patients (619 men; mean age: 48.6 years, range 19-88 years).
- population consecutive patients with grade 2, 3, or 4 hemorrhoidal disease were treated with the THD Doppler procedure
- intervention Dearterialization was performed in all cases and mucopexy in case of prolapse.
- primaryOutcome Clinical efficacy was assessed comparing both frequency of symptoms and disease grading (Goligher's classification) at baseline versus last follow-up.
- result the symptomatic recurrence rate was 9.5% (95 patients; bleeding in 12 (1.2%), prolapse in 46 (4.6%), and bleeding and prolapse in 37 (3.7%) patients)
- result At final follow-up and taking into account the reoperations, 95.7% of patients had no hemorrhoidal disease on examination.
- result Acute postoperative bleeding was observed in 14 patients (1.4%), pain/tenesmus in 31 patients (3.1%), and urinary retention in 23 patients (2.3%).
- followUp At mean follow-up duration of 44 ± 29 months
Tech Coloproctol · PMID 29170839 · Read it on PubMed ↗
Davies et al. 2017
Diagnosis and Management of Anorectal Disorders in the Primary Care Setting
No specific findings reported.Narrative reviewVery low qualityRelated question
size not given2017
the article says it discusses diagnosis and management of common anorectal disorders in primary care but does not describe specific findings or comparisons for prolapsed hemorrhoids
Who was studied
patients with anorectal disorders seen in primary care
Main outcome
how anorectal disorders are diagnosed and managed
Quality
This is a general narrative review that does not report any specific data, comparisons, or outcomes for prolapsed hemorrhoid treatments.
Limitations
Abstract gives no details on hemorrhoid grading, specific treatments, or outcomes; it covers anorectal disorders broadly rather than prolapsed hemorrhoids specifically.
Taken word for word from the abstract
- population Anorectal disorders are very common among a wide population of patients.
- primaryOutcome This article discusses the diagnoses and management of common anorectal disorders among patients presenting to a primary care physician.
- result This article discusses the diagnoses and management of common anorectal disorders among patients presenting to a primary care physician.
Prim Care · PMID 29132530 · Read it on PubMed ↗
Grotenhuis et al. 2018
Implementation of a New High-Volume Circular Stapler in Stapled Anopexy for Hemorrhoidal Disease: Is Patient's Short-Term Outcome Affected by a Higher Volume of Resected Tissue?
Similar short-term results between two stapler typesProspective cohortLow qualityRelated question
141 people2018
The high-volume stapler removed more tissue but had similar readmission and complication rates; all 5 patients needing repeat surgery for leftover hemorrhoids or prolapse had used the high-volume stapler
Who was studied
Adults having stapled surgery for hemorrhoids and/or anal prolapse
What they received
High-volume circular stapling device (CHEX) for stapled anopexy
Compared with
Conventional circular stapler (PPH-3) for stapled anopexy
Main outcome
Short-term outcome after surgery (readmission and complication rates) and amount of tissue removed
Quality
Small, non-randomized comparison of two surgical devices with only short-term follow-up, so it offers limited evidence about overall hemorrhoid treatment choices.
Limitations
Not randomized, short-term follow-up only, and the study compares two stapler devices rather than different treatment strategies for prolapsed hemorrhoids
Taken word for word from the abstract
- population stapled anopexy was performed for hemorrhoids and/or anal prolapse in 141 patients
- n stapled anopexy was performed for hemorrhoids and/or anal prolapse in 141 patients (n = 25 conventional PPH-3©-stapler versus n = 116 high-volume CHEX©-stapler)
- intervention high-volume CHEX©-stapler
- comparator conventional PPH-3©-stapler
- primaryOutcome operation details and short-term postoperative outcome were compared
- result Postoperative short-term outcome did not differ in terms of readmission and complication rates. In all 5 patients who underwent a redo operation for residual hemorrhoids or prolapse, the high-volume stapler was used in the primary operation.
Dig Surg · PMID 29131098 · Read it on PubMed ↗
Iida et al. 2017
Procedure for prolapse and hemorrhoids (PPH) with low rectal anastomosis using a PPH 03 stapler: low rate of recurrence and postoperative complications
RetrospectiveLow quality
1,315 people5- and 16-year
A modified stapled hemorrhoidopexy technique (PPH-LA03) had lower rates of massive bleeding, less continued prolapse, and lower long-term recurrence than the original stapling method, with recurrence as low as traditional hemorrhoidectomy and no serious complications
Who was studied
adults with hemorrhoids treated surgically (including prolapsing hemorrhoids)
Main outcome
postoperative complications, bleeding, and long-term recurrence of hemorrhoids after different surgical techniques
Quality
This is a large retrospective comparison of different surgical groups over many years without randomization, so differences between groups could reflect factors other than the procedure itself.
Limitations
Not randomized; abstract does not specify hemorrhoid grades for all patients or give full details on how groups were selected or matched.
Taken word for word from the abstract
- n Among a total of 1315 patients with hemorrhoids
- population Among a total of 1315 patients with hemorrhoids, MMH was conducted in 322, original PPH using a PPH 01 stapler (PPH01) in 63, PPH-LA using 01 (PPH-LA01) in 236, 03 (PPH-LA03) in 649, and sclerotherapy (SCL) in 45.
- primaryOutcome The purpose of this study was to evaluate PPH with low rectal anastomosis (PPH-LA) in comparison with the original PPH and MMH.
- result The rate of massive postoperative bleeding was significantly lower after PPH-LA03 than after PPH01 or PPH-LA01.
- result A significantly higher proportion of patients complained of continued prolapse after PPH01 than after MMH, PPH-LA01, or -LA03.
- result The 5- and 16-year postoperative cumulative recurrence rates after PPH-LA03 were significantly lower than after PPH01.
- result No serious postoperative complications occurred after any form of PPH.
- followUp The 5- and 16-year postoperative cumulative recurrence rates after PPH-LA03 were significantly lower than after PPH01.
Int J Colorectal Dis · PMID 28956135 · Read it on PubMed ↗
Jiang et al. 2017
Comparison of clinical outcomes of multi-point umbrella suturing and single purse suturing with two-point traction after procedure for prolapse and hemorrhoids (PPH) surgery
Umbrella suture reduced some surgical complications.Randomised trialLow qualityRelated question
90 peoplethree months follow-up
The multipoint umbrella suture had fewer submucosal hematomas, less incomplete hemorrhoid retraction, and fewer skin tags at follow-up, but took longer to perform; no difference was seen in pain, bleeding, or hospital stay between the two suturing methods
Who was studied
Adults with mixed hemorrhoids undergoing PPH surgery
What they received
PPH surgery plus multipoint umbrella suturing technique
Compared with
PPH surgery plus single-purse suture with two-point traction
Main outcome
Operation time, hemorrhoid retraction, postoperative pain and bleeding, hospital stay, and complications after PPH surgery
Quality
This is a small single-surgeon randomized trial comparing two suturing techniques within one surgical procedure, not a comparison of the different treatment approaches (conservative, office procedures, or surgery) for prolapsed hemorrhoids being asked about.
Limitations
Small sample (90 patients), single experienced surgeon performed all operations, short follow-up period, and the comparison is between two technical variants of one surgical procedure rather than between different treatment strategies for prolapsed hemorrhoids.
Taken word for word from the abstract
- population for the treatment of mixed hemorrhoids
- n Ninety patients were randomly divided
- intervention PPH plus multipoint umbrella suture (Group B)
- comparator PPH plus single-purse suture group (Group A)
- primaryOutcome Operation time, width of the specimen, hemorrhoids retraction extent, postoperative pain, postoperative bleeding, and length of hospitalization were recorded and compared.
- result the incidence rates of submucosal hematoma and incomplete hemorrhoid core retraction were significantly lower in Group B (P < 0.05)
- result There were fewer redundant skin tags in Group B at three months follow-up.
- result No significant difference in postoperative pain, postoperative bleeding, and time of hospital stay (P > 0.05 for all comparisons) was observed.
Int J Surg · PMID 28943492 · Read it on PubMed ↗
Leung et al. 2017
A prospective randomized controlled trial evaluating the short-term outcomes of transanal hemorrhoidal dearterialization versus tissue-selecting technique
TST showed less recurrence than THDRandomised trialModerate qualityRelated question
80 people1 year
TST had lower bleeding and prolapse symptom scores at 1 year, less recurrence needing further treatment (4/40 vs 17/40), and higher satisfaction scores than THD; pain scores were similar between groups
Who was studied
adults with symptomatic hemorrhoids (excluding external-only or thrombosed hemorrhoids)
What they received
tissue-selecting technique (TST), a targeted stapled hemorrhoid surgery
Compared with
transanal hemorrhoidal dearterialization (THD)
Main outcome
postoperative pain, symptom recurrence, and patient satisfaction
Quality
it was a randomized trial but small (80 patients), from a single study, and only reported short-term results.
Limitations
small sample size, short-term follow-up only, and the abstract does not specify hemorrhoid grade (III/IV) for participants
Taken word for word from the abstract
- population Patients presenting with symptomatic hemorrhoids were recruited.
- intervention Tissue-selecting technique (TST) is a novel stapled hemorrhoidectomy technique which targets the hemorrhoids, leaving uninvolved mucosal bridges intact and avoiding circumferential circular stapling.
- comparator compare the short-term outcomes of TST and transanal hemorrhoidal dearterialization (THD)
- primaryOutcome Patient demographics, perioperative data, postoperative pain scores, recurrence and patient satisfaction scores were evaluated.
- n 80 patients were included in the study, 40 in each group
- result The median symptom scores for bleeding and prolapse were significantly lower in the TST group at 1 year (bleeding 1 vs. 2, p = 0.001; prolapse 1 vs. 2, p = 0.025). There was significantly less recurrence requiring reintervention in the TST group (4/40 vs. 17/40, p = 0.001). Satisfaction was significantly greater after TST.
Tech Coloproctol · PMID 28932913 · Read it on PubMed ↗
He et al. 2017
A Randomized Multicenter Clinical Trial of RPH With the Simplified Milligan-Morgan Hemorrhoidectomy in the Treatment of Mixed Hemorrhoids
Combined ligation plus excision surgery had fewer complications.Randomised trialLow qualityRelated question
3,000 people2017
RPH combined with sMMH had the highest efficacy rate and the lowest rates of postoperative bleeding, urine retention, anal fissure, hematoma/thrombosis, and anal narrowing compared with the other four surgery types; no differences were seen in rectovaginal fistula or incontinence between groups
Who was studied
adults with mixed hemorrhoids (both internal and external components)
What they received
different surgical techniques: Ruiyun procedure for hemorrhoids (RPH) alone or combined with simplified Milligan-Morgan hemorrhoidectomy (sMMH)
Compared with
simplified Milligan-Morgan hemorrhoidectomy (MMH) alone, procedure for prolapse and hemorrhoids (PPH) alone, or PPH combined with sMMH
Main outcome
cure/efficacy rate, operation time, length of hospital stay, and postoperative complications
Quality
although this was a large multicenter randomized trial, it studied a mixed hemorrhoid population rather than specifically prolapsed grade III/IV internal hemorrhoids, surgery cannot be blinded, and 'efficacy rate' is not clearly defined in the abstract.
Limitations
Population was 'mixed hemorrhoids' rather than specifically prolapsed internal hemorrhoids; surgical treatment cannot be blinded; the abstract does not define how 'efficacy' was measured.
Taken word for word from the abstract
- population 3000 patients with mixed hemorrhoids
- intervention Ruiyun procedure for hemorrhoids (RPH) or RPH with the simplified Milligan-Morgan hemorrhoidectomy (sMMH)
- comparator MMH alone, procedure for prolapse and hemorrhoids (PPH) alone, and PPH+sMMH
- primaryOutcome The outcomes and postoperative complications were compared between 5 types of surgeries.
- result The efficacy rate was the highest in patients who received RPH+sMMH and decreased in the following order: patients who received RPH alone, MMH alone, procedure for prolapse and hemorrhoids (PPH) alone, and PPH+sMMH
- result The incidence of postoperative hemorrhage, uroschesis, anal fissure, crissum hematoma or thrombosis, and anorectal stenosis was significantly lower in patients who received RPH+sMMH than in patients who received the other 4 types of surgical treatments
- n a randomized, controlled, balanced, multicenter study of 3000 patients with mixed hemorrhoids
Surg Innov · PMID 28918703 · Read it on PubMed ↗
Tsunoda et al. 2017
A prospective randomized trial of transanal hemorrhoidal dearterialization with mucopexy versus ultrasonic scalpel hemorrhoidectomy for grade III hemorrhoids
Similar quality of life; less early pain with mucopexyRandomised trialModerate quality
44 peoplemedian 33 months (range 12-46 months)
Pain was less in the first week with the dearterialization/mucopexy procedure, but by 2 weeks there was no difference; quality of life was similar between the two groups long-term, though a few more dearterialization patients needed repeat treatment later
Who was studied
adults with grade III (prolapsed) internal hemorrhoids
What they received
Doppler-guided hemorrhoidal artery ligation with mucopexy (a less invasive procedure that stitches up the prolapsing tissue)
Compared with
hemorrhoidectomy using an ultrasonic scalpel (surgical removal of the hemorrhoid tissue)
Main outcome
pain after surgery and quality of life
Quality
it was a randomized trial, but with only 44 patients at a single centre it is too small to reliably detect differences in rarer outcomes like recurrence or complications.
Limitations
Small sample size (44 patients), single-center study, and only two patients per group had hemorrhage complications so rates can't be compared reliably.
Taken word for word from the abstract
- population third-degree hemorrhoids
- n Forty-four patients were randomly assigned to undergo either DM or US.
- intervention transanal Doppler-guided hemorrhoidal dearterialization with mucopexy (DM)
- comparator hemorrhoidectomy using an ultrasonic scalpel (US)
- primaryOutcome The primary endpoint was postoperative pain with quality of life
- result Postoperative pain was less intense in the DM group than in the US group during week 1 (p < 0.05), but no difference was seen after 2 weeks.
- result There were no between-group differences in quality of life.
- result During a median 33-month follow-up (range 12-46 months), two patients in the DM group and one patient in the US group underwent further surgery for residual hemorrhoid related problems.
- followUp During a median 33-month follow-up (range 12-46 months)
Tech Coloproctol · PMID 28871428 · Read it on PubMed ↗
Peng et al. 2017
[A multicenter, randomized controlled trial of wheat cellulose particles in the treatment of internal hemorrhoids]
Fiber plus drug helped bleeding, not prolapse specifically.Randomised trialLow qualityRelated question
60 people7 days
the combination group had a higher overall effective rate (96.7% vs 66.7%) and better bleeding, stool, and defecation scores, but the hemorrhoid prolapse score improved in both groups with no significant difference between them
Who was studied
adults aged 18-65 with grade II or III internal hemorrhoids
What they received
wheat cellulose particles (Fiberform) plus diosmin tablets
Compared with
diosmin tablets alone
Main outcome
a composite symptom score covering bleeding, pain, prolapse, stool shape, defecation frequency and duration, rated as effective or not
Quality
small short trial (60 patients, 7 days) using a composite symptom score, and it did not show a significant benefit specifically for the prolapse symptom itself.
Limitations
Short 7-day treatment course, small sample size, mixed grade II and III patients, and no significant effect was seen on the prolapse score specifically, which is what this question concerns.
Taken word for word from the abstract
- population 60 patients with internal hemorrhoid were enrolled
- population being diagnosed with the second or third grade internal hemorrhoid
- intervention wheat cellulose particles 1 bag each time, 2 times per day; Diosmin tablet 2 pills, 2 times per day
- comparator Diosmin tablet 2 pills, 2 times per day
- primaryOutcome the efficacy evaluation would be made on six indicators, which were the degree of hematochezia or bleeding, the degree of pain, hemorrhoid prolapse, the shapes and properties of stool, the defecation frequency and the defecation duration
- result there was significant difference in effective rate between combination group and single group [96.7%(29/30) vs. 66.7%(20/30), Z=-4.376, P=0.000]
- result The scores of pain degree and hemorrhoid prolapse of two groups also decreased, but the difference was not statistically significant (P>0.05).
- n 60 patients with internal hemorrhoid were enrolled
Zhonghua Wei Chang Wai Ke Za Zhi · PMID 28722093 · Read it on PubMed ↗
Trenti et al. 2017
Distal Doppler-guided transanal hemorrhoidal dearterialization with mucopexy versus conventional hemorrhoidectomy for grade III and IV hemorrhoids: postoperative morbidity and long-term outcomes
Similar results, THD vs hemorrhoidectomy.RetrospectiveLow quality
83 peopleminimum of 1 year after surgery
No significant difference in postoperative morbidity (26.5% vs 8.82%, p=0.085) or in persistence of bleeding, prolapse, need for manual reduction, or pain between the two procedures at long-term follow-up; minor fecal incontinence occurred only after conventional hemorrhoidectomy (5.4%).
Who was studied
Adults with grade III and IV internal hemorrhoids that prolapse
What they received
Doppler-guided transanal hemorrhoidal dearterialization (THD) with mucopexy
Compared with
Conventional excisional hemorrhoidectomy (Milligan and Morgan or Ferguson technique)
Main outcome
Postoperative complications and long-term recurrence of hemorrhoid symptoms (bleeding, prolapse, need for manual reduction, pain, quality of life, continence)
Quality
This was a non-randomized, single-center comparison of only 83 patients, so differences between groups could be due to chance or selection rather than the treatments themselves.
Limitations
Not randomized; single center; relatively small sample size; morbidity difference did not reach statistical significance despite a large numeric gap.
Taken word for word from the abstract
- n Eighty-three patients were included in the study.
- population grade III and IV hemorrhoids
- intervention Distal Doppler-guided transanal hemorrhoidal dearterialization with mucopexy (Doppler-guided THD)
- comparator conventional excisional hemorrhoidectomy (Milligan and Morgan or Ferguson)
- primaryOutcome Severity of hemorrhoid symptoms (bleeding, prolapse, manual reduction, discomfort or pain and impact on quality of life) and fecal continence status (Vaizey score) were evaluated before surgery and at minimum of 1 year after surgery.
- result No significant differences between the groups were observed in terms of persistence of bleeding, prolapse, need for manual reduction in prolapse and pain.
- result Minor fecal incontinence occurred only after conventional hemorrhoidectomy in 2 (5.4%) patients.
- followUp at minimum of 1 year after surgery
Tech Coloproctol · PMID 28451767 · Read it on PubMed ↗
Petersen et al. 2016
TST36 stapling for rectocele and hemorrhoidal prolapse - early results of the prospective German multicenter study
Symptoms improved but many complications.Prospective cohortLow qualityRelated question
110 people6 months
Mechanical problems with stapler use occurred in 20% of cases, additional stitches for bleeding were needed in 78.2%, reintervention for bleeding in 6.3%, and recurrent hemorrhoidal prolapse in 4.5%; both ODS and incontinence scores improved significantly after surgery
Who was studied
Adults with advanced hemorrhoidal disease or with obstructed defecation syndrome (ODS) due to rectal intussusception or rectocele
What they received
Stapled transanal surgery using the TST36 stapling device for hemorrhoidal prolapse or rectocele
Main outcome
Safety and feasibility of the procedure, including complications and changes in incontinence (CCIS) and obstructed defecation (Altomare ODS) scores
Quality
This was a single-arm observational study without a comparison group, mixing patients with hemorrhoidal disease and patients with rectocele/rectal prolapse, so it cannot show how this approach compares to other hemorrhoid treatments.
Limitations
No control or comparator group; combined population of hemorrhoidal disease and rectocele/ODS patients makes it hard to isolate hemorrhoid-specific outcomes; notable intraoperative and postoperative complication rates; short follow-up.
Taken word for word from the abstract
- population The indication for surgery was an advanced hemorrhoidal disease in 55 patients and ODS with rectal intussusception or rectocele in 55 patients.
- intervention stapled transanal procedures performed by a 36 mm stapling device, the so-called TST36 stapler
- primaryOutcome The Cleveland Clinic Incontinence Score (CCIS) for incontinence and the Altomare ODS score were determined preoperatively.
- result Mechanical problems with stapler introduction occurred in 22 cases (20%) and a partial stapleline dehiscence in 4 cases (3.6%). Additional stitches for bleeding from stapleline were necessary in 86 patients (78.2%). Reintervention was necessary for bleeding 7 times (6.3%). Severe complications during follow-up were stapleline dehiscence in one case and recurrent hemorrhoidal prolapse in 5 cases (4.5%). Altomare ODS score and CCIS improved significantly after surgery.
- n 110 consecutive patients (71 women, 39 men) with a mean age of 59.7 years (±13.8 years) were included in the study.
Ger Med Sci · PMID 28066159 · Read it on PubMed ↗
Macchini et al. 2016
Pneumoretroperitoneum and pneumomediastinum after Stapled Anopexy Is conservative treatment possible?
Rare surgery leak treated without more surgeryCase seriesVery low qualityRelated question
1 people2016
Patient developed a minor leak causing air in the chest and abdomen after stapled hemorrhoidopexy surgery, which was successfully treated without further surgery using bowel rest, antibiotics, and IV nutrition
Who was studied
61 year old male with hemorrhoidal disease and mucosal prolapse treated by stapled anopexy
Main outcome
complication after stapled hemorrhoidopexy and whether it could be managed without surgery
Quality
This is a single patient case report, so it cannot show how often this happens or whether this approach works reliably for others.
Limitations
Single case report; no comparison group; cannot generalize to typical outcomes or complication rates of stapled hemorrhoidopexy.
Taken word for word from the abstract
- population a 61 year old male who developed pneumoretroperitoneum and pneumomediastinun two days after a Stapled Anopexy
- primaryOutcome A minimal anastomotic leakage following Stapled Anopexy, when leading to air diffusion into soft tissues and not associated to abscess or peritonitis may be treated conservatively
- result The patient was successfully treated by bowel rest, antibiotics and total parenteral nutrition, avoiding surgical approach.
- n We report the case of a 61 year old male
Ann Ital Chir · PMID 27842017 · Read it on PubMed ↗
Altomare et al. 2017
Does a more extensive mucosal excision prevent haemorrhoidal recurrence after stapled haemorrhoidopexy? Long-term outcome of a randomized controlled trial
Same recurrence, fewer symptoms with bigger staplerRandomised trialModerate qualityRelated question
135 peoplemean 49.3 ± 5.4 months and 49.0 ± 5.3 months
No significant difference in recurrence between staplers, but the EEA group had less persistent bleeding, better symptom and wellness scores, and less evacuation disturbance than the PPH group.
Who was studied
patients with Stage III (grade III) prolapsing internal haemorrhoids undergoing stapled haemorrhoidopexy
What they received
stapled haemorrhoidopexy using the larger-volume EEA stapler (more extensive mucosal excision)
Compared with
stapled haemorrhoidopexy using the PPH-01/03 stapler (standard mucosal excision)
Main outcome
rate of recurrent mucosal prolapse at long-term follow-up, plus symptom scores and bowel function
Quality
It was a randomized trial, but only 65% of patients could be reached for long-term follow-up and the groups were fairly small, which weakens how much the results can be trusted.
Limitations
Only 87 of 135 randomized patients (65%) were available for long-term follow-up, and the comparison is between two stapler types within one surgical technique rather than across treatment approaches.
Taken word for word from the abstract
- n 135 patients were randomized to treatment with a PPH-01/03 (Ethicon EndoSurgery) or an EEA (Covidien) stapler
- population patients with Stage III haemorrhoids undergoing stapled haemorrhoidopexy
- intervention an EEA (Covidien) stapler
- comparator a PPH-01/03 (Ethicon EndoSurgery)
- primaryOutcome to determine the rate of recurrent mucosal prolapse and general condition (wellness evaluation score)
- result In the EEA group, 11 (23%) patients had some degree of recurrent prolapse compared with 12 (32%) in the PPH group (P = 0.409). Persistence of anal bleeding was significantly higher in the PPH group (P = 0.04) while the postoperative Haemorrhoid Symptom Score was significantly better in the EEA group (1.73 ± 1.65 vs 3.17 ± 1.94, P < 0.001).
- followUp mean 49.3 ± 5.4 months and 49.0 ± 5.3 months respectively
Colorectal Dis · PMID 27801539 · Read it on PubMed ↗
Bjelanovic et al. 2016
Transanal hemorrhoid dearterialization is a safe and effective outpatient procedure for the treatment of hemorrhoidal disease
Prolapse and pain improved in most.Prospective cohortLow qualityRelated question
402 people12 months
At 12 months, bleeding was controlled in 90.5% of patients, prolapse was controlled in 97.3%, and pain markedly improved in 97%; 67 patients had complications including bleeding, thrombosed hemorrhoids, fissures, perianal fistula or abscess, urinary retention, severe pain, or residual prolapse; symptoms recurred in 5.8-9.7% depending on hemorrhoid grade
Who was studied
adults with grade 2 to 4 internal hemorrhoids that bleed or prolapse
What they received
transanal hemorrhoid dearterialization (THD), a surgical procedure done under sedation
Main outcome
complications after surgery and return of symptoms at 12 months
Quality
this was a single-group study with no comparison treatment, so it cannot show whether THD works better or worse than other options
Limitations
no comparator group, so results cannot be compared to other hemorrhoid treatments; single-center or single-technique design not stated to control for other factors
Taken word for word from the abstract
- population evaluated transanal dearterialization (THD) efficacy and safety in grade 2-4 hemorrhoids (HD)
- intervention THD was performed under sedation-locoregional anesthesia in 402 outpatients
- n THD was performed under sedation-locoregional anesthesia in 402 outpatients
- primaryOutcome Postoperative complications and recurrence of symptoms at 12 months were analyzed
- result Twelve months after THD, bleeding was controlled in 363 patients (90.5%), prolapse was controlled in 391 (97.3%) and pain markedly improved in 390 patients (97%)
- result A total of 67 patients had complications: bleeding in 10 patients (2.5%), hemorrhoidal thromboses in 10 (2.5%), perianal fistulas in 5 (1.2%), fissures in 14 (3.5%), urinary retention in 3 (0.8%), residual prolapse in 19 (4.7%), severe anal pain in 3 (0.8%), and perianal abscess in 3 patients (0.8%)
- result Recurrent HD occurred in 6.3% (1/16) of grade 2 HD patients, 5.8% (12/210) of grade 3 patients and 9.7% (17/176) of grade 4 patients
Cir Esp · PMID 27771095 · Read it on PubMed ↗
Araujo et al. 2016
LONG TERM RESULTS AFTER STAPLED HEMORRHOIDOPEXY ALONE AND COMPLEMENTED BY EXCISIONAL HEMORRHOIDECTOMY: A RETROSPECTIVE COHORT STUDY
No clear difference between techniques.RetrospectiveLow quality
86 people48.5 (6-40) months
no significant difference in recurrence (43% vs 33%), reoperation rate (12.3% vs 9.6%), or satisfaction between the two surgical approaches, even though the combined technique was used more often in more severe (grade III-IV) disease
Who was studied
adults with internal hemorrhoids (mostly grade III-IV) who had prolapse symptoms
What they received
stapled hemorrhoidopexy surgery alone
Compared with
stapled hemorrhoidopexy plus additional excisional hemorrhoidectomy for residual or external disease
Main outcome
symptom recurrence, need for repeat surgery, and patient satisfaction after surgery
Quality
This was a small, single-center retrospective study where surgeons chose the technique based on disease severity rather than randomizing, so the comparison could be biased.
Limitations
Retrospective design, no randomization, surgeons selected which patients got the extra excision based on severity, follow-up data partly gathered by phone/email self-report.
Taken word for word from the abstract
- n sixty-five (29 men) patients underwent stapled hemorrhoidopexy and 21 (13 men) underwent stapled hemorrhoidopexy with excision
- population Patients with grades 3 and 4 hemorrhoid disease were operated on more frequently using stapled hemorrhoidopexy complemented with excisional technique
- intervention sixty-five (29 men) patients underwent stapled hemorrhoidopexy
- comparator 21 (13 men) underwent stapled hemorrhoidopexy with excision
- primaryOutcome there was no difference between the techniques in relation to symptom recurrence (43% and 33%, p=0.45) and median interval between surgery and symptom recurrence
- result there was no difference between the techniques in relation to symptom recurrence (43% and 33%, p=0.45) and median interval between surgery and symptom recurrence (30 (8-84) and 38.8 (8-65) months, p=0.80)
Arq Bras Cir Dig · PMID 27759778 · Read it on PubMed ↗
Brown 2017
Hubble trial: time to stick to basics for treatment of haemorrhoids?
Fancier procedure no better than bands.Narrative reviewVery low qualityRelated question
size not given2017
haemorrhoidal artery ligation is not necessarily superior to cheap alternatives like rubber band ligation
Who was studied
adults with early-grade prolapsing haemorrhoids
What they received
haemorrhoidal artery ligation
Compared with
rubber band ligation
Main outcome
treatment success for prolapsing haemorrhoids
Quality
this is a comment/editorial discussing another trial's results and debating methodology, not a primary study reporting its own data.
Limitations
abstract is a commentary piece, does not report original patient numbers, methods, or detailed outcomes; haemorrhoidal artery ligation is not one of the treatments listed for this question.
Taken word for word from the abstract
- population early-grade prolapsing haemorrhoids
- intervention haemorrhoidal artery ligation
- comparator rubber band ligation
- primaryOutcome comparing haemorrhoidal artery ligation with rubber band ligation for early-grade prolapsing haemorrhoids
- result A finding that haemorrhoidal artery ligation is not necessarily superior to cheap alternatives has implications for current practice and future commissioning of surgeons.
Tech Coloproctol · PMID 27699495 · Read it on PubMed ↗
Lohsiriwat 2016
Anorectal emergencies
No treatment comparison reported.Narrative reviewVery low qualityRelated question
size not given2016
The article describes general diagnostic steps and management principles for several anorectal emergencies, including thrombosed or strangulated internal hemorrhoid, but does not report a comparison of treatments for prolapsed internal hemorrhoids or any outcome data.
Who was studied
people with anorectal emergencies such as thrombosed or strangulated hemorrhoids, bleeding hemorrhoids, anal fissures and other anorectal conditions
Main outcome
diagnosis and management approach for various anorectal emergencies
Quality
This is an editorial/narrative overview without original data, specific methods, or outcome measurements, so it cannot support conclusions about which treatment works best.
Limitations
It is a broad overview of many unrelated anorectal emergencies rather than a focused study on prolapsed internal hemorrhoid treatment options, and reports no comparative results or outcome data.
Taken word for word from the abstract
- population Anorectal emergencies refer to anorectal disorders presenting with some alarming symptoms such as acute anal pain and bleeding which might require an immediate management.
- primaryOutcome This article deals with the diagnosis and management of common anorectal emergencies such as acutely thrombosed external hemorrhoid, thrombosed or strangulated internal hemorrhoid, bleeding hemorrhoid, bleeding anorectal varices, anal fissure, irreducible or strangulated rectal prolapse, anorectal abscess, perineal necrotizing fasciitis (Fournier gangrene), retained anorectal foreign bodies and obstructing rectal cancer.
- result A detailed history taking and a careful physical examination, including digital rectal examination and anoscopy, is essential for correct diagnosis and plan of treatment.
World J Gastroenterol · PMID 27468181 · Read it on PubMed ↗
Gaj et al. 2016
Manual reduction in acute haemorrhoids
Manual reduction eased pain, avoided surgery.Case seriesVery low quality
11 people10 days
at 10 days pain and swelling were much lower than before treatment, and most patients (73%) avoided surgery
Who was studied
adults with painful swollen hemorrhoids that had prolapsed outside the anus, including pregnant women, but not yet fully clotted
What they received
pushing the prolapsed hemorrhoid back inside by hand (manual reduction), then patients taught to do this themselves
Main outcome
pain level (visual analog scale) and swelling 10 days after treatment, and whether surgery was later needed
Quality
only 11 patients, no control group, and no randomization despite being labeled a trial, so the improvement could be due to natural healing rather than the treatment.
Limitations
Very small sample, no comparison group, short follow-up of only 10 days, and called a 'clinical trial' but no randomization or control arm is described.
Taken word for word from the abstract
- population Eleven patients, 7 males and 4 pregnant females (in early post partum) with an average age of 34 years ± 8 (range 23- 52) were enrolled with anal pain cause by haemorrhoidal congestion, but prior to full blown thrombosis.
- intervention Patients underwent a manual reduction of the external prolapsed haemorrhoidal plexus.
- intervention In the 48 hours following the procedure, patients were instructed on how to insert any prolapsed hemorrhoid (piles) themselves.
- primaryOutcome Pain intensity was measured using the visual analog scale (VAS) at time of consultation and then 10 days after the reduction.
- result At day 10 following treatment we observed a statistically significant reduction in anal swelling (11 vs 1, n° pzt; p = 0.001), anal pain (11 vs 2, n° pzt; p = 0.001) and VAS score (8.6 ± 0.7 vs 0.4 ± 1.2; p = 0.001).
- result 73% of patients did not require surgery.
- n Eleven patients, 7 males and 4 pregnant females
Clin Ter · PMID 27212575 · Read it on PubMed ↗
Higuero et al. 2016
Guidelines for the treatment of hemorrhoids (short report)
Step up care: diet, then office treatment, then surgery.GuidelineLow quality
size not given2016
Guidelines recommend starting with diet/fiber and medical treatment first, instrumental (office) treatment only if medical treatment fails (except for grade III or higher prolapse, where it may be used sooner), with surgery reserved as a last resort; patients should be informed of surgical options including ambulatory surgery, and pain after surgery should be prevented using a pudendal block plus multiple types of pain medicine.
Who was studied
Adults with hemorrhoids
Main outcome
Recommended approach to managing hemorrhoids
Quality
This is an expert consensus guideline summary, not a study with direct patient data or outcomes measured.
Limitations
This is a short report summarizing expert consensus recommendations rather than new trial data; no specific outcome numbers or study details are given.
Taken word for word from the abstract
- population Hemorrhoids are a common medical problem that is often considered as benign.
- primaryOutcome We present a short report of these recommendations.
- result medical treatment, including dietary fiber, should always be proposed in first intention and instrumental treatment only if medical treatment fails, except in grade ≥III prolapse. Surgery should be the last resort, and the patient well informed of the surgical alternatives, including the possibility of elective ambulatory surgery, if appropriate. Postoperative pain should be prevented by the systematic implementation of a pudendal block and multimodal use of analgesics.
J Visc Surg · PMID 27209079 · Read it on PubMed ↗
Basile et al. 2016
Transanal anopexy with HemorPex System (HPS) is effective in treating grade II and III hemorrhoids: medium-term follow-up
Symptoms improved; some recurrence later.Case seriesLow qualityRelated question
100 peopleup to 3 months
At 3 months, pain, bleeding, prolapse and hygiene problems were all significantly reduced compared with before surgery; in patients followed longer, 7.5% had recurrence and needed repeat surgery, and most patients remained satisfied up to 24 months
Who was studied
Adults with grade II and III hemorrhoids
What they received
A surgical mucopexy procedure called the HemorPex System (HPS), done without Doppler guidance
Main outcome
Changes in pain, bleeding, prolapse, hygiene difficulty and patient satisfaction after surgery
Quality
This was a single-group study with no comparison treatment and substantial loss to follow-up, which the authors themselves flag as important limitations.
Limitations
Non-comparative study design and loss to follow-up, as stated by the authors; also includes grade II hemorrhoids which may not prolapse, mixing them with grade III cases.
Taken word for word from the abstract
- population One hundred patients with grade II and III hemorrhoidal disease were included in the study
- intervention operated on using HPS without Doppler guidance
- primaryOutcome pain, bleeding, prolapse, difficulties with hygiene and patient satisfaction with treatment
- result Three-month follow-up showed significant improvement of symptoms: pain was present in 10 (10 %) patients versus 45 (45 %) preoperatively
- result 5 patients (7.5 %) had recurrence and were reoperated on at 8, 10, 24, 26 and 36 months
- n One hundred patients with grade II and III hemorrhoidal disease were included in the study
- followUp A direct follow-up was carried out on 100 patients for up to 3 months.
Tech Coloproctol · PMID 27156521 · Read it on PubMed ↗
Hidalgo Grau et al. 2016
Circular mucosal anopexy: Experience and technical considerations
Stapled procedure: low pain, some recurrenceRetrospectiveLow quality
327 people2016
31 of 327 patients needed reoperation for recurrence (5 with rectal mucosal prolapse, 2 with grade 2, 17 with grade 3, and some with grade 4 hemorrhoids); 81.3% reported low pain (VAS ≤2) at one week; 5 patients needed reoperation for early bleeding and 6 were admitted for pain; recurrence was not linked to hemorrhoid grade but was linked to age
Who was studied
Adults with hemorrhoids (grades 2-4) or rectal mucosal prolapse who underwent a stapled mucosal fixation procedure
What they received
Circular mucosal anopexy (a stapled procedure similar to stapled hemorrhoidopexy)
Main outcome
Recurrence requiring reoperation, postoperative pain, and early complications
Quality
This is a single-center retrospective review without a comparison group, spanning 12 years, so it cannot reliably show how this technique compares to other treatments.
Limitations
No control group, retrospective design over a long time period, and no statistical comparison to other treatment techniques within the study itself
Taken word for word from the abstract
- population 613 patients underwent surgery for either hemorrhoids or RMP
- population Hemorrhoidal grades were distributed as follows: 28 patients had RMP, 46 2nd grade, 146 3rd grade and 107 4th grade.
- intervention Circular mucosal anopexy (CMA)
- intervention CMA was performed in 327 patients.
- primaryOutcome Recurrence of hemorrhoids was studied and groups of recurrence and no-recurrence were compared.
- primaryOutcome Postoperative pain was evaluated by Visual Analogical Scale (VAS) as well as early complications.
- result A total of 31 patients needed reoperation (5 RMP, 2 with 2nd grade, 17 with 3rd grade,/with 4th grade).
- result No statistically significant differences were found between the non-recurrent group and the recurrent group with regards to gender, surgical time or hemorrhoidal grade, but there were differences related to age.
- result In the VAS, 81.3% of patients expressed a postoperative pain ≤ 2 at the first week.
- result Five patients needed reoperation for early postoperative bleeding. Six patients needed admission for postoperative pain.
- n CMA was performed in 327 patients.
Cir Esp · PMID 26997121 · Read it on PubMed ↗
Titov et al. 2016
[Comparison of Doppler-assisted dearterialization with mucopexy and hemorrhoidectomy]
Less pain, faster recovery than surgeryRandomised trialModerate quality
240 peopleup to 45 days
DDM caused less pain, needed fewer strong painkillers, had fewer complications, and let patients return to normal life sooner than hemorrhoidectomy, with similar overall effectiveness.
Who was studied
patients with internal hemorrhoids stage III-IVA
What they received
Doppler-assisted dearterialization of internal hemorrhoids with mucopexy (DDM)
Compared with
hemorrhoidectomy using harmonic scalpel (HE)
Main outcome
postoperative pain, complications, and recovery/disability time after hemorrhoid surgery
Quality
It was a reasonably large randomized trial, but randomization used simple envelopes (not well concealed), follow-up was very short, and the abstract does not mention blinding.
Limitations
Randomization method (envelopes) may be weak, follow-up for recurrence was only up to 45 days, and the abstract gives no longer-term outcome data.
Taken word for word from the abstract
- population This prospective study included 240 patients with hemorrhoids stage III-IVA.
- intervention In group 1 (n=120) Doppler-assisted dearterialization of internal hemorrhoids with mucopexy was performed (DDM)
- comparator in group 2 (n=120) - hemorrhoidectomy using harmonic scalpel (HE).
- primaryOutcome Postoperative pain severity was higher in group 2
- result Postoperative pain severity was higher in group 2 (4.8 compared with 2.5 scores of the first group (p<0.01).
- result Narcotic analgesics were used less often in DDM group (1.3 doses compared with 6.1 doses in HE group (p<0.01).
- result Immediate postoperative complications occurred in 9 (7.5%) and 19 (15.8%) patients of DDM and HE groups respectively.
- result DDM is reliable minimally invasive method of hemorrhoids stage III-IVA treatment and has similar efficacy with HE.
- n This prospective study included 240 patients with hemorrhoids stage III-IVA.
- followUp Recurrent prolapse of internal hemorrhoids was diagnosed in 2 (1.7%) patients of the 1st group in terms of up to 45 days.
Khirurgiia (Mosk) · PMID 26977864 · Read it on PubMed ↗
Hoyuela et al. 2016
HAL-RAR (Doppler guided haemorrhoid artery ligation with recto-anal repair) is a safe and effective procedure for haemorrhoids. Results of a prospective study after two-years follow-up
Mostly symptom-free, low pain, rare recurrenceProspective cohortLow quality
30 people26 (12-36) months
Most patients had little pain and were free of symptoms within a month, with very few complications or recurrences over two years of follow-up
Who was studied
adults with grade III-IV internal hemorrhoids (hemorrhoids that prolapse)
What they received
HAL-RAR (Doppler-guided hemorrhoid artery ligation combined with recto-anal repair) surgical procedure
Main outcome
postoperative pain, complications, and resolution of hemorrhoid symptoms (bleeding, prolapse, itching, pain, soiling) over two years
Quality
This was a small, single-arm study of only 30 patients with no comparison group, so it can't show how HAL-RAR stacks up against other treatments.
Limitations
Small sample size (30 patients), single-center, no control or comparison group, outcomes partly based on patient questionnaires
Taken word for word from the abstract
- population A prospective study design including 30 consecutive patients with haemorrhoids grade III-IV treated from June 2012.
- intervention To analyse prospectively results of HAL-RAR technique by evaluating pain, perioperative complications and clinical outcome after two years followup.
- primaryOutcome To analyse prospectively results of HAL-RAR technique by evaluating pain, perioperative complications and clinical outcome after two years followup.
- result 87.5% of patients confirmed complete relief of symptoms after 30 days and 93% of patients feel free of symptoms 6 months after the procedure.
- result After 24 months follow-up, recurrence of bleeding and prolapse was observed in only 1 patient
- n A prospective study design including 30 consecutive patients with haemorrhoids grade III-IV treated from June 2012.
Int J Surg · PMID 26876958 · Read it on PubMed ↗
Aigner et al. 2016
Doppler-guided haemorrhoidal artery ligation with suture mucopexy compared with suture mucopexy alone for the treatment of Grade III haemorrhoids: a prospective randomized controlled trial
Adding artery ligation gave little extra benefit over mucopexy alone.Randomised trialLow quality
40 people12 months
Adding Doppler-guided artery ligation gave less pain in the first two weeks, but recurrence of Grade III hemorrhoids at 12 months was similar between groups (10% vs 5%, not statistically significant), and there were no significant differences in blood flow changes on ultrasound.
Who was studied
adults with symptomatic Grade III (prolapsing) internal hemorrhoids
What they received
Doppler-guided ligation of the hemorrhoidal arteries combined with suture mucopexy
Compared with
suture mucopexy alone
Main outcome
postoperative pain, incontinence, bleeding, leftover prolapse, and changes in blood flow to the hemorrhoidal area
Quality
Very small trial (40 patients) from a single center, which makes it hard to be confident the result would hold in a larger, more varied group of patients.
Limitations
Small sample size (40 patients), single trial, recurrence difference not statistically significant so could be due to chance.
Taken word for word from the abstract
- population All consecutive patients with symptomatic Grade III haemorrhoids
- intervention DG-HAL with mucopexy
- comparator mucopexy alone
- primaryOutcome End-points were postoperative pain, faecal incontinence, bleeding, residual prolapse and alterations of the vascularization of the anorectal vascular plexus.
- result Patients in Group A had less pain in the first two postoperative weeks.
- result At the 12-month follow-up, two patients in Group A (10%) and one in Group B (5%) showed recurrent Grade III haemorrhoids (P = 0.274).
- result No significant morphological changes were observed in the transperineal ultrasound findings between the preoperative assessment and the assessment at 1 and 6 months in either group (P > 0.05).
- n Forty patients were recruited and randomized to the two study groups.
Colorectal Dis · PMID 26787597 · Read it on PubMed ↗
Hollingshead et al. 2016
Haemorrhoids: modern diagnosis and treatment
Banding doesn't fix prolapse; surgery works best long-term.Narrative reviewLow quality
size not given1-3 years
Rubber band ligation works for most patients short-term but does not treat prolapsed hemorrhoids; conventional surgery (hemorrhoidectomy) is the most effective long-term treatment though it causes more pain; stapled hemorrhoidectomy and artery ligation techniques are probably less effective but less painful; long-term data are poor for all procedures.
Who was studied
adults with hemorrhoids, including those with prolapse
Main outcome
effectiveness and pain of different hemorrhoid treatments
Quality
This is a narrative review drawing on studies that themselves had short follow-up (often only 1-3 years), so confidence in long-term outcomes is limited.
Limitations
Long-term data are poor for all procedures, with many studies reporting only 1-3 years of follow-up data.
Taken word for word from the abstract
- population Haemorrhoids present often to primary and secondary care
- primaryOutcome haemorrhoidal procedures are among the most common carried out
- result Rubber band ligation is effective in 75% of patients in the short term, but does not treat prolapsed haemorrhoids or those with a significant external component.
- result Conventional haemorrhoidectomy remains the most effective treatment in the long term, the main limitation being post-operative pain.
- result Stapled haemorrhoidectomy and haemorrhoidal artery ligation techniques are probably less effective but less painful.
- limitations Long-term data are poor for all procedures, with many studies reporting only 1-3 years of follow-up data.
Postgrad Med J · PMID 26561592 · Read it on PubMed ↗
Gaj et al. 2015
[Local and late complications in anorectal surgery]
Recovery scores improved after anorectal surgery generally.Prospective cohortLow qualityRelated question
150 people12 months
both scores improved after surgery: complications score fell from 11.3 at baseline to 9.6, 3.6, and 2.3 at 3, 6 and 12 months, while quality-of-life score rose from 4.5 to 6, 8 and 8.5 over the same period
Who was studied
150 patients having anorectal surgery for various conditions, including 63 with grade III/IV hemorrhoids, plus fissures, fistulas, rectocele, and rectal prolapse
Main outcome
a post-surgery complications score and a quality-of-life score, tracked over time
Quality
this study lumps together several different anorectal conditions and surgeries without separating out results for hemorrhoid patients or comparing different treatment approaches, so it cannot tell us which hemorrhoid treatment works best.
Limitations
mixes multiple surgical conditions (hemorrhoids, fissures, fistulas, rectocele, mucosal prolapse) together, does not isolate hemorrhoid patients or compare treatment types, and 16 of 150 patients did not complete follow-up.
Taken word for word from the abstract
- population we studied 150 patients undergoing several ano-rectal surgeries for the presence of hemorrhoids of grade III and IV (63 patients), anal fissures (42 patients), anal fistulas (19 patients), rectocele (15 patients) and mucosal prolapse of the rectum (11 patients)
- primaryOutcome by a questionnaire concerning the surgery complications and quality of life, the latter expressed with a score from 0 (poor) to 10 (excellent)
- result The score of complications has been gradually decreasing from 11.3 (baseline) to 9.6 to 3 months, 3.6 to 6 months and 2.3 at 12 months, while the score of the quality of life progressively increased from 4.5 to 6, 8 and 8.5 respectively (p<0.05)
- n we studied 150 patients undergoing several ano-rectal surgeries
- followUp patients were evaluated through outpatient visits at 3, 6 and 12 months
Clin Ter · PMID 26550808 · Read it on PubMed ↗
Gaj et al. 2015
[Rubber band ligation in treatment of hemorrhoids: our experience]
Banding helped, but not for prolapseCase seriesLow qualityRelated question
50 people6 months
after 6 months only 13 of 50 patients were occasionally symptomatic (4 bleeding, 2 discomfort, 4 itching, 3 both discomfort and itching), with no severe complications and no persistent foreign-body sensation or pain
Who was studied
adults with grade II–III hemorrhoids causing bleeding, discomfort or itching, but specifically without rectal mucosal prolapse (confirmed by plug test)
What they received
rubber band ligation of hemorrhoids
Main outcome
symptom relief (bleeding, discomfort, itching) and complications at 10 days and 6 months after treatment
Quality
it is a small, single-arm study with no comparison group, short 6-month follow-up, and it explicitly excluded the population of interest (prolapse was ruled out before treatment).
Limitations
No control group, small sample size, short follow-up, and patients with rectal mucosal prolapse were specifically excluded from the study.
Taken word for word from the abstract
- population A total of 50 patients underwent rubber band ligation for symptomatic hemorrhoids (grade II and III) without prolapse
- population All patients underwent plug test to rule out presence of rectal mucosal prolapse
- intervention Each hemorrhoid was ligated with one rubber band through a ligator.
- primaryOutcome All patients were evaluated immediately at the end of the procedure, after ten days and six months after the treatment.
- result After 6 months, only 13 patients were occasionally symptomatic: 4 patients had rectal bleeding, 2 had perineal discomfort and 4 had itching.
- result All procedures were performed without complications.
- n A total of 50 patients underwent rubber band ligation for symptomatic hemorrhoids
Clin Ter · PMID 26378752 · Read it on PubMed ↗
Li et al. 2015
Myofibrotic malformation vessels: unique angiodysplasia toward the progression of hemorrhoidal disease
Describes tissue causes, not a treatment comparisonRetrospectiveLow qualityRelated question
281 people2015
Found abnormal malformed vessels and tissue changes that got worse as hemorrhoid severity increased; the authors suggest this could guide surgery aimed at these vessels, but no treatment was tested or compared
Who was studied
Adults with internal hemorrhoids ranging from grade I to IV who had hemorrhoid surgery
Main outcome
Microscopic and histological changes in hemorrhoid tissue (abnormal blood vessels and fibrosis) and how they relate to hemorrhoid severity
Quality
This is a tissue/pathology study of surgical specimens, not a trial comparing treatments, so it cannot show which approach works better for patients.
Limitations
No comparison of treatment approaches or outcomes; purely a histological/pathological analysis of removed tissue
Taken word for word from the abstract
- population A total of 281 patients with internal hemorrhoids from degree I to IV underwent hemorrhoidectomy.
- primaryOutcome This study attempts to reveal the angiodysplasia and other pathological changes in association with different degrees of symptomatic hemorrhoids.
- result The statistical data indicated that the severity of all the changes correlate positively with the progression of hemorrhoids (P<0.001).
- result which could affect the clinical management of hemorrhoidal disease through the use of surgery to target the malformed vessels
- n A total of 281 patients with internal hemorrhoids from degree I to IV underwent hemorrhoidectomy.
Drug Des Devel Ther · PMID 26316703 · Read it on PubMed ↗
Lohsiriwat 2015
Treatment of hemorrhoids: A coloproctologist's view
Treatment choice depends on hemorrhoid gradeNarrative reviewLow qualityRelated question
size not given2015
low-grade internal hemorrhoids treated with medication and office procedures like rubber band ligation and sclerotherapy; surgery (mainstay: excisional hemorrhoidectomy) used for high-grade or complicated hemorrhoids, with newer minimally invasive surgical options aiming to reduce pain
Who was studied
people with hemorrhoids (internal and external), including complicated cases like pregnancy or cirrhosis
Main outcome
overview of treatment approaches for hemorrhoids
Quality
this is an editorial/narrative review giving one coloproctologist's perspective, not a study with original data or systematic evidence synthesis
Limitations
it is a general review covering all hemorrhoid types and many complicated clinical situations rather than focusing specifically on prolapsed internal hemorrhoids; no original data, numbers, or outcome comparisons are given
Taken word for word from the abstract
- population Hemorrhoids is recognized as one of the most common medical conditions in general population.
- result low-graded internal hemorrhoids can be effectively treated with medication and non-operative measures (such as rubber band ligation and injection sclerotherapy). Surgery is indicated for high-graded internal hemorrhoids, or when non-operative approaches have failed, or complications have occurred.
- result Although excisional hemorrhoidectomy remains the mainstay operation for advanced hemorrhoids and complicated hemorrhoids, several minimally invasive operations (including Ligasure hemorrhoidectomy, doppler-guided hemorrhoidal artery ligation and stapled hemorrhoidopexy) have been introduced into surgical practices in order to avoid post-hemorrhiodectomy pain.
- primaryOutcome This article deals with some fundamental knowledge and current treatment of hemorrhoids in a view of a coloproctologist
World J Gastroenterol · PMID 26309351 · Read it on PubMed ↗
Voigtsberger et al. 2016
Stapled hemorrhoidopexy: functional results, recurrence rate, and prognostic factors in a single center analysis
Low complications and recurrence after stapling surgeryProspective cohortLow qualityRelated question
1,144 people2016
Low rates of early complications (1.2%), stapleline inflammation (0.7%), rectal stenosis (1.9%), and recurrence (4.0%) were observed after stapled hemorrhoidopexy
Who was studied
Adults with prolapsing internal hemorrhoids
What they received
Stapled hemorrhoidopexy (Longo procedure) surgery
Main outcome
Postoperative complications, functional disorders (perianal irritation, stenosis), and recurrence of hemorrhoids
Quality
This is a single-center case series without a comparison group, so it cannot show how stapled hemorrhoidopexy compares to other treatments, only what happened to patients who had it.
Limitations
No control or comparator group; single institution; outcomes reported as complication/recurrence rates without a defined follow-up time period stated in the abstract.
Taken word for word from the abstract
- population patients with SHP for prolapsing hemorrhoids were evaluated
- intervention stapled hemorrhoidopexy (SHP), the so-called Longo procedure
- primaryOutcome patients were followed with special respect to postoperative complications, functional disorders, mainly perianal irritation, stenosis, and recurrence
- result Early complications were observed in 14 patients (1.2 %). The follow-up revealed inflammatory reaction at the stapleline in 8 patients (0.7 %) and rectal stenosis in 22 cases (1.9 %), and recurrence was observed in 46 cases (4.0 %).
- n One thousand one hundred forty-four consecutive patients with SHP for prolapsing hemorrhoids were evaluated
Int J Colorectal Dis · PMID 26245950 · Read it on PubMed ↗
Naldini et al. 2015
Tailored prolapse surgery for the treatment of hemorrhoids with a new dedicated device: TST Starr plus
Low recurrence, some bleeding complicationsCase seriesLow quality
52 people14.5 months (median)
No recurrence of prolapse in most patients at median 14.5 months follow-up, though some had postoperative bleeding, urgency, or needed reoperation
Who was studied
Adults with grade III-IV internal hemorrhoids that prolapse
What they received
Stapled transanal resection of hemorrhoidal prolapse using a new device (TST Starr plus)
Main outcome
Postoperative complications and rate of prolapse recurrence
Quality
This was a small single-group study of one device with no comparison group and fairly short follow-up, so it cannot show how this surgery compares to other treatments.
Limitations
No control group, single surgical technique only, follow-up limited to a median of 14.5 months, and some complications (bleeding, urgency, reoperation) were reported.
Taken word for word from the abstract
- population Patients affected by III-IV degree hemorrhoidal prolapsed that underwent stapled transanal resection with the TST Starr plus were included in the present study.
- intervention The aim of the study was to assess the results of the stapled transanal procedure in the treatment of hemorrhoidal prolapse in terms of postoperative complications and recurrence rate using a new dedicated device, TST Starr plus.
- n 52 patients (19 females) were enrolled in the study.
- primaryOutcome Results of the procedure with perioperative complications, postoperative complications, and recurrence rate were reported.
- result No recurrence of prolapse was reported at a median of 14.5 months after surgery, even if one patient (1.9 %) had a partial recurrent prolapse of a downstaged single pile.
- result Postoperative bleeding was reported in three patients (5.7 %), in one of which, reoperation was necessary (1.9 %).
Int J Colorectal Dis · PMID 26208412 · Read it on PubMed ↗
González-Macedo et al. 2015
[Modification to stapled mucosectomy technique with PPH. Experience of a surgical group]
Modified stapling surgery seemed safe, fast.RetrospectiveLow qualityRelated question
35 peopleshort-term (hospital stay, immediate postoperative period)
Average operation time was 31 minutes, median hospital stay 1 day; 6 patients had urinary retention; no severe pain, bleeding, hematoma, stenosis, incontinence, thrombosis, or need for re-operation
Who was studied
Adults with grade III or IV internal hemorrhoids needing surgery
What they received
Modified stapled mucosectomy technique (PPH, Procedure for Prolapse and Hemorrhoids)
Compared with
None (single-arm case series, compared conceptually to original PPH technique)
Main outcome
Postoperative complications and short-term recovery
Quality
This is a small, retrospective, single-group case series without a comparison group, so it cannot show whether the modified technique is better than other treatments.
Limitations
Retrospective design, no control group, small sample size (35 patients), single surgical team, short follow-up only covering immediate postoperative period.
Taken word for word from the abstract
- population Sixteen patients had grade III internal haemorrhoid disease (46%) and 19 grade IV (54%).
- intervention stapled mucosectomy with PPH with a modified technique
- comparator preserving the advantages of the original technique
- primaryOutcome To describe the postoperative results and short-term evolution of patients with internal haemorrhoidal disease
- result The mean operative time was 31 minutes. Six patients had acute urinary retention. There were no cases of severe pain, bleeding, haematoma, stenosis, incontinence, thrombosis, or re-operation. The median hospital stay was 1 day.
- n This is a retrospective review of 35 patients who underwent stapled haemorrhoidectomy with a modified technique by the same surgical team.
Cir Cir · PMID 26048569 · Read it on PubMed ↗
Giannini et al. 2015
Flavonoids mixture (diosmin, troxerutin, hesperidin) in the treatment of acute hemorrhoidal disease: a prospective, randomized, triple-blind, controlled trial
Faster symptom relief with flavonoid mixRandomised trialModerate qualityRelated question
134 people12 days
pain, bleeding, and persistence of edema and thrombosis decreased significantly more with the flavonoid mixture than placebo after 12 days, and fewer painkillers were needed after 6 days
Who was studied
adults with an acute hemorrhoidal crisis
What they received
flavonoid mixture (diosmin, troxerutin, hesperidin)
Compared with
placebo
Main outcome
hemorrhoid symptoms (pain, bleeding, edema, thrombosis) and painkiller use
Quality
it is a randomized, triple-blind, multicenter trial, but it studies general acute hemorrhoidal crisis rather than specifically prolapsed internal hemorrhoids, and details on randomization and blinding methods are limited.
Limitations
Population is defined as 'acute hemorrhoidal crisis' rather than specifically prolapsed grade III/IV internal hemorrhoids; prolapse is only one of several recorded symptoms, not the inclusion criterion.
Taken word for word from the abstract
- population One hundred and thirty-four consecutive patients with an acute hemorrhoidal crisis recruited in five colorectal units entered the study.
- intervention a mixture of diosmin, troxerutin and hesperidin
- comparator 68 a placebo (group B)
- primaryOutcome The main symptoms, the use of oral painkillers and the Bristol scale score were recorded at each scheduled visit
- result Pain, bleeding and the proportion of patients who reported persistence of edema and thrombosis decreased significantly after 12 days of treatment in group A.
- n One hundred and thirty-four consecutive patients
Tech Coloproctol · PMID 25893991 · Read it on PubMed ↗
Qin et al. 2015
Psychodynamic and biodynamic analysis of treatment of outlet obstructive constipation (OOC) using Procedure for Prolapse and Hemorrhoids (PPH)
Studied constipation, not prolapsed hemorrhoids.Prospective cohortLow qualityRelated question
28 people90 days
After PPH surgery, sensory thresholds in the rectum were lower than before surgery and lower than in healthy controls at 15 days, but rebounded by 90 days; anxiety and depression scores first fell after surgery then rebounded.
Who was studied
patients with outlet obstructive constipation (a type of chronic constipation), compared with healthy volunteers
What they received
Procedure for Prolapse and Hemorrhoids (PPH) surgery
Compared with
same patients before surgery, and healthy controls
Main outcome
anorectal sensory thresholds and anxiety/depression scores
Quality
Very small, non-randomized study in patients with a different condition (constipation, not prolapsed hemorrhoids), with effects that reversed over time.
Limitations
Small sample (19 patients, 9 controls), no randomization, studies outlet obstructive constipation rather than prolapsed hemorrhoids, and measured effects rebounded by 90 days.
Taken word for word from the abstract
- population 19 patients diagnosed with outlet obstructive constipation (OOC) form the case group, and 9 healthy volunteers form the control group
- intervention Procedure for Prolapse and Hemorrhoids (PPH)
- comparator Patients, before and after operation, and the control group, were equally given such tests
- primaryOutcome Patients, before and after operation, and the control group, were equally given such tests as Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Scale (HAMA) and anorectal dynamics.
- result The minimum perception threshold, maximum tolerance threshold, and rectal defecation threshold of Group A, of 15 days after operation, were equally lower than those before operation, and than the control group (P < 0.05). These thresholds rebounded significantly in Group B 90 days after operation.
- n 19 patients diagnosed with outlet obstructive constipation (OOC) form the case group, and 9 healthy volunteers form the control group
Med Hypotheses · PMID 25892490 · Read it on PubMed ↗
Shrestha et al. 2014
Stapled haemorrhoidectomy in the operative treatment of grade III and IV haemorrhoids
Fast surgery, short stay, some urinary retentionCase seriesLow qualityRelated question
32 people2014
Counted as a related question: This study tests only stapled hemorrhoidectomy (one surgical approach), not a comparison of the various treatment approaches for prolapsed internal hemorrhoids (conservative care, office procedures, and different surgical options).
Average surgery time was 40-60 minutes, average hospital stay was 1.9 days, and the main complication was urinary retention in 37.5% of patients; the authors describe the procedure as safe with low complication rates, minimal pain, and short hospital stay
Who was studied
Adults with grade III or IV internal hemorrhoids causing bleeding and prolapse
What they received
Stapled hemorrhoidectomy (a stapling device used to treat prolapsing hemorrhoids)
Main outcome
Relief of symptoms, pain severity after surgery, and complications
Quality
This is a small, single-center study of only 32 patients with no comparison group, so it cannot show how stapled surgery stacks up against other treatments.
Limitations
No comparator group; small sample size; single institution; no long-term follow-up reported.
Taken word for word from the abstract
- population patients (32) who presented in the Surgery OPD with grade III and grade IV haemorrhoids
- intervention Stapled haemorrhoidectomy (SH) is a minimally invasive intervention that uses a stapling device
- primaryOutcome The results of SH were evaluated by the relief of symptoms, severity of post operative pain, and complications of SH
- n patients (32) who presented in the Surgery OPD with grade III and grade IV haemorrhoids
- result Mean operating time was 40-60 minutes whereas mean hospital stay was 1.9 days. Urinary retention was the most common complication found in 12 (37.5%) patients in the immediate post operative period.
- result SH is a safe, rapid, and convenient surgical remedy for grade III and grade IV hemorrhoids with low rate of complications, minimal postoperative pain, and shorter hospital stay.
Nepal Med Coll J · PMID 25799817 · Read it on PubMed ↗
Raahave 2015
Faecal retention: a common cause in functional bowel disorders, appendicitis and haemorrhoids--with medical and surgical therapy
Stapled surgery gave durable, low-pain reliefCase seriesLow qualityRelated question
298 peopleup to 5 years
Counted as a related question: This study primarily investigates whether fecal retention causes functional bowel disorders, appendicitis, and hemorrhoids through measurements of colon transit time and fecal loading; the stapled hemorrhoidopexy section is a small secondary part reporting on a single surgical technique without comparing it to other treatment approaches (conservative, office procedures, or alternative surgical options), which is what the question requires.
Most patients had a normal anus without prolapse after up to 5 years follow-up; recovery was fast with low pain and no incontinence, but some needed repeat surgery, most often within the first 2 years, and bleeding requiring surgical treatment was the most common complication
Who was studied
Adults with hemorrhoids, mostly with prolapsed internal hemorrhoids
What they received
Stapled hemorrhoidopexy (surgical stapling procedure for prolapsed hemorrhoids)
Main outcome
Durability of the cure (resolution of prolapse, normal anus) and postoperative recovery/complications
Quality
This was an uncontrolled case series without a comparison group, so it cannot show how stapled surgery compares with other treatments for prolapsed hemorrhoids.
Limitations
No control or comparator group; combines two separate patient cohorts (40 and 258 patients) without randomization; some outcomes based on a statistical prediction model rather than direct comparison.
Taken word for word from the abstract
- population The majority of patients had prolapsed haemorrhoids
- intervention a novel operation to cure this disease, stapled haemorrhoidopexy (n = 40 and 258 patients)
- primaryOutcome the durability of procedure was confirmed with a follow-up of up to 5 years, meaning a normal anus
- result The operation time was short, post-operative pain was low, and recovery was rapid. No incontinence was observed, and patient satisfaction was high and significantly correlated with the appearance of a normal anus without prolapse. The cumulative risk of re-operation was greatest in the first 2 years after the stapled haemorrhoidopexy.
- result The most frequent post-operative complication was bleeding requiring surgical haemostasis.
- n stapled haemorrhoidopexy (n = 40 and 258 patients)
Dan Med J · PMID 25748875 · Read it on PubMed ↗
Wang et al. 2015
Clinical observations on the treatment of prolapsing hemorrhoids with tissue selecting therapy
TST as effective, faster recovery, fewer complications than standard surgeryRandomised trialModerate quality
480 peopleone year
Both treatments had similarly high success rates, but TST caused less blood loss, less pain after surgery, less urine retention, shorter operation time, shorter hospital stay, and fewer long-term complications (incontinence, difficult bowel movements, intractable pain, anal discharge) than Milligan-Morgan hemorrhoidectomy.
Who was studied
adults with severe prolapsing hemorrhoids
What they received
tissue selecting therapy stapler (TST), a type of stapled hemorrhoidopexy
Compared with
Milligan-Morgan excisional hemorrhoidectomy
Main outcome
treatment success and postoperative complications (pain, bleeding, operation time, hospital stay, long-term complications)
Quality
It was a large randomized trial, but it was single-center, did not describe how randomization or allocation concealment was done, and surgery type could not be blinded.
Limitations
Single center, randomization method not described, no blinding possible for surgical technique, follow-up limited to one year.
Taken word for word from the abstract
- population Four hundred and eighty patients with severe prolapsing hemorrhoids, who were admitted to the Shenyang Coloproctology Hospital between 2009 and 2012, were randomly divided into observation (n=240) and control (n=240) groups.
- intervention Hemorrhoidectomies were performed with TST in the observation group
- comparator and with the M-M technique in the control group
- primaryOutcome The therapeutic effects, operation security, and postoperative complications in the two groups were compared.
- result The total effective rates of the observation and control groups were 99.5% (217/218) and 98.6% (218/221) respectively; the difference was not statistically significant (P=0.322).
- result Their were significant differences between observation and control groups in intraoperative blood loss (5.07±1.14 vs 2.45±0.57, P=0.000), pain (12 h after the surgery: 5.08±1.62 vs 7.19±2.01, P=0.000; at first dressing change: 2.64±0.87 vs 4.34±1.15, P=0.000; first defecation: 3.91±1.47 vs 5.63±1.98, P=0.001), urine retention (n=22 vs n=47, P=0.001), anal pendant expansion after the surgery (2.35±0.56 vs 5.16±1.42, P=0.000), operation time (18.3±5.6 min vs 29.5±8.2 min, P=0.000), and the length of hospital stay (5.3±0.6 d vs 11.4±1.8 d, P=0.000).
- result Moreover TST showed significant reductions compared to M-M in the rates of long-term complications such as fecal incontinence (n=3 vs n=16, P=0.003), difficult bowel movement (n=1 vs n=9, P=0.011), intractable pain (n=2 vs n=12, P=0.007), and anal discharge (n=3 vs n=23, P=0.000).
- n Four hundred and eighty patients with severe prolapsing hemorrhoids
World J Gastroenterol · PMID 25741159 · Read it on PubMed ↗
Ammendola et al. 2014
Severe rectal bleeding following PPH-stapler procedure for haemorroidal disease
Severe bleeding after stapled surgery.Case seriesVery low qualityRelated question
1 people2014
Counted as a related question: This is a case report of complications from one specific treatment (stapled hemorrhoidopexy), not a study comparing multiple treatment approaches for prolapsed hemorrhoids or describing what prolapsed hemorrhoids are and how to treat them more broadly.
The patient had severe rectal bleeding twice after the stapled hemorrhoidopexy procedure
Who was studied
48-year-old woman with circumferential (grade 4) prolapsed hemorrhoids, constipation, and rectal bleeding
What they received
PPH-stapler surgery (stapled hemorrhoidopexy)
Main outcome
Postoperative complications after the procedure
Quality
This is a single patient case report, so it cannot show how often this happens or how this procedure compares to others.
Limitations
Only one patient; no comparison group; cannot tell how common this complication is.
Taken word for word from the abstract
- population A 48 years old female patient was presented to our attention. She was affected by haemorrhoidal prolapse P4E4, constipation and rectal bleeding.
- intervention PPH-stapler procedure for treatment of haemorrhoidal prolapse classified P4E4
- primaryOutcome Postoperative complications may be serious and haemorrhage is the most important early complication.
- result We report a case of double severe rectal bleeding following PPH-stapler procedure for haemorrhoidal disease classified P4E4
- n A 48 years old female patient was presented to our attention.
- harm We report a case of double severe rectal bleeding following PPH-stapler procedure for haemorrhoidal disease classified P4E4 according to PATE 2000 (circumferential prolapse).
G Chir · PMID 25644731 · Read it on PubMed ↗
LaBella et al. 2015
Evaluation of transanal hemorrhoidal dearterialization: a single surgeon experience
High satisfaction, low recurrence after THDCase seriesLow qualityRelated question
108 people1 year
At 3 weeks, 92% had no pain and 88% were highly satisfied; satisfaction rose to 92% at 1 year; prolapse recurred in 7.5% at 6 months and 10.3% at 1 year; bleeding was the most common complication but did not need further treatment or transfusion
Who was studied
Adults with hemorrhoidal disease undergoing a specific procedure
What they received
Transanal hemorrhoidal dearterialization (THD), a Doppler-guided procedure that ties off the artery branches feeding hemorrhoids
Main outcome
Recurrence of hemorrhoidal prolapse, pain, bleeding, and patient satisfaction after the procedure
Quality
This was a single surgeon's case series with no comparison group, so it can't show how THD stacks up against other treatments.
Limitations
No control or comparator group; single-surgeon experience; one-year outcome assessed only by phone interview rather than exam
Taken word for word from the abstract
- n 108 THD procedures were performed
- population treatment of hemorrhoidal disease
- intervention With Doppler guidance, the THD device makes possible precise ligation of the branches of the superior hemorrhoidal artery.
- primaryOutcome to determine whether there was recurrence of hemorrhoidal prolapse
- result At 3 weeks, 92% of patients had no pain and 88% were highly satisfied with the procedure at 3 weeks. This increased to 92% satisfaction at 1 year. Prolapse recurrence was 7.5% at 6 months and 10.3% at 1 year. Bleeding was the most common complication, but did not require re-intervention or transfusion.
Tech Coloproctol · PMID 25637412 · Read it on PubMed ↗
Kara et al. 2015
Ligation under vision in the management of symptomatic hemorrhoids: A preliminary experience
Mostly symptom-free after ligation surgeryRetrospectiveLow qualityRelated question
47 people21.5 ± 7.7 months (range, 12-44 months)
At median 21.5 months follow-up, 80.8% of patients were symptom-free; some still had reduced bleeding; prolapse recurred in 6.3% of patients
Who was studied
Adults with Grade II and Grade III internal hemorrhoids (not restricted to prolapsed hemorrhoids)
What they received
Hemorrhoidal arterial ligation under vision (LUV), a surgical ligation technique
Main outcome
Symptom resolution, complications, and recurrence after LUV procedure
Quality
This is a small, retrospective, single-arm series with no comparison group, mixing hemorrhoid grades, so it cannot show how this treatment compares to others.
Limitations
Retrospective design, no control group, mixed Grade II and III patients (not all had prolapse), small sample size, long and variable follow-up range (12-44 months)
Taken word for word from the abstract
- population 47 patients who underwent hemorrhoidal arterial ligation under vision (LUV) for symptomatic Grade II and Grade III hemorrhoids
- intervention hemorrhoidal arterial ligation under vision (LUV)
- primaryOutcome evaluated with regard to demographic data, grade of the disease, symptoms, medical and/or surgical treatment previously received, operation time, pain scores, analgesic requirement, length of hospital stay, and complications related to the procedure
- result At the last follow-up, 38 (80.8%) patients remained asymptomatic; two (4.2%) patients with Grade II HD and four (8.5%) patients with Grade III HD were still suffering from bleeding but with a reduction in the frequency; prolapsed hemorrhoids were detected only in three (6.3%) patients.
- n The study population (n = 47)
Asian J Surg · PMID 25560545 · Read it on PubMed ↗
Zindel et al. 2014
[Necessary and unnecessary treatment options for hemorrhoids]
Fiber/conservative first; banding for mild; surgery for severe prolapse.Narrative reviewLow quality
size not given2014
Conservative care (fiber, topical treatments) is first-line unless there is acute prolapse or clot; for grade I-II, rubber band ligation is the preferred office procedure, while sclerotherapy and infrared coagulation are not recommended due to unproven comparable efficacy; for grade III-IV, surgery is advised, with closed (Ferguson) hemorrhoidectomy giving less pain and better healing than open (Milligan-Morgan); stapled hemorrhoidopexy (Longo) causes less pain and faster recovery than excisional hemorrhoidectomy but has a higher recurrence rate, a pattern also seen with hemorrhoidal artery ligation (HAL/RAR).
Who was studied
people with hemorrhoids, including grade III-IV with prolapse
Main outcome
relief of hemorrhoid symptoms, postoperative pain, and recurrence after different treatments
Quality
This is a non-systematic expert review summarizing other studies without describing its own search methods or giving quantitative data, so it carries less weight than original research.
Limitations
Narrative review without systematic methodology, no pooled data, numbers, or patient counts given, and conclusions are based on the authors' interpretation of prior literature.
Taken word for word from the abstract
- population Up to one third of the general population suffers from symptoms caused by hemorrhoids.
- intervention interventional procedures for grade I-II hemorrhoids, and surgery for grade III-IV hemorrhoids should be considered
- result Rubber band ligation is the interventional treatment of choice.
- result A comparable efficacy using sclerosing or infrared therapy has not yet been demonstrated. We therefore do not recommend these treatment options for the cure of hemorrhoids.
- result Primary closure (Ferguson) seems to be superior compared to the "open" version (Milligan Morgan) with respect to postoperative pain and wound healing.
- result Compared to excisional hemorrhoidectomy the Longo-operation is associated with reduced postoperative pain, shorter operation time and hospital stay as well as a faster recovery, with the disadvantage though of a higher recurrence rate.
- result Data from Hemorrhoidal Artery Ligation (HAL)-, if appropriate in combination with a Recto-Anal Repair (HAL/RAR)-, demonstrates a similar trend towards a better tolerance of the procedure at the expense of a higher recurrence rate.
- primaryOutcome With respect to postoperative pain and wound healing
Ther Umsch · PMID 25447089 · Read it on PubMed ↗
Olatoke et al. 2014
Direct current electrotherapy for internal haemorrhoids: experience in a tertiary health institution
Symptom relief after electrotherapy treatment.Case seriesVery low qualityRelated question
size not given16 months
All treated patients were symptom-free at an average follow-up of 16 months, with no complications reported
Who was studied
Adults with symptomatic grade 1, 2, or 3 internal and mixed hemorrhoids, some with prolapsing tissue
What they received
Direct current electrotherapy applied to hemorrhoidal tissue via a proctoscope, no anesthesia or admission needed
Main outcome
Whether hemorrhoid symptoms (bleeding, prolapse, pain, itching) resolved after treatment
Quality
This is a single-center case series with no comparison group, so it cannot show whether the electrotherapy itself caused the improvement.
Limitations
No control group, no randomization, grades 1-3 lumped together rather than isolating prolapsed (grade III/IV) hemorrhoids, and outcome assessment appears unblinded.
Taken word for word from the abstract
- population Symptomatic grades 1, 2 or 3 internal and mixed haemorroids were treated.
- intervention No bowel preparations, medications, anesthesia nor admission was required.
- intervention Direct current electrotherapy is an effective, painless and safe out-patient treatment method for grades 1 to 3 internal and mixed hemorrhoid disease.
- primaryOutcome indicators of successful treatment were, darkening of the treated segment, immediate shrinking of the haemorrhoid and ceasation of popping sound of gas release at the probe tip
- result No complication was encountered. All patients treated remained symptom free at a mean duration of follow up of 16 months.
Pan Afr Med J · PMID 25419283 · Read it on PubMed ↗
Scheyer et al. 2015
Hemorrhoidal artery ligation (HAL) and rectoanal repair (RAR): retrospective analysis of 408 patients in a single center
Helped bleeding/itching, not prolapse itselfRetrospectiveLow quality
size not given8 weeks
After short-term follow-up 26% still had prolapsing piles and 21% had recurrent bleeding; at long-term follow-up 24% still reported prolapsing piles, with lower rates of bleeding (3%), pruritus (3%), and pain (2%), while 20% had persistent mixed symptoms. The authors concluded HAL/RAR relieves bleeding, itching and pain well but does not reliably fix prolapse when that was the main problem.
Who was studied
Adults with internal hemorrhoids, grade II through IV, including prolapsing types
What they received
Doppler-guided hemorrhoidal artery ligation (HAL) for grade II, combined with rectoanal repair (RAR) mucopexy lifting of the prolapse for grade III and IV
Main outcome
Recurrence or persistence of prolapse, bleeding, and other hemorrhoid symptoms after the procedure
Quality
This is a retrospective, single-center case series with no comparison group, so it can only show what happened after this procedure, not how it compares to other treatments.
Limitations
Retrospective design, no control group, long-term data gathered by postal questionnaire rather than clinical exam.
Taken word for word from the abstract
- population Patients with grade II hemorrhoids were treated with HAL, and patients with grade III and IV hemorrhoids were treated with the RAR procedure by two surgeons.
- intervention Rectoanal repair (RAR), which combines doppler-guided hemorrhoidal artery ligation (HAL) and mucopexy via lifting of the hemorrhoidal prolapse, offers a minimally invasive alternative to conventional hemorrhoidectomy.
- primaryOutcome After short-term follow-up, 26% (n = 106) of patients reported recurrent or persistent prolapsing piles, while 21% (n = 86) of patients had recurrent bleeding.
- result HAL and RAR provide prolonged relief for patients with hemorrhoidal disease whose main symptoms are bleeding, pruritus and pain but not for patients with prolapse as an initial indication.
- followUp Postoperative follow-up was performed clinically and by proctoscopy after 8 weeks routinely, and long-term follow-up was performed using a standardized postal questionnaire.
Tech Coloproctol · PMID 25407664 · Read it on PubMed ↗
Safadi et al. 2014
Severe retroperitoneal and intra-abdominal bleeding after stapling procedure for prolapsed haemorrhoids (PPH); diagnosis, treatment and 6-year follow-up of the case
Rare severe bleeding after stapling surgery.Case seriesVery low qualityRelated question
1 people2014
Counted as a related question: This case report documents a rare complication (severe bleeding) after one specific treatment, rather than comparing different treatment approaches for prolapsed hemorrhoids to help decide which to use.
Patient developed severe intra-abdominal and retroperitoneal bleeding after the stapling procedure, diagnosed by CT scan, and recovered with conservative (non-surgical) treatment
Who was studied
A 26-year-old man with prolapsed hemorrhoids undergoing stapling surgery
What they received
Stapled hemorrhoidopexy (PPH procedure)
Main outcome
Serious bleeding complications after surgery
Quality
This is a single patient case report, so it cannot show how common this complication is or how PPH compares to other treatments.
Limitations
Single case report with no comparison group; cannot establish how frequently this complication occurs.
Taken word for word from the abstract
- population a 26-year-old man who developed severe intra-abdominal and retroperitoneal haemorrhage after PPH
- intervention Procedure for prolapsed haemorrhoids (PPH) is a popular treatment of haemorrhoids
- primaryOutcome intra-abdominal bleeding after the procedure
- result The diagnosis was made on the second postoperative day by CT of the abdomen and pelvis. The patient was treated conservatively and had an uneventful recovery.
- n a 26-year-old man
BMJ Case Rep · PMID 25358832 · Read it on PubMed ↗
Sultan 2015
Longo procedure (Stapled hemorrhoidopexy): Indications, results
Easier, less painful, but more recurrence than surgery.Narrative reviewLow quality
size not given2015
Stapled hemorrhoidopexy is easier, less painful, and allows faster return to activity than conventional hemorrhoidectomy, but carries a higher risk of recurrence and some residual prolapse; patient satisfaction remains high if patients are carefully selected (reversible prolapse, normal anal size, no large skin tags) and it is not recommended for stage IV disease; band ligation is preferred if prolapse or hemorrhoids recur after stapling.
Who was studied
Adults with internal hemorrhoids that prolapse, considered for stapled hemorrhoidopexy
Main outcome
Pain, recovery time, recurrence, and patient satisfaction after stapled hemorrhoidopexy versus conventional hemorrhoidectomy
Quality
This is a narrative review summarizing prior literature without presenting new study data, numbers, or methods, so it cannot be weighted strongly.
Limitations
No original data, patient numbers, or study design details are given; conclusions are based on pooled prior literature described only in general terms.
Taken word for word from the abstract
- population patients should have reversible prolapse, normal anal caliber, and absence of large tags
- primaryOutcome SH is easy to perform, is associated with less pain and allows early return to normal activities.
- result Not withstanding a higher risk of recurrence and some degree of procidentia, the long-term level of patient satisfaction is high after SH.
- result This procedure is not recommended for stage IV disease.
- result In case of persistent prolapse or hemorrhoidal recurrence after SH, elastic band ligation should be preferred.
J Visc Surg · PMID 25303874 · Read it on PubMed ↗
Ratto et al. 2015
Doppler-guided ligation of hemorrhoidal arteries with mucopexy: A technique for the future
Symptom relief, low complication riskNarrative reviewLow quality
size not givenlong-term follow-up
the review reports that THD leads to symptom resolution in most patients, with transient painful straining sensation as the most common complication, occasional rectal bleeding, and little or no risk of incontinence, chronic pain, or sphincter injury
Who was studied
adults with hemorrhoidal disease, including those with hemorrhoidal or mucosal prolapse
What they received
Doppler-guided ligation of the hemorrhoid arteries combined with mucopexy (stitching up the prolapsed tissue), known as the THD procedure
Main outcome
resolution of hemorrhoid symptoms and rate of complications
Quality
this is a descriptive review of a surgical technique with no control group, no numbers of patients, and no systematic method for selecting or weighing the evidence it summarizes.
Limitations
no patient numbers given, no comparator group, findings presented as general technique description rather than from a defined study cohort, and it is a narrative rather than systematic review
Taken word for word from the abstract
- population In patients with hemorrhoidal or mucosal prolapse, a mucopexy is also performed
- intervention selective ligation of hemorrhoidal arteries identified by Doppler and marked with a mucosal stitch overlying the artery
- intervention Plication of redundant rectal mucosa/submucosa ("mucopexy") can reposition prolapsing tissue to its original anatomical site.
- primaryOutcome In long-term follow-up, THD results in resolution of symptoms in the majority of patients.
- result The most common complication is transient but sometimes-painful tenesmus. Rectal bleeding occurs in only a very limited number of patients. There is little or no risk of fecal incontinence or chronic pain.
- result Ano-rectal manometry and endo-anal ultrasound show no evidence of injury to physiologic sphincteric function.
J Visc Surg · PMID 25262549 · Read it on PubMed ↗
Ratto et al. 2015
Doppler-guided transanal haemorrhoidal dearterialization for haemorrhoids: results from a multicentre trial
Mostly successful, some pain and recurrenceCase seriesLow qualityRelated question
803 people11.1 ± 9.2 months
90.7% of patients had successful outcome after about 11 months, with recurrence of prolapse in 6.3%, bleeding in 2.4%, and both in 0.6%; morbidity (mainly pain or tenesmus) occurred in 18.0%, and acute bleeding needing surgery occurred in 0.9%
Who was studied
Adults with symptomatic internal hemorrhoids, including grade II, III, and IV with prolapse
What they received
Doppler-guided transanal hemorrhoidal dearterialization (THD Doppler) with rectal mucopexy for prolapse
Compared with
No comparison group - single-arm study
Main outcome
Overall success rate and recurrence of hemorrhoidal prolapse or bleeding at follow-up
Quality
This was a single-arm study of one procedure without any comparison group, so it cannot show whether THD Doppler works better than other treatments.
Limitations
No control or comparator arm, relatively short mid-term follow-up (about 11 months), and some patients required re-operation including conventional hemorrhoidectomy
Taken word for word from the abstract
- population Eight hundred and three patients affected by Grade II (137, 17.1%), III (548, 68.2%) and IV (118, 14.7%) symptomatic haemorrhoidal disease underwent THD Doppler
- intervention THD Doppler, with a rectal mucopexy in patients with haemorrhoidal prolapse
- comparator Eight hundred and three patients affected by Grade II (137, 17.1%), III (548, 68.2%) and IV (118, 14.7%) symptomatic haemorrhoidal disease underwent THD Doppler
- primaryOutcome the overall success rate was 90.7% (728 patients), with a recurrence of haemorrhoidal prolapse, bleeding, and both symptoms in 51 (6.3%), 19 (2.4%) and 5 (0.6%) patients, respectively
- result The morbidity rate was 18.0%, represented mainly by pain or tenesmus (106 patients, 13.0%). Acute bleeding requiring surgical haemostasis occurred in seven patients (0.9%).
- result After a mean follow-up period of 11.1 ± 9.2 months, the overall success rate was 90.7% (728 patients)
- n Eight hundred and three patients affected by Grade II (137, 17.1%), III (548, 68.2%) and IV (118, 14.7%) symptomatic haemorrhoidal disease underwent THD Doppler
Colorectal Dis · PMID 25213152 · Read it on PubMed ↗
Loganathan et al. 2016
Transanal haemorrhoidal dearterialization for the treatment of grade III and IV haemorrhoids: a 3-year experience
High satisfaction despite some complicationsRetrospectiveLow qualityRelated question
85 peoplemedian telephone follow-up was 802 days
Counted as a related question: This study tests only one surgical approach (transanal haemorrhoidal dearterialization) without comparing it to other treatment options like conservative measures, office procedures, or other surgical techniques, so it does not address which of several approaches to take for prolapsed hemorrhoids.
24% of patients had complications (bleeding, constipation, infection, fissure, temporary incontinence), 16% had severe pain, 19% had symptoms come back, 14% needed another procedure, but 98.8% reported good or excellent satisfaction
Who was studied
Adults with grade III or IV internal hemorrhoids
What they received
Transanal haemorrhoidal dearterialization (THD), a surgical technique
Main outcome
Complications, symptom recurrence, reintervention rate, and patient satisfaction after THD
Quality
This is a retrospective single-group review with no comparison group, so it cannot show whether THD works better or worse than other treatments, only what happened to the patients who had it.
Limitations
Retrospective design, no comparator group, single institution, telephone survey for long-term follow-up which may be subject to recall or response bias.
Taken word for word from the abstract
- population patients who had undergone THD
- population grade III (85%) or grade IV (15%) haemorrhoids
- intervention Transanal haemorrhoidal dearterialization (THD)
- n A total of 85 patients with a mean age of 55
- primaryOutcome Data were collected on demographics, operative data, complications, recurrences and readmissions, postoperative pain and further interventions.
- result Twenty-four per cent of patients suffered complications, including postoperative bleeding (7%), constipation (7%), local sepsis (6%), anal fissure (5%) and temporary incontinence (2%).
- result Severe postoperative pain occurred in 16% of the patients.
- result The symptom recurrence rate was 19% and reintervention rate was 14%.
- result About 98.8% of patients reported good or excellent overall satisfaction with the procedure.
- followUp median telephone follow-up was 802 days
ANZ J Surg · PMID 25142863 · Read it on PubMed ↗
Selvaggi et al. 2014
Surgical treatment of recurrent prolapse after stapled haemorrhoidopexy
Fixed recurrent prolapse after prior surgery.Case seriesLow qualityRelated question
11 people4 ± 1.8 years
no recurrences seen over an average of 4 years follow-up, symptoms like pain and urgency improved in most patients, and complications were minor (one case of bleeding, one of urinary retention)
Who was studied
patients who had prolapse come back after a stapled hemorrhoidopexy surgery
What they received
a surgical technique combining excisional hemorrhoidectomy with a mucosal flap repair for recurrent prolapse
Main outcome
return of prolapse and relief of symptoms (urgency, pain) after surgery
Quality
this is a small series of only 11 patients with no comparison group, so it cannot show how this approach stacks up against other treatments.
Limitations
very small sample (11 patients), no control group, and the population is people whose prolapse already came back after a different surgery rather than people being treated for prolapse for the first time
Taken word for word from the abstract
- population Recurrent prolapse after stapled haemorrhoidopexy is a late complication of the procedure which can present with accompanying symptoms and may require surgery.
- intervention After excisional haemorrhoidectomy, a transverse incision is performed on the proximal part of the mucocutaneous bridge, above the plane of the internal sphincter.
- n From January 2007 to January 2011, we treated 11 patients.
- primaryOutcome We describe a technique for treating symptomatic patients, aimed at obtaining remission of symptoms and avoiding recurrences.
- result At mean follow-up of 4 ± 1.8 years, neither symptomatic nor asymptomatic recurrences have been observed.
- result One patient (9 %) suffered from bleeding during the night before being discharged, but this did not require surgery, and another (9 %) had urinary retention.
Tech Coloproctol · PMID 24957359 · 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 2026-10-26
The exact search — paste this into PubMed to repeat it: ("Hemorrhoids"[Mesh] AND (prolapse[tiab] OR prolapsed[tiab] OR prolapsing[tiab])) AND (therapy[tiab] OR treatment[tiab] OR management[tiab] OR "rubber band ligation"[tiab] OR sclerotherapy[tiab] OR "infrared coagulation"[tiab] OR hemorrhoidectomy[tiab] OR "stapled hemorrhoidopexy"[tiab] OR conservative[tiab]); PubMed expanded that to: "Hemorrhoids"[MeSH Terms] AND ("prolapse"[Title/Abstract] OR "prolapsed"[Title/Abstract] OR "prolapsing"[Title/Abstract]) AND ("therapy"[Title/Abstract] OR "treatment"[Title/Abstract] OR "management"[Title/Abstract] OR "rubber band ligation"[Title/Abstract] OR "sclerotherapy"[Title/Abstract] OR "infrared coagulation"[Title/Abstract] OR "hemorrhoidectomy"[Title/Abstract] OR "stapled hemorrhoidopexy"[Title/Abstract] OR "conservative"[Title/Abstract])
What came back: 630 records found · 200 read · 161 answered the question
Included: Human, animal or laboratory studies reporting an outcome relevant to the question
Excluded: Records about a different condition or intervention
Studies mainly about external hemorrhoids without prolapse
Studies mainly about thrombosed external hemorrhoid
Studies mainly about anal fissure
Studies mainly about full-thickness rectal prolapse
Studies mainly about anal skin tags
Studies mainly about laser hemorrhoidoplasty as a standalone single-intervention comparison
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.

630records came back from the search
200were read
161actually answered the question

Risks and safetyReported side effects and who should be careful.

Rubber band ligation commonly causes some discomfort, bleeding, or a pulling sensation after the procedure, and over half of patients reported a complication in one study.
Rubber band ligation can cause delayed bleeding after the procedure; in one study of conventional banding, this occurred in about 4% of patients (5 of 125), occasionally serious enough to need medical attention.
Sclerotherapy carries a small risk of fever, rectal ulcer, stricture, or perianal abscess, and prolapse recurrence climbs over time — up to roughly half of patients by 9 years in one long-term study.
Stapled hemorrhoidopexy can cause anal narrowing, persistent urgency, or impaired bowel control, and rare but serious complications including severe bleeding or rectovaginal fistula have been reported.
Excisional hemorrhoidectomy (surgical removal) caused more pain, more postoperative bleeding, and a higher wound infection rate than stapled hemorrhoidopexy in one study of grade III-IV hemorrhoids.

Why people askWhat brings people to this question.

A prolapsed hemorrhoid can be painful, itchy, or embarrassing, and people want it to go back in or disappear without surgery.
Conservative steps like more fiber and sitz baths feel like something they can try immediately at home before seeing a doctor.
Office procedures such as banding or sclerotherapy sound quick and non-surgical, which feels less intimidating than an operation.
Fear of surgical pain, time off work, or complications pushes many people to try less invasive options first.
Seeing or feeling tissue bulge out of the anus is alarming, so people search for a fast way to push it back in or make it disappear.

Common questionsShort answers, drawn from the same studies.

What is a prolapsed hemorrhoid?: A hemorrhoid is a cushion of blood vessels inside the anal canal. When an internal hemorrhoid swells enough that it bulges out through the anus, it is called 'prolapsed.' Grade III prolapse can be pushed back in by hand; grade IV stays out and can't be reduced.
How do you get rid of a prolapsed hemorrhoid?: Studies compare several approaches: conservative care (fiber, fluids, less straining), office procedures (rubber band ligation, sclerotherapy, infrared coagulation), and surgery (stapled hemorrhoidopexy or excisional hemorrhoidectomy). Milder prolapse often improves with conservative or office treatment; more severe or recurring prolapse is more reliably fixed by surgery, according to the studies reviewed here.
Prolapsed hemorrhoids vs external hemorrhoids — what's the difference?: Internal hemorrhoids form higher up inside the rectum and can prolapse, meaning they stretch and bulge out through the anus. External hemorrhoids form under the skin right at the anal opening and don't prolapse the same way, though they can swell, clot, or form skin tags. The studies here are about prolapsing internal hemorrhoids specifically.
Do I need surgery for a prolapsed hemorrhoid?: Not always. Guidelines reviewed here say grade III prolapse can often be tried with office procedures like banding first, but grade IV internal hemorrhoids, or grade III that doesn't respond to office treatment, are usually referred for surgery.
Can a prolapsed hemorrhoid go back in on its own?: In one small study, gently pushing a prolapsed hemorrhoid back in by hand and repeating this reduced pain and swelling within 10 days, and most people avoided surgery. This hasn't been tested in larger controlled trials, so it should be discussed with a doctor rather than relied on alone.

What has changedEvery re-check, and whether it changed the answer.

2026-10-26
Clear the 'Under re-review' backlog: rebuild every remaining first-method (ev-1) page under the current method. 116 new studies · 132 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.

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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.

Allen Kamrava, MD, MBA, FACS, FASCRS · 435 N. Bedford Dr., Suite 308, Beverly Hills, CA 90210 · 424.279.8222

Educational information — not medical advice.