How do you get rid of prolapsed hemorrhoids?

Studied options include rubber band ligation, injection treatments, laser or radiofrequency procedures, stapled hemorrhoidopexy, and excisional hemorrhoidectomy (surgical removal). In the trials reviewed here, excisional surgery gave the lowest chance of the prolapse returning, while banding and newer minimally invasive techniques caused less pain but recurred more often.

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

A prolapsed hemorrhoid starts inside the anal canal and pushes out through the anus; an external hemorrhoid forms under the skin right at the anal opening and doesn't come from inside. The studies summarized here focus on internal hemorrhoids that have prolapsed (grade III-IV), not on external hemorrhoids alone.

Should I avoid stapled hemorrhoid surgery (stapled hemorrhoidopexy)?

Not necessarily, but go in informed: a large pooled analysis of randomized trials found stapled hemorrhoidopexy comes back more often long-term than standard excisional surgery, and rare serious complications have been reported. Ask your surgeon how recurrence and complication rates compare for the specific technique they're offering you.

Can I push a prolapsed hemorrhoid back in myself?

A single case report describes a prolapsed hemorrhoid being pushed back manually, but this isn't a studied, reliable treatment for grade III-IV disease and doesn't prevent it from prolapsing again. See a doctor for an evaluation rather than relying on manual reduction alone.

Since stapled surgery can raise the risk of prolapse coming back, what should I do instead?

A large analysis of 17 trials (2,072 patients) found that stapled hemorrhoidopexy had a higher rate of long-term recurrence than conventional excisional hemorrhoidectomy, especially prolapse coming back again, with no difference in reoperation, pain, or quality of life between the two. If avoiding recurrence is your priority, conventional excisional hemorrhoidectomy is the better-supported surgical option for grade III-IV prolapse — talk with your surgeon about this trade-off against stapled surgery's usually easier recovery.

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

Name: What is a prolapsed hemorrhoid, and how do you treat it?
Published: 2026-10-13
Keywords: what is a prolapsed hemorrhoid, how to get rid of prolapsed hemorrhoids, prolapsed hemorrhoids vs external hemorrhoids

In adults with grade III–IV internal hemorrhoids that protrude through the anus, what defines a prolapsed hemorrhoid, and which treatments (manual reduction, rubber band ligation, excisional hemorrhoidectomy, stapled hemorrhoidopexy, or conservative care) resolve the 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”
“prolapsed hemorrhoids vs external hemorrhoids”

Evidence review in plain language · compiled 2026-10-13 · checked 2026-10-13 · next 2026-11-13 · automated review, how it works

Bottom line

A prolapsed hemorrhoid is internal hemorrhoid tissue that has slipped down and bulges out of the anus; a well-conducted analysis of randomized trials found that stapling it back in place lets it prolapse again more often than cutting it out, though stapling causes less pain at first.

This comes from a pooled analysis of 17 randomized trials comparing stapled hemorrhoidopexy with conventional excisional hemorrhoidectomy, which found a higher rate of prolapse returning after stapling, especially prolapse-specific recurrence, with no difference in needing further surgery, anal function, or quality of life. Other approaches such as rubber band ligation have also been compared with cutting the hemorrhoid out in smaller trials, with results that point the same direction but are less consistent, so the overall picture is only moderately certain.

How certain

Moderate

8 well-conducted randomised trials address this question directly. The studies disagree with one another, so the overall certainty is lower than any single one of them.

What it shows

Signal of harm

A well-conducted study in people reported harm.

studies found: 177studies found
randomised trials: 29randomised trials
people studied: 46,835people studied
reviews of trials: 14reviews of trials
years covered: 2023–2026years covered

Read this first

A well-conducted analysis of randomized trials found stapled hemorrhoidopexy had a higher rate of long-term prolapse recurrence than standard excisional surgery. Isolated case reports also describe rare but serious complications after various minimally invasive hemorrhoid procedures, including rectal perforation, sepsis, and abscess, but these come from single patients and don't show how often such problems occur or whether they are specific to any one technique.
Stapled procedures for hemorrhoids (stapled hemorrhoidopexy, also called PPH) carry a risk of the anal canal narrowing (stenosis or stricture) at the staple site; one large study found a 16.0% stricture rate with the standard technique, falling to 2.9% with a modified injection technique, and another study found this narrowing happened more often after stapled surgery than after conventional hemorrhoidectomy.
Patients who have had hemorrhoidectomy report complications that can include pain, bleeding, itching, and difficulty controlling stool; in one study following recovery after Milligan-Morgan surgery, pain gradually lessened over time and had resolved completely in all patients by 28 days.

What the research shows

Resolution or reduction of prolapse
Across many single-arm and comparative studies, most people had the visible prolapse shrink or disappear after banding, laser, or surgical treatment, though few studies compared treatment with doing nothing at all.[1,2,3,4,5,6,7]
Improvement shown
Symptom score (pain, bleeding, itching, soiling)
Pain, bleeding, itching, and soiling scores dropped after most treatments studied, including surgery, banding, laser, and sclerotherapy, in the weeks to months after treatment.[1,2,3,4,5]
Improvement shown
Recurrence rate at 12 months
Several trials and a pooled analysis found that stapled hemorrhoidopexy, banding, and other less invasive techniques come back more often than standard excisional surgery, sometimes by a wide margin (for example, 47.5% vs 6.1% in one trial).[1,2,3,4,5,6,7]
Possible harm
Complication rate
Complication rates varied widely by technique and were reported inconsistently across studies; case reports describe rare but serious events like bowel perforation, sepsis, and abscess, but how often these actually occur isn't established.[1,2,3,4,5,6]
Insufficient evidence
Time to return to normal activity
Less invasive options — laser, LigaSure, and stapled surgery — generally let people return to normal activity sooner than traditional cutting surgery (excisional hemorrhoidectomy).[1,2,3,4,5]
Improvement shown
Need for repeat or escalated intervention
In separate trials, both rubber band ligation and hemorrhoidal artery ligation had higher rates of prolapse recurrence than excisional surgery, which can mean further treatment is eventually needed: one trial found 47.5% recurrence with banding versus 6.1% with surgery at 12 months, and another found higher recurrence with artery ligation than with excisional surgery at 24 months.[1,2]
Possible harm

What it may help with

In randomized and large retrospective studies, standard surgical removal (excisional hemorrhoidectomy) had a lower rate of prolapse returning than rubber band ligation, stapled hemorrhoidopexy, or hemorrhoidal artery ligation, though one smaller randomized trial found no statistically significant difference between excisional surgery, laser treatment, and mucopexy at 5 years.[1,2,3,4,5]
Rubber band ligation can control prolapse and bleeding without surgery for many people with grade III disease, though trials show it fails more often than surgery does.[1,2,3]
Newer techniques like laser hemorrhoidoplasty, LigaSure, and stapled hemorrhoidopexy cause less pain and let people return to normal activity sooner than traditional cutting surgery.[1,2,3,4]

Important limitations

Most of the studies compared one surgical technique with another, not treatment with doing nothing, so it's often unclear how much better any option is than leaving the hemorrhoid untreated.[1,2,3,4]
Many studies were small, retrospective (looking back at records rather than randomly assigning treatment), or from a single hospital, which makes it hard to know if results would hold up elsewhere.[1,2,3,4,5]
The randomized trials in this body of evidence don't agree with each other — some show stapled surgery working as well as cutting surgery, others show it failing more often — which is why overall certainty is moderate rather than high.[1,2,3,4,5]

What the studies found

Found a benefit76 · 43%
Found no clear effect6 · 3%
Mixed or unclear85 · 48%
Found possible harm10 · 6%

What kind of studies

Retrospective62 · 35%
Randomised trial29 · 16%
Case series27 · 15%
Prospective cohort18 · 10%
Narrative review17 · 10%
Meta-analysis9 · 5%
Systematic review5 · 3%
Guideline3 · 2%
Registered trial, no results posted3 · 2%
Laboratory study2 · 1%
Animal study1 · 1%
Registry1 · 1%

The studies that decided it

Makunaite et al. 2026
Five-Year Follow-up of the Double-Blinded Randomized Controlled Trial Comparing Laser Hemorrhoidoplasty With Sutured Mucopexy and Excisional Hemorrhoidectomy
Similar long-term recurrence across treatments.Randomised trialModerate quality
102 people5 years
symptom recurrence at 5 years was 24% after excisional hemorrhoidectomy, 29% after laser hemorrhoidoplasty, and 44% after sutured mucopexy, a difference that was not statistically significant
Who was studied
patients with symptomatic second- or third-degree hemorrhoids
What they received
laser hemorrhoidoplasty or sutured mucopexy
Compared with
excisional hemorrhoidectomy
Main outcome
return of hemorrhoid symptoms over 5 years
Quality
this was a randomized, double-blinded trial but from a single small center, so the long-term differences between treatments could not be shown with confidence.
Limitations
single-center study with a relatively small sample size
Taken word for word from the abstract
- n A total of 102 patients were evaluated at 5 years (34 per group).
- population Patients with symptomatic second- or third-degree hemorrhoids 5 years after surgery were interviewed via telephone or online questionnaire.
- intervention Patients randomly assigned to laser hemorrhoidoplasty, excisional hemorrhoidectomy, and sutured mucopexy were followed up at 5 years after surgery.
- comparator excisional hemorrhoidectomy
- primaryOutcome Recurrence of symptoms was the primary outcome
- result Kaplan-Meier estimates of 5-year symptom recurrence were 24% for excisional hemorrhoidectomy, 29% for laser hemorrhoidoplasty, and 44% for sutured mucopexy; these differences did not reach statistical significance (log-rank p = 0.076).
- limitations This is a single-center study with a relatively small sample size.
- followUp A total of 102 patients were evaluated at 5 years (34 per group).
Dis Colon Rectum · PMID 42478482 · Read it on PubMed ↗
Qureshi et al. 2026
AGA Clinical Practice Update on Diagnosis and Treatment of Hemorrhoids: Expert Review
Banding works better long-term for prolapse.GuidelineLow quality
size not given2026
banding and infrared coagulation are safe and effective, with banding giving longer-term control of prolapse and bleeding than infrared coagulation
Who was studied
people with hemorrhoids, including those with prolapse
What they received
rubber band ligation or infrared coagulation (with diet/lifestyle and topical treatments)
Compared with
other treatments or no treatment
Main outcome
control of symptoms like prolapse and bleeding
Quality
This is an expert consensus guideline based on opinion and literature review without systematic review or formal evidence ratings.
Limitations
No systematic review was performed and statements are not formally graded for evidence quality.
Taken word for word from the abstract
- intervention Both hemorrhoid banding and infrared coagulation are safe, effective, and easy to perform in the office setting.
- comparator Infrared coagulation and rubber band ligation have similar benefits in the short term.
- result Rubber band ligation has longer-term benefits for treatment of prolapsing hemorrhoids and recurrent bleeding.
- primaryOutcome Symptoms caused by hemorrhoids include bleeding, itching, discomfort, and/or prolapse.
- population Hemorrhoid banding or infrared coagulation should be employed prior to surgical hemorrhoidectomy for grades 1 to 3 hemorrhoids.
- limitations Because systematic reviews were not performed, these BPA statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations.
Clin Gastroenterol Hepatol · PMID 42067175 · Read it on PubMed ↗
Fernandez-Hurtado et al. 2025
Open excisional haemorrhoidectomy versus transanal haemorrhoidal dearterialization for grade III haemorrhoids: open-label randomized clinical trial
Surgery works better, but hurts moreRandomised trialModerate quality
50 people12 months
THD had a much higher failure and reoperation rate than OEH, but OEH caused more early pain and longer recovery
Who was studied
adults with grade III hemorrhoids (prolapsed hemorrhoids)
What they received
transanal hemorrhoidal dearterialization (THD)
Compared with
open excisional hemorrhoidectomy (OEH)
Main outcome
change in hemorrhoid symptom and quality-of-life scores, and clinical failure rate at 1 year
Quality
it was a randomized trial but came from a single center, was not blinded, and included only 50 patients
Limitations
single-centre, open-label design with small sample size and three patients lost to follow-up
Taken word for word from the abstract
- population patients with grade III haemorrhoids
- n 50 patients were randomized (25 OEH patients and 25 THD patients)
- intervention Transanal haemorrhoidal dearterialization (THD) is an alternative with reduced pain but potentially higher recurrence
- comparator Open excisional haemorrhoidectomy (OEH) remains the standard treatment for advanced haemorrhoidal disease
- primaryOutcome The primary outcome was the relative change at 12 months in Haemorrhoidal Disease Symptom Score (HDSS) and Short Health Scale adapted for Haemorrhoidal Disease (SHS-HD) from baseline.
- result CFR was significantly higher in the THD group (14 of 23 (61%)) versus the OEH group (2 of 24 (8%)) (P <0.001). All eigth reoperations occurred in the THD group (P = 0.001).
- result OEH was associated with greater early postoperative pain and a longer time to return to work (median of 21 versus 14 days; P = 0.010).
Br J Surg · PMID 41553737 · Read it on PubMed ↗
Lauricella et al. 2026
Long-term outcomes of stapled haemorrhoidopexy versus conventional haemorrhoidectomy: An updated systematic review, meta-analysis and trial-sequential analysis of randomized controlled trials
More recurrence after stapling surgery.Meta-analysisModerate quality
2,072 peopleminimum follow-up of 12 months
stapled hemorrhoidopexy had higher long-term recurrence, especially prolapse-related, with no difference in reintervention, pain, function or quality of life
Who was studied
adults with grade II-IV hemorrhoids
What they received
stapled hemorrhoidopexy
Compared with
conventional hemorrhoidectomy
Main outcome
long-term recurrence, reintervention, anal function and quality of life
Quality
it pools many randomized trials but trial-sequential analysis shows the evidence is still underpowered and there was some inconsistency between studies.
Limitations
Trial Sequential Analysis showed the accrued information size did not reach the required information size, indicating current evidence remains underpowered; moderate heterogeneity (I2=48%) for overall recurrence.
Taken word for word from the abstract
- n Seventeen RCTs including 1,041 SH and 1,031 CH patients were analysed.
- population adult patients with grade II-IV haemorrhoids
- intervention Stapled haemorrhoidopexy (SH)
- comparator conventional haemorrhoidectomy
- primaryOutcome Primary outcomes included recurrence, reintervention, anal function, and quality of life (QoL).
- result SH was associated with a higher risk of overall recurrence compared with CH (RR = 1.56,95%CI = 1.00-2.44;I2 = 48%).
- result Prolapse-related recurrence was significantly more frequent after SH (RR = 3.28,95%CI = 1.49-7.25;I2 = 12%)
- result No significant differences were found for reintervention, persistent anal pain, functional impairment or QoL.
Int J Colorectal Dis · PMID 41535511 · Read it on PubMed ↗
Ashburn 2025
Hemorrhoidal Disease: A Review
Fiber, banding, or surgery relieve prolapse.Narrative reviewLow quality
size not given3 to 6 months
Dietary changes and phlebotonics help first; rubber band ligation resolves symptoms in most patients with less severe prolapse; surgery has low recurrence for severe or mixed disease but longer recovery
Who was studied
people with hemorrhoidal disease, including prolapsed internal hemorrhoids
What they received
range of treatments including fiber/water intake, phlebotonics, rubber band ligation, sclerotherapy, infrared coagulation, and excisional hemorrhoidectomy
Compared with
different treatments compared to each other and to no treatment/before treatment
Main outcome
resolution of symptoms such as bleeding, pain, and prolapse
Quality
This is a narrative review summarizing other studies rather than a new controlled trial, so the strength of each claim cannot be verified here.
Limitations
Abstract does not describe how underlying studies were selected or their individual quality; recurrence rates vary widely by treatment.
Taken word for word from the abstract
- population Hemorrhoidal disease, pathology of the tissue lining of the anal canal, affects approximately 10 million individuals in the US.
- intervention Initial treatment of all hemorrhoidal disease involves increasing intake of dietary fiber and water and avoiding straining during defecation.
- intervention Rubber band ligation-placing a band around the base of hemorrhoid tissue during anoscopy to restrict blood flow-resolves symptoms in 89% of patients, but repeated banding is needed in up to 20%.
- intervention Excisional hemorrhoidectomy, for disease unresponsive to office-based therapy or for mixed hemorrhoidal disease, achieves low recurrence (2%-10%), although with longer recovery (9-14 days).
- comparator If dietary modification and phlebotonics are ineffective, grade I to grade III internal hemorrhoidal disease can be treated with office-based interventions.
- primaryOutcome Hemorrhoidal disease may impair quality of life due to bleeding, pain, anal irritation, and tissue prolapse.
- result Rubber band ligation-placing a band around the base of hemorrhoid tissue during anoscopy to restrict blood flow-resolves symptoms in 89% of patients, but repeated banding is needed in up to 20%.
- result Excisional hemorrhoidectomy, for disease unresponsive to office-based therapy or for mixed hemorrhoidal disease, achieves low recurrence (2%-10%), although with longer recovery (9-14 days).
- followUp symptom recurrence reaches 80% within 3 to 6 months after treatment cessation
JAMA · PMID 40824576 · Read it on PubMed ↗
Khalid et al. 2025
A Comparative Analysis of Gastrointestinal Recovery and Pain Management Outcomes in Stapled Versus Open Hemorrhoidectomy: A Meta-Analysis
Less pain but more recurrence.Meta-analysisModerate quality
292 people12-18 months
stapled hemorrhoidectomy had less pain, faster bowel recovery, and shorter hospital stay, but a higher recurrence rate later on
Who was studied
patients with grade III and IV hemorrhoids
What they received
stapled hemorrhoidectomy (surgical stapling device to remove hemorrhoid tissue)
Compared with
open hemorrhoidectomy (traditional surgical removal)
Main outcome
gastrointestinal recovery (time to normal diet and bowel movements) and postoperative pain scores
Quality
it pools only seven small studies with 292 patients total, and the included trials varied in design even though risk of bias was mostly rated low.
Limitations
Risk of bias was generally low in most studies, with only a few showing moderate concerns; small number of pooled studies and patients.
Taken word for word from the abstract
- n Seven studies involving 292 patients met the inclusion criteria.
- population patients with grade III and IV hemorrhoids
- intervention Stapled hemorrhoidectomy (SH)
- comparator open hemorrhoidectomy (OH)
- primaryOutcome The primary outcomes were gastrointestinal recovery, measured by time to resumption of normal diet and bowel movements, and pain management, assessed by postoperative pain scores.
- result SH consistently demonstrated advantages over OH regarding pain management, gastrointestinal recovery, and hospital stay.
- result though a higher recurrence rate was noted in the SH group, especially at 12-18 months post-surgery
- followUp especially at 12-18 months post-surgery
- qualityWhy The risk of bias was generally low in most studies, with only a few showing moderate concerns.
Cureus · PMID 40125221 · Read it on PubMed ↗
van Oostendorp et al. 2025
Comparison of Rubber Band Ligation and Hemorrhoidectomy in Patients With Symptomatic Hemorrhoids Grade III: A Multicenter, Open-Label, Randomized Controlled Noninferiority Trial
Surgery better long-term, banding faster recovery.Randomised trialLow quality
87 people12 months
Rubber band ligation was not as good as surgery for quality of life and had a much higher recurrence rate (47.5% vs 6.1%), though it caused less pain and allowed faster return to work
Who was studied
adults with symptomatic grade III hemorrhoids
What they received
rubber band ligation (non-surgical banding procedure)
Compared with
hemorrhoidectomy (surgical removal of hemorrhoids)
Main outcome
quality of life and recurrence rate at 12 months
Quality
The trial stopped early due to funding problems, leaving a small sample and limited statistical power.
Limitations
Early termination due to funding constraints resulted in a relatively small sample size and limited statistical power; recruitment was hindered by treatment preferences and the COVID-19 pandemic.
Taken word for word from the abstract
- population Patients (aged 18 years or older) with symptomatic grade III (Goligher) hemorrhoids were included in this study.
- intervention rubber band ligation
- comparator Hemorrhoidectomy is the criterion standard
- primaryOutcome Primary outcomes included 12-month health-related quality of life and recurrence rate.
- result Rubber band ligation was not noninferior to hemorrhoidectomy in quality-adjusted life years (-0.045; 95% CI, -0.087 to -0.004). Recurrence rate was worse in the rubber band ligation group (47.5% vs 6.1%)
- n Eighty-seven patients were randomly assigned (47 rubber band ligation vs 40 hemorrhoidectomy).
- followUp 12-month health-related quality of life
- limitations The primary limitation of the study was its early termination due to funding constraints, resulting in a relatively small sample size and limited statistical power.
Dis Colon Rectum · PMID 39952268 · Read it on PubMed ↗
Giuliani et al. 2023
Excisional Hemorrhoidectomy Versus Dearterialization With Mucopexy for the Treatment of Grade III Hemorrhoidal Disease: The EMODART3 Multicenter Study
Fewer complications, but more recurrence.RetrospectiveLow quality
1,681 people24-month
Artery ligation had fewer complications but significantly more recurrences than excisional hemorrhoidectomy at 24 months
Who was studied
patients with grade III prolapsed hemorrhoids (Goligher grade III)
What they received
hemorrhoidal artery ligation with mucopexy (dearterialization)
Compared with
excisional hemorrhoidectomy (surgical removal)
Main outcome
symptoms, postoperative complications, and recurrence at 24 months
Quality
This was a retrospective, multicenter study relying on self-reported data from different centers, which limits confidence in the comparison.
Limitations
The retrospective design and the self-reported nature of data from different centers.
Taken word for word from the abstract
- n Data from 1681 patients were analyzed.
- population Clinical data from patients with Goligher's grade III hemorrhoidal disease
- intervention hemorrhoidal artery ligation
- comparator excisional hemorrhoidectomy
- primaryOutcome to compare them in terms of symptoms, postoperative adverse events, and recurrences at a 24-month follow-up
- result Patients who underwent excisional hemorrhoidectomy had a significantly higher risk of postoperative complication (adjusted OR = 1.58; p = 0.006).
- result At the 24-month follow-up assessment, recurrence was significantly higher in the hemorrhoidal artery ligation group (adjusted OR = 0.50; p = 0.001).
- followUp 24-month follow-up period
Dis Colon Rectum · PMID 37616177 · Read it on PubMed ↗

What actually helps, on this site

Treatments Dr. Kamrava performs for this:

More about the condition:

All 177 studiesEvery study that answered the question, with its design, size and result.

The other 169 studiesEverything else the search returned, including anything retracted.

Barone et al. 2026
LigaSure versus conventional excisional haemorrhoidectomy: A systematic review and meta-analysis with trial sequential analysis of randomised controlled trials
Less pain, faster recovery with LigaSureMeta-analysisModerate quality
3,277 people2026
LigaSure caused less early pain, less bleeding, and faster recovery, but no difference in recurrence or other longer-term outcomes
Who was studied
patients with grade IV hemorrhoids undergoing surgery
What they received
LigaSure (energy-based) hemorrhoidectomy
Compared with
conventional excisional hemorrhoidectomy
Main outcome
postoperative pain and other surgical recovery outcomes
Quality
It combines 43 randomized trials with over 3000 patients, but the authors note real uncertainty remains for several outcomes including recurrence.
Limitations
Uncertainty remains for several outcomes, and evidence regarding recurrence and other long-term anorectal outcomes remains limited.
Taken word for word from the abstract
- n Forty-three unique RCTs comprising 3,277 participants were analysed.
- population Conventional excisional haemorrhoidectomy remains the gold standard treatment for grade IV haemorrhoids
- intervention although energy-based devices may reduce postoperative pain
- comparator Randomised controlled trials comparing LigaSure with conventional techniques were included.
- primaryOutcome LigaSure was associated with lower postoperative pain scores on days 1 and 2 and during the first and second postoperative weeks
- result No statistically significant differences were observed in immediate postoperative pain, pain on postoperative day 3 or week 4, recurrence, length of hospital stay, constipation, pruritus, surgical site infection, incomplete healing, anal fissure, anal stenosis, or faecal incontinence.
Colorectal Dis · PMID 42816945 · Read it on PubMed ↗
Parkhi et al. 2026
Comparative Study of Postoperative Outcomes and Morbidity Among Laser, Open, and Stapled Hemorrhoidectomy for the Treatment of Grade III and Grade IV Hemorrhoids
Laser caused less pain, faster recovery.Prospective cohortLow quality
180 peoplethree months
Laser surgery caused less pain on day 1, shorter operations, shorter hospital stays, faster recovery, and higher satisfaction than open or stapled surgery, with similar recurrence and only mild complications across all groups
Who was studied
adults aged 18-60 with grade III-IV hemorrhoids at a tertiary care center
What they received
laser hemorrhoidoplasty
Compared with
open hemorrhoidectomy (Milligan-Morgan technique) and stapled hemorrhoidopexy
Main outcome
pain on postoperative day 1 (VAS score)
Quality
Patients were not randomly assigned to treatments, so the groups could differ in ways that affect the results.
Limitations
Allocation was non-random, determined by clinical suitability, device availability, affordability, and patient preference; short three-month follow-up.
Taken word for word from the abstract
- population 180 patients aged 18-60 years with Grade III-IV hemorrhoids were enrolled over six months by consecutive sampling
- intervention laser hemorrhoidoplasty (LHP)
- comparator Grade III and Grade IV disease may be treated by open hemorrhoidectomy (Milligan-Morgan technique), stapled hemorrhoidopexy, or laser hemorrhoidoplasty (LHP)
- primaryOutcome The primary outcome was pain on the Visual Analogue Scale (VAS) at postoperative day 1 (POD1).
- result LHP showed lower VAS at POD1 (4.04 ± 1.36) than open (7.53 ± 1.28; mean difference -3.49, 95% CI -3.97 to -3.01) and stapled (5.12 ± 1.10; -1.08, 95% CI -1.53 to -0.63) procedures (p < 0.001).
- result Recovery was fastest after laser surgery (10.72 ± 3.10 days) vs. stapled (13.85 ± 3.50) and open (20.40 ± 4.20) (p < 0.001).
- result Good or excellent satisfaction at three months was highest after laser surgery (88.3%) vs. stapled (80.0%) and open (60.0%) (p < 0.001).
- result three-month recurrence did not differ between groups (p = 0.548)
- n 180 patients aged 18-60 years with Grade III-IV hemorrhoids were enrolled
- limitations Allocation was non-random, determined by clinical suitability, device availability, affordability, and patient preference.
- followUp each followed for three months
Cureus · PMID 42802752 · 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
Non-surgical care healed eroded hemorrhoid.Case seriesVery low qualityRelated question
1 people30 days
after 30 days of treatment, fever resolved and the eroded hemorrhoid healed completely
Who was studied
a 51-year-old woman with breast cancer who developed severe low blood counts and sepsis after chemotherapy, with eroded prolapsed hemorrhoids
What they received
non-surgical treatment: antibiotics, blood/immune support, and multimodal local wound care including traditional Chinese medicine
Compared with
no comparison group; single patient case
Main outcome
resolution of infection and healing of the eroded hemorrhoid
Quality
This is a single patient case report, so it cannot show whether this treatment works in general.
Limitations
Single case report with no control group, in a patient with unusual severe immune suppression from chemotherapy, limiting generalizability to typical prolapsed hemorrhoid cases.
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
- population 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 The eroded hemorrhoid healed entirely, allowing for a successful transfer to a lower-level hospital for continued supportive care.
- result After 30 days of treatment, the patient became afebrile, and her perianal swelling and inflammation completely resolved. The eroded hemorrhoid healed entirely
Medicine (Baltimore) · PMID 42798126 · Read it on PubMed ↗
Neola et al. 2026
Polidocanol foam sclerotherapy for hemorrhoidal disease in a private outpatient setting: a real-world single-center study combining chart review and WhatsApp-delivered patient-reported outcomes
Most patients reported improved prolapse symptoms.RetrospectiveLow qualityRelated question
84 people2026
Among those with prolapse symptoms at baseline, 86.4% reported improvement or resolution after treatment, with similarly high improvement in bleeding (95.8%) and heaviness/pain (97.4%)
Who was studied
adults with symptomatic hemorrhoidal disease treated in a private proctology clinic
What they received
polidocanol foam sclerotherapy (an injection treatment for hemorrhoids)
Compared with
none (single-arm, before-and-after comparison within the same patients)
Main outcome
patient-reported improvement in hemorrhoid symptoms (bleeding, heaviness/pain, prolapse) and satisfaction
Quality
This was a retrospective, single-center study with no control group and relied on self-reported surveys with incomplete response and follow-up, so its findings are not strong proof the treatment works.
Limitations
Retrospective design, no comparator group, survey response rate was 65.5%, chart and survey follow-up used different, non-comparable methods, and the authors note possible ascertainment bias.
Taken word for word from the abstract
- n Eighty-four patients underwent 118 sessions
- population patients treated with PFS (3% polidocanol, Tessari method) in a single private proctology office
- intervention Polidocanol foam sclerotherapy (PFS) is an effective office-based treatment for symptomatic hemorrhoidal disease (HD)
- comparator We retrospectively reviewed all consecutive patients treated with PFS
- primaryOutcome exploring symptoms before and after treatment, post-procedural discomfort and satisfaction
- result improvement or resolution was reported by 95.8% (46/48) for bleeding, 97.4% (37/38) for heaviness/pain and 86.4% (38/44) for prolapse (composite 121/130, 93.1%)
Updates Surg · PMID 42791481 · Read it on PubMed ↗
Pei et al. 2026
Dynamic Changes and Influencing Factors of Acute Pain After Elastic Band Ligation of Internal Hemorrhoids in Patients With Mixed Hemorrhoids
Pain patterns vary; risk factors identified.RetrospectiveLow qualityRelated question
173 people14 days
Patients fell into two pain recovery patterns (fast relief or poor relief); younger age, higher anxiety/depression, lower social support, and more ligations predicted poor pain relief
Who was studied
Patients with grade III or IV mixed hemorrhoids
What they received
Elastic band ligation of internal hemorrhoids
Main outcome
Pattern of pain severity over 14 days after surgery and factors affecting it
Quality
This is a retrospective single-center study without a comparison treatment, so it shows pain patterns after this procedure but cannot say if it works better than other options.
Limitations
Retrospective design, single center, no control group or comparison treatment, so causal conclusions about treatment effectiveness cannot be drawn.
Taken word for word from the abstract
- population 173 patients with mixed hemorrhoids (grade III or IV) who underwent elastic band ligation of internal hemorrhoids
- intervention elastic band ligation of internal hemorrhoids
- n included 173 patients with mixed hemorrhoids
- primaryOutcome dynamic trajectory of acute pain after elastic band ligation of internal hemorrhoids
- result Multivariate logistic regression analysis showed that age (odds ratio [OR] = 0.90, 95% confidence interval [CI]: 0.85-0.96, p = 0.002), SAS score (OR = 1.05, 95% CI: 1.01-1.10, p = 0.018), SDS score (OR = 1.05, 95% CI: 1.01-1.09, p = 0.009), SSRS total score (OR = 0.72, 95% CI: 0.65-0.81, p < 0.001), and number of ligations (OR = 4.96, 95% CI: 1.25-19.77, p = 0.023) were independent factors influencing the pain trajectory.
- followUp visual analog scale (VAS) pain scores on postoperative days 1, 3, 7, and 14
Ann Ital Chir · PMID 42755315 · Read it on PubMed ↗
de Oliveira et al. 2026
HARMONIC SCALPEL HEMORRHOIDECTOMY VERSUS STAPLED HEMORRHOIDOPEXY IN GRADE III / IV HEMORRHOIDS: SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Mixed resultsMeta-analysisModerate quality
375 people2026
harmonic scalpel surgery had lower recurrence but more pain; stapled surgery had less pain but no difference in other outcomes
Who was studied
patients with grade III or IV prolapsed hemorrhoids needing surgery
What they received
harmonic scalpel hemorrhoidectomy
Compared with
stapled hemorrhoidopexy
Main outcome
recurrence, pain, bleeding, incontinence, operative time, hospital stay, urinary retention
Quality
it pools six randomized trials but only 375 patients total, so results could still be imprecise
Limitations
small number of trials and patients pooled together
Taken word for word from the abstract
- n We included six randomized controlled trials with a total of 375 patients.
- population patients with grade III/IV hemorrhoids
- intervention harmonic scalpel hemorrhoidectomy (HSH)
- comparator stapled hemorrhoidopexy (SH)
- primaryOutcome there were no significant differences in bleeding, fecal incontinence, operative time, hospital stay and urinary retention
- result HSH was associated with a lower recurrence compared to SH
- result SH group was associated with less postoperative severe pain and overall pain
Dig Surg · PMID 42715146 · Read it on PubMed ↗
Chang et al. 2026
CT-Guided Inferior Rectal Nerve Block for Postoperative Pain Management After Hemorrhoidectomy
Found a benefitRetrospectiveLow qualityRelated question
69 people28
patients who got the nerve block had lower pain scores than those on standard pain medicine, especially in the first two weeks
Who was studied
patients with grade III or IV mixed hemorrhoids who had hemorrhoid removal surgery
What they received
CT-guided nerve block near the rectum given the day after surgery, using numbing medicine and steroid
Compared with
standard pain medicine after surgery (no nerve block)
Main outcome
pain intensity after surgery, measured on a 0-10 pain scale
Quality
patients chose their own group rather than being randomly assigned, and the study only looked back at records from one hospital.
Limitations
patients self-selected into groups rather than being randomized, it is a retrospective review, and it addresses pain control after surgery rather than how prolapsed hemorrhoids themselves should be treated
Taken word for word from the abstract
- n This retrospective study enrolled 69 patients with grade III or IV mixed hemorrhoids undergoing hemorrhoidectomy between April 2024 and March 2026.
- population patients with grade III or IV mixed hemorrhoids undergoing hemorrhoidectomy
- intervention Group 1 received bilateral CT-guided IRNB on postoperative day 1 using a mixture of triamcinolone acetonide, 0.5% bupivacaine HCl, normal saline, and epinephrine.
- comparator those who declined formed Group 2 (n = 31, standard analgesia)
- primaryOutcome Pain intensity was assessed using the Numerical Rating Scale (NRS, 0-10) at baseline and on postoperative days 1 to 10, 14, and 28.
- result Group 1 showed significantly lower median NRS scores than Group 2 on postoperative day 1 (2 [1-5] vs 5 [4-7]; P < .001), with sustained superiority through day 14 (1 [0-1] vs 2 [0-3]; P < .05).
Can Assoc Radiol J · PMID 42698285 · Read it on PubMed ↗
Vignesh et al. 2026
Comparing Outcomes of Conventional Hemorrhoidectomy With Hemorrhoidectomy Using the Harmonic Scalpel
Less pain, faster surgery, quicker recovery.Prospective cohortLow quality
112 people2026
significant reduction in operating time, blood loss, postoperative pain, urinary catheterization, and hospital stay with harmonic scalpel
Who was studied
patients with grade III and IV hemorrhoids
What they received
hemorrhoidectomy using the harmonic scalpel
Compared with
conventional hemorrhoidectomy
Main outcome
intraoperative bleeding, operating time, and postoperative pain
Quality
This was a non-randomized observational study comparing two surgical techniques, so differences between groups could be due to factors other than the treatment itself.
Limitations
Observational study design, not randomized, single-center.
Taken word for word from the abstract
- population This prospective single-center observational study included 112 patients with grade III and IV hemorrhoids
- intervention hemorrhoidectomy using the harmonic scalpel (HS) has gained attention because of its potential to reduce tissue injury and postoperative pain
- comparator who underwent hemorrhoidectomy using the conventional technique (n = 59) or the harmonic scalpel (n = 53)
- primaryOutcome The primary outcomes included intraoperative bleeding, operating time, and postoperative pain
- result A significant reduction in operating time (<0.001), intraoperative blood loss (<0.001), postoperative pain (<0.001), postoperative urinary catheterization (0.018), and hospital stay (<0.001) was noted in the group undergoing hemorrhoidectomy using the harmonic scalpel compared with the conventional group.
- n This prospective single-center observational study included 112 patients with grade III and IV hemorrhoids
Cureus · PMID 42577337 · Read it on PubMed ↗
Cai et al. 2026
Short- and Medium-Term Efficacy of Super-Selective Haemorrhoidal Artery Embolisation for Internal Haemorrhoids and Its Relationship With Severity Grading: A Single-Centre Retrospective Study
Early relief fades, worse in severe cases.RetrospectiveLow qualityRelated question
32 people12 months
symptom relief was high at 1 month (87.5%) but declined over time to 56.2% at 12 months, with success rates falling as hemorrhoid grade increased (100% for Grade I down to 40% for Grade IV)
Who was studied
adults with internal hemorrhoids (various severity grades I-IV)
What they received
super-selective hemorrhoidal artery embolisation (a minimally invasive procedure blocking blood flow to hemorrhoids)
Compared with
none; outcomes compared to patients' own pre-treatment scores
Main outcome
symptom relief (bleeding and pain scores) and clinical success rate over 12 months
Quality
this was a small, single-center retrospective study with no comparison group, so its findings can't reliably show whether the treatment truly works better than other options.
Limitations
retrospective design, small sample size, no control group, and declining efficacy over time not fully explained
Taken word for word from the abstract
- population 32 patients with internal haemorrhoids
- intervention super-selective haemorrhoidal artery embolisation (HAE)
- comparator Efficacy was assessed using Visual Analogue Scale (VAS) and French Bleeding Scale (FBS) scores at 1, 3, 6, and 12 months postoperatively.
- primaryOutcome To evaluate the 12-month symptom relief rate of super-selective haemorrhoidal artery embolisation (HAE) for Grade I-IV internal haemorrhoids
- result The rates at 3 months, 6 months, and 12 months were 68.8% (22/32), 59.4% (19/32), and 56.2% (18/32).
- result The 12-month efficacy rate remained at 100% for Grade I haemorrhoids, 54.5% for Grade II, 50% for Grade III, and 40% for Grade IV.
- n A retrospective analysis was conducted on 32 patients with internal haemorrhoids who underwent HAE
J Med Imaging Radiat Oncol · PMID 42573173 · Read it on PubMed ↗
Wu et al. 2026
Suture Reinforcement of Rubber Band Ligation for Internal Hemorrhoids: A Technical Modification to Reduce Delayed Massive Bleeding
Added stitches reduced bleeding risk.RetrospectiveLow quality
530 people2026
adding a stitch led to fewer delayed heavy bleeding events (1 vs 7) but no significant difference in recurrence or other symptoms
Who was studied
adults with grade II or III internal hemorrhoids
What they received
rubber band ligation plus an added absorbable stitch
Compared with
rubber band ligation alone
Main outcome
rate of delayed heavy bleeding and hemorrhoid recurrence after treatment
Quality
this was a non-randomized, single-center look-back study with very few bleeding events, so the result could easily be due to chance or bias.
Limitations
Retrospective, nonrandomized design with sequential (not randomized) allocation, small number of bleeding events, wide confidence intervals, single center.
Taken word for word from the abstract
- population patients with grade II/III internal hemorrhoids who were treated with RBL
- intervention RBL combined with absorbable suture ligation (RBL-SL)
- comparator RBL alone
- primaryOutcome The incidence of DMB and hemorrhoids recurrence were evaluated as the primary outcomes.
- result Compared with one patient who underwent DMB in the RBL-SL group, seven cases of DMB were observed in the RBL group. The difference was statistically significant (P < 0.05).
- result there was no statistically significant difference in the recurrence rate between the two groups (8.0% vs 12.7%, P > 0.05)
- n A total of 530 patients were enrolled, including 263 patients received RBL combined with suture ligation and 267 patients underwent RBL alone.
Am Surg · PMID 42572365 · Read it on PubMed ↗
Yeo et al. 2026
Comparative Outcomes of Hemorrhoidectomy under Spinal Anesthesia between Older and Super-old Patients
Surgery equally safe in very old patients.RetrospectiveLow qualityRelated question
761 people6 months
no significant difference in early complications between age groups, but very old patients needed a urinary catheter more often
Who was studied
adult patients who had surgery to remove hemorrhoids, divided into older (65-79) and very old (80+) age groups
What they received
open hemorrhoidectomy under spinal anesthesia in very old patients (age 80 and above)
Compared with
open hemorrhoidectomy under spinal anesthesia in older patients (age 65-79)
Main outcome
complications within 6 months after surgery, and need for urinary catheter or extra pain medication
Quality
This was a single retrospective study at one hospital with very unequal group sizes, so it cannot prove the surgery is equally safe for everyone.
Limitations
Retrospective design, single center, much smaller very-old group (68 vs 693), and only looked at surgery safety by age rather than comparing surgery to other treatments for prolapsed hemorrhoids.
Taken word for word from the abstract
- population Patients were stratified into older (65-79 years) and very old (≥80 years) groups.
- n Overall, 693 older patients and 68 very old patients were included.
- intervention open hemorrhoidectomy under spinal anesthesia
- comparator compared postoperative outcomes between older (age 65-79 years) and very old (age ≥80 years) patients undergoing open hemorrhoidectomy under spinal anesthesia
- primaryOutcome postoperative outcomes, including 6-month complications, and predictors of Foley catheter insertion or additional analgesic injections were assessed
- result The incidence of early (≤6 months) postoperative complications, including constipation, bleeding, and recurrence, did not differ significantly between the two groups. Foley catheter insertion occurred more frequently in the very old group than in the older group (45.6% vs 31.0%, p = 0.021).
J Anus Rectum Colon · PMID 42535235 · Read it on PubMed ↗
Al Hakkak 2026
LigaSure™ Hemorrhoidectomy for Complex Grade III Hemorrhoidal Disease: A Prospective, Single-Center, Cohort Study
Found a benefitProspective cohortLow quality
316 peopleone-year
Surgery was quick, severe pain and major complications were rare, and no patients needed repeat surgery within a year, though urinary retention was more common with spinal anesthesia
Who was studied
adults with grade III hemorrhoids with large or circumferential prolapse, some after failed prior treatment
What they received
LigaSure hemorrhoidectomy (a device that seals and cuts tissue during surgical removal of hemorrhoids)
Compared with
none; all patients received the same surgery (spinal vs general anesthesia compared as a secondary analysis)
Main outcome
how long surgery took and complications within 30 days (severe pain, urinary retention, bleeding, infection, narrowing, loss of bowel control)
Quality
This was a single-group study at one hospital with no comparison treatment, so it can't show whether this surgery works better than other options.
Limitations
No comparator group, single-center design, and about 8.5% of patients were lost to one-year follow-up.
Taken word for word from the abstract
- n enrolled 316 adults with Grade III HD
- population Grade III hemorrhoidal disease (HD) with large-volume or circumferential prolapse
- intervention LigaSure™ (Covidien plc, Dublin, Ireland; now acquired by Medtronic plc, Galway, Ireland) hemorrhoidectomy
- comparator the rate of postoperative urinary retention was higher with spinal (19.6%, n=240) versus general anesthesia (9.2%, n=76)
- primaryOutcome Primary endpoints included operative time and 30-day complications (visual analog scale ≥7 pain, urinary retention, bleeding, infection, stenosis, incontinence).
- result Mean operative time was 28.0 ± 6.0 minutes. Severe pain was recorded in 6.9% (95% CI 4.4-10.3), urinary retention in 17.1% (95% CI 13.1-21.7)
- result There were no patients with reoperation
- followUp with a follow-up to October 2025
- followUp The one-year follow-up rate was achieved in 91.5% (289/316) of the patients.
Cureus · PMID 42460166 · 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 symptoms including prolapse/swelling.Randomised trialLow qualityRelated question
52 people40 days treatment plus 30-day telephone follow-up
mesoglycan reduced hemorrhoid symptom score more than placebo, including swelling/prolapse scores
Who was studied
adults with symptomatic grade II to III hemorrhoid disease
What they received
oral mesoglycan taken for 40 days
Compared with
placebo
Main outcome
change in hemorrhoid symptom score (itching, pain, bleeding, swelling/prolapse) from baseline to day 40
Quality
small phase 2 trial with only 52 patients, so results need confirmation in larger studies.
Limitations
small sample size (52 patients), phase 2 study, grade II-III disease pooled together rather than focused on prolapse specifically
Taken word for word from the abstract
- n Fifty-two patients were randomized (26 mesoglycan, 26 placebo)
- population adults with symptomatic grade II to III hemorrhoidal disease
- intervention oral mesoglycan or placebo for 40 days
- comparator 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)
- result Symptom-specific analysis showed significant reductions in itching (P = .0048), pain (P = .0246), and swelling/prolapse (P = .0418) in the mesoglycan group
Surgery · PMID 42442141 · Read it on PubMed ↗
Liu et al. 2026
Hemorrhoids or not? Inflammatory cloacogenic polyps mimicking prolapsed hemorrhoids: a 10-year case series of 56 patients
Some 'hemorrhoids' are actually a different lesion.Case seriesLow qualityRelated question
56 people2026
all 56 had a prolapsing anal mass and most had bleeding; excision allowed correct diagnosis as ICP rather than hemorrhoids
Who was studied
patients diagnosed with hemorrhoids before surgery who turned out to have a different condition (inflammatory cloacogenic polyp)
What they received
surgical excision performed during hemorrhoid treatment
Compared with
none
Main outcome
whether the removed tissue was confirmed as hemorrhoids or actually a different lesion (ICP) on pathology
Quality
This is a retrospective case series without a comparison group, so it cannot show whether any treatment works better than another.
Limitations
Retrospective design, no control group, and the abstract focuses on a rare mimicking condition rather than true hemorrhoid treatment outcomes.
Taken word for word from the abstract
- n 56 (0.29%;12 males, 44 females; median age 56.5 years, range 18-81) were histopathologically confirmed to have ICP
- population patients who were preoperatively diagnosed with hemorrhoids and subsequently found to have ICP on histopathological examination
- intervention Lesions detected on digital rectal examination or anoscopy were completely excised during hemorrhoid treatment and confirmed as ICP
- primaryOutcome subsequently found to have ICP on histopathological examination
- result All 56 patients presented with a prolapsing anal mass, and 51 (91.1%) also had hematochezia
- comparator Among 19364 patients treated for hemorrhoids, 56 (0.29%;12 males, 44 females; median age 56.5 years, range 18-81) were histopathologically confirmed to have ICP
Rev Esp Enferm Dig · PMID 42439421 · Read it on PubMed ↗
Shu et al. 2026
Low excision and high suspension hemorrhoidectomy versus conventional Milligan-Morgan hemorrhoidectomy for mixed hemorrhoids: a 12-month prospective randomized controlled trial
Similar healing, less pain, fewer complications.Randomised trialModerate qualityRelated question
120 people12 months
LEHS was as effective as MM in healing and preventing recurrence, with less pain, fewer complications, and better preserved anal function
Who was studied
adults with grade III-IV mixed hemorrhoids (which can include prolapsed hemorrhoids)
What they received
low excision and high suspension hemorrhoidectomy (LEHS), a tissue-preserving surgical technique
Compared with
standard Milligan-Morgan hemorrhoidectomy (MM), the traditional surgical removal method
Main outcome
rate of successful treatment at 12 weeks and rate of hemorrhoid recurrence at 12 months
Quality
It was a randomized, blinded trial but came from a single hospital with a modest number of patients and a short follow-up window for recurrence.
Limitations
Single-center study, trial registered retrospectively after the study period, and results may not generalize to other settings or hemorrhoid types.
Taken word for word from the abstract
- n enrolled 120 eligible patients between January 2024 and June 2024
- population grade III-IV mixed hemorrhoids
- intervention Low excision and high suspension hemorrhoidectomy (LEHS) is a refined, function-preserving technique
- comparator Milligan-Morgan hemorrhoidectomy (MM) is the gold-standard treatment
- primaryOutcome Primary outcomes were 12-week clinical effective rate and 12-month hemorrhoid recurrence rate
- result The 12-week effective rate (96.4% vs. 92.9%) and 12-month recurrence rate (1.8% vs. 5.4%) confirmed LEHS non-inferiority (both P > 0.05). LEHS yielded longer operative time, less blood loss, lower VAS pain scores, faster recovery, fewer complications (14.8% vs. 33.3%, P = 0.027), and more favorable anorectal physiology (all P < 0.001), with higher patient satisfaction.
BMC Surg · PMID 42393699 · Read it on PubMed ↗
Wei et al. 2026
Multidisciplinary management of Grade III circumferential mixed hemorrhoids in a patient with Marfan syndrome receiving long-term anticoagulation: a case report
Surgery healed hemorrhoids safely in this case.Case seriesVery low qualityRelated question
1 people41 months
wounds healed well with no recurrent prolapse or serious bleeding at long-term follow-up, after a brief episode of minor self-limiting bleeding after surgery
Who was studied
a 33-year-old man with Marfan syndrome on long-term warfarin, with severe prolapsed hemorrhoids not helped by non-surgical treatment
What they received
surgery combining external hemorrhoid removal, internal ligation, and sclerotherapy injection, managed with a careful multi-specialty plan for blood thinners
Compared with
no comparison group; single patient case report
Main outcome
healing of hemorrhoids and bleeding complications after surgery
Quality
This is a single patient case report, so it cannot show whether this treatment works better than other options in general.
Limitations
Only one patient was studied, there is no comparison group, and the patient had unusual medical complexity (Marfan syndrome and anticoagulation) that limits how well this applies to typical patients with prolapsed hemorrhoids.
Taken word for word from the abstract
- n We report the case of a 33-year-old male with MFS
- population a 33-year-old male with MFS, status post-aortic dissection repair (Sun's procedure and Bentall operation) on continuous warfarin therapy, who presented with persistent Grade III circumferential mixed hemorrhoids that had not responded adequately to prior conservative outpatient management
- intervention underwent external dissection and internal ligation combined with liquid polidocanol injection sclerotherapy
- comparator We report the case of a 33-year-old male
- primaryOutcome At 41 months of follow-up, the wounds remained well healed, with no recurrent prolapse or severe hemorrhagic complications.
- result At 41 months of follow-up, the wounds remained well healed, with no recurrent prolapse or severe hemorrhagic complications.
- followUp At 41 months of follow-up
Front Surg · PMID 42376216 · Read it on PubMed ↗
Vergara Torrente et al. 2026
Benign lesions prolapsing through the anus: a differential diagnostic algorithm and evidence-based surgical management-a narrative review
Describes diagnosis, not treatment effectiveness.Narrative reviewLow qualityRelated question
size not given2026
The review describes seven benign conditions that can prolapse through the anus, including internal and thrombosed hemorrhoids, and proposes a clinical algorithm using fold pattern, texture, mobility and location to tell them apart and guide surgical decisions, while flagging signs that need cancer or emergency work-up
Who was studied
people with a mass or lump coming out of the anus
What they received
clinical exam-based diagnosis and surgical treatment approaches for benign prolapsing anal conditions (including hemorrhoids)
Compared with
no single comparator; different diagnoses and treatments compared against each other
Main outcome
a diagnostic algorithm to tell apart benign causes of anal prolapse and guide treatment choice
Quality
This is a narrative review summarizing existing evidence and expert opinion rather than new patient data, so it cannot show how well any treatment actually works.
Limitations
Narrative (non-systematic) review covering multiple different conditions, not focused specifically on prolapsed hemorrhoid outcomes; no original patient data or quantitative results given.
Taken word for word from the abstract
- population Masses prolapsing through the anus represent a frequent diagnostic challenge in coloproctological practice.
- intervention proposes a clinical decision algorithm based on findings from physical examination
- comparator seven benign entities that may prolapse through the anus-complete rectal prolapse, mucosal rectal prolapse, internal hemorrhoids, thrombosed hemorrhoids, anal condylomas, hypertrophied anal papilla, and anal canal polyps
- primaryOutcome proposes a clinical decision algorithm based on findings from physical examination
- result The proposed algorithm prioritizes objective clinical characteristics-fold pattern, texture, mobility, and anatomical location-to guide differential diagnosis and the sequence of complementary studies, optimizing surgical decision-making.
Front Surg · PMID 42369632 · Read it on PubMed ↗
Jin et al. 2026
Proximal sigmoid fecaloma after stapled hemorrhoidopexy: a diagnostic pitfall and stepwise nonoperative management
Found harmCase seriesVery low qualityRelated question
1 people14 days
Patient developed severe abdominal pain and constipation from a fecaloma above the staple line, which was treated successfully without surgery using enemas and bowel irrigation
Who was studied
49-year-old woman with prolapsing hemorrhoids after stapled surgery
What they received
stapled hemorrhoidopexy for prolapsing hemorrhoids
Compared with
none
Main outcome
development and management of proximal sigmoid fecaloma (severe constipation complication)
Quality
This is a single patient case report describing a complication, so it cannot show how well the surgery works overall.
Limitations
Single case report; no comparison group; cannot establish how common this complication is or how well the original hemorrhoid surgery worked.
Taken word for word from the abstract
- population a 49-year-old woman who presented with severe abdominal pain and obstipation 14 days after SH
- intervention Stapled hemorrhoidopexy (SH) is used for prolapsing hemorrhoids
- comparator Stapled hemorrhoidopexy (SH) is used for prolapsing hemorrhoids and is associated with less short-term postoperative pain.
- primaryOutcome proximal sigmoid fecaloma is rarely reported
- result computed tomography (CT) demonstrated a large fecaloma in the proximal sigmoid colon, 15 cm proximal to the intact staple line
- result successful evacuation with nasogastric polyethylene glycol irrigation
- n We report a 49-year-old woman
- followUp 14 days after SH
J Surg Case Rep · PMID 42359159 · Read it on PubMed ↗
Spiridon et al. 2026
Radiofrequency Ablation for Hemorrhoidal Disease
Less pain than surgery, similar relief.Narrative reviewLow qualityRelated question
size not givenshort- and mid-term
RFA may cause less pain, fewer painkillers needed, shorter hospital stay and faster return to normal life, with acceptable symptom control in the short and medium term, compared to surgery
Who was studied
people with internal hemorrhoids, especially grade II-III
What they received
radiofrequency ablation (RFA, including the Rafaelo procedure)
Compared with
conventional hemorrhoidectomy
Main outcome
pain, recovery and symptom control after treatment
Quality
This is a narrative review of studies that the authors themselves describe as varied in design, technique and follow-up, with no pooled statistics and a call for more randomized trials.
Limitations
Studies reviewed are heterogeneous in design, technique, patient selection, outcome definitions and follow-up duration; long-term recurrence and cost-effectiveness data are lacking.
Taken word for word from the abstract
- population especially those with grade II-III internal hemorrhoids
- intervention Radiofrequency ablation (RFA) has emerged as a minimally invasive, tissue-sparing technique for symptomatic internal hemorrhoids
- comparator compared with conventional hemorrhoidectomy
- primaryOutcome postoperative pain, analgesic requirements, wound-related morbidity, hospital stay and time to return to normal activity
- result Current evidence suggests that RFA may reduce postoperative pain, analgesic requirements, wound-related morbidity, hospital stay and time to return to normal activity compared with conventional hemorrhoidectomy, while maintaining acceptable short- and mid-term symptom control in selected patients, especially those with grade II-III internal hemorrhoids.
- limitations available studies remain heterogeneous in design, technique, patient selection, outcome definitions and follow-up duration
- followUp acceptable short- and mid-term symptom control
Life (Basel) · PMID 42355550 · Read it on PubMed ↗
Elhardello et al. 2026
Laser hemorrhoidoplasty: two-year outcomes from a retrospective observational cohort study
Good symptom relief, low pain, high satisfaction.RetrospectiveLow quality
77 people2 years
over 90% had full symptom relief at 1 year, 9.1% recurrence, low pain, and high satisfaction
Who was studied
adults with symptomatic hemorrhoids grade 2 to 4, mostly advanced (grade III/IV) with minimal to moderate prolapse
What they received
laser hemorrhoidoplasty
Main outcome
symptom resolution, recurrence, pain, complications, and patient satisfaction after surgery
Quality
this was a single-group study without a comparison treatment, and fewer than half of patients were followed up at 2 years, so it cannot show how laser treatment compares to other options.
Limitations
only 33.8% of patients followed at 2 years, and the abstract title describes it as retrospective and observational with no comparison group
Taken word for word from the abstract
- n LHP was carried out in 77 patients
- population symptomatic haemorrhoids of grade 2 to 4 with minimal to moderate prolapse
- intervention Laser hemorrhoidoplasty (LHP)
- primaryOutcome Post operative pain, recurrence of the disease, persistence of symptoms, complications, length of stay and patients' satisfaction were all documented.
- result Over 90% of patients achieved complete and sustained symptom resolution over 1-year follow-up period, despite the predominance of advanced disease. Disease recurrence occurred in 9.1% of patients.
Lasers Med Sci · PMID 42337174 · Read it on PubMed ↗
Wu et al. 2026
Cap-assisted endoscopic sclerotherapy for bleeding-predominant grade III hemorrhoids: efficacy and risk factor analysis focusing on two dimensions of bleeding score
Good for bleeding, less for prolapse.RetrospectiveLow qualityRelated question
82 people24 months
96.3% effective for bleeding but only 58.2% effective for prolapse, with 25.3% bleeding recurrence over 24 months
Who was studied
adults with bleeding-predominant grade III internal hemorrhoids
What they received
cap-assisted endoscopic sclerotherapy (CAES) with polidocanol injection via long needle
Compared with
none (single-arm, before-after comparison)
Main outcome
improvement in hemorrhoid symptoms (bleeding and prolapse) measured by severity scores
Quality
This was a retrospective study of one group of patients with no comparison group, so it can't prove the treatment caused the improvement.
Limitations
Single-arm retrospective design, patients selected specifically for bleeding-predominant symptoms, no control group.
Taken word for word from the abstract
- n This single-arm retrospective observational study included 82 patients with bleeding-predominant grade III internal HDs who underwent a single CAES procedure by the injection of liquid polidocanol via a long needle.
- population This single-arm retrospective observational study included 82 patients with bleeding-predominant grade III internal HDs
- intervention 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.
- result The overall efficacy rate was 85.4%. The effective rates for bleeding and prolapse symptoms were 96.3% and 58.2%, respectively.
- result the bleeding recurrence rate was 25.3% (20/79)
- followUp During a follow-up of 24 months
Tech Coloproctol · PMID 42323500 · Read it on PubMed ↗
Heynderickx et al. 2026
Outcomes of laser hemorrhoidoplasty in grade II-IV hemorrhoidal disease: a four-year, single center experience
Low pain, good satisfaction, more recurrence in severe casesRetrospectiveLow quality
132 peopleone month
Low pain scores, 95.5% satisfaction, 9.1% complications, 9.8% recurrence overall; grade IV disease linked to higher recurrence
Who was studied
adults with grade II-IV hemorrhoids (some prolapsed)
What they received
laser hemorrhoidoplasty (minimally invasive laser procedure)
Compared with
no comparison group (single-arm outcomes)
Main outcome
postoperative pain, complications, satisfaction, and recurrence
Quality
This was a retrospective single-center study without a comparison group, so results could be biased or not generalizable.
Limitations
Retrospective design, no control/comparison group, single center, authors call for prospective studies with larger samples and longer follow-up.
Taken word for word from the abstract
- n This retrospective study included 132 patients
- population 132 patients (72 % male, mean age 52.8 years) with grade II-IV hemorrhoidal disease
- intervention Laser Hemorrhoidoplasty (LHP) has emerged as a minimally invasive alternative
- comparator Further prospective studies with larger sample sizes, comparison group and longer follow-up are needed
- primaryOutcome Postoperative pain, complications, patient satisfaction, and recurrence rates were analyzed.
- result Postoperative pain scores were low, with a median Visual Analogue Scale (VAS) score of zero at discharge, after one week and after one month.
- result Postoperative complications occurred in twelve patients (9.1 %)
- result Overall recurrence occurred in thirteen patients (9.8 %)
- result Higher hemorrhoidal grade was significantly associated with recurrence
- followUp after one week and after one month
Rev Esp Enferm Dig · PMID 42313087 · Read it on PubMed ↗
Youn et al. 2026
Efficacy and safety of low-dose triamcinolone acetonide injections in reducing stricture at stapled hemorrhoidopexy sites
Fewer strictures, fewer reoperations.RetrospectiveLow qualityRelated question
1,023 people2026
stricture rate was 2.9% with steroid injection versus 16.0% with epinephrine, and reoperation rate was 5.9% versus 14.4%
Who was studied
patients who had surgery (stapled hemorrhoidopexy) for severe internal hemorrhoids with prolapse
What they received
low-dose triamcinolone acetonide (steroid) injection at the surgical staple site
Compared with
conventional epinephrine injection at the staple site
Main outcome
rate of stricture (narrowing) at the surgical site and need for reoperation
Quality
this was a retrospective, non-randomized comparison using statistical matching rather than a randomized trial, so bias cannot be ruled out.
Limitations
not randomized; relies on propensity score matching to balance groups; single intervention variant (dose/technique) so may not generalize to other stricture-prevention methods
Taken word for word from the abstract
- n Between 2020 and 2023, 1,023 patients underwent SH
- population Stapled hemorrhoidopexy (SH) is commonly used to treat severe internal hemorrhoids and rectal mucosal prolapse associated with prolapsing hemorrhoids.
- intervention with 5 mL (2 mg of TA) injected at the SH site
- comparator the non-TA group (n=469; after PSM, n=375) received conventional epinephrine injections
- primaryOutcome This study evaluated the efficacy and safety of low-dose triamcinolone acetonide (TA) injection at the SH site for the prevention of SHsS.
- result SHsS rate was significantly lower in the TA group (2.9%) than in the non-TA group (16.0%). Furthermore, the reoperation rate was lower in the TA group (5.9%) than in the non-TA group (14.4%).
Ann Coloproctol · PMID 42266125 · Read it on PubMed ↗
Galli et al. 2026
Defining proficiency in THD-Anolift: a CUSUM analysis of the learning curve in 51 consecutive cases
Faster surgery with experience; complication benefit unclearCase seriesLow qualityRelated question
51 peopleMedian follow-up was 12 months (range 3-33)
Operating time fell significantly as the surgeon gained experience (from about 27 to 20 minutes), and the complication/recurrence rate also fell (from 52% to 25%) but this drop was not statistically significant
Who was studied
patients with hemorrhoidal disease (mostly grade III) undergoing a minimally invasive hemorrhoid procedure
What they received
transanal hemorrhoidal dearterialization with Anolift mucopexy (THD-Anolift), performed by one surgeon learning the technique
Compared with
the surgeon's own earlier cases (first 23) compared to later cases (after case 23) as experience increased
Main outcome
a combined measure of recurrence and/or complications, and operating time, used to find the point where the surgeon became proficient
Quality
This is a single surgeon's retrospective case series with no comparison group and too few patients to reliably show whether complications truly improved.
Limitations
Retrospective, single-surgeon, single-center design; 9 patients excluded for incomplete data; the complication/recurrence improvement did not reach statistical significance (p = 0.080).
Taken word for word from the abstract
- n leaving 51 for analysis
- population 80.4% had grade III hemorrhoids
- intervention Transanal hemorrhoidal dearterialization (THD) with Anolift mucopexy
- comparator the failure rate decreased from 52.2% in Phase 1 (cases 1-23) to 25.0% in Phase 2 (cases 24-51
- primaryOutcome Cumulative sum (CUSUM) charts were constructed for a composite failure endpoint (recurrence and/or any complication) and for operative time.
- result Operative time decreased from 27.1 ± 7.4 to 20.4 ± 6.0 min (p < 0.001).
- result the failure rate decreased from 52.2% in Phase 1 (cases 1-23) to 25.0% in Phase 2 (cases 24-51; p = 0.080, not statistically significant at the conventional threshold)
- followUp Median follow-up was 12 months (range 3-33).
Int J Colorectal Dis · PMID 42159773 · Read it on PubMed ↗
Alvandipour et al. 2026
Effect of intrasphincteric botulinum toxin on postoperative urinary retention following stapled hemorrhoidopexy: a randomized, double-blind, placebo-controlled trial
Less urinary retention after surgeryRandomised trialModerate qualityRelated question
68 people2026
botulinum toxin lowered the rate of urinary retention compared to placebo
Who was studied
adults with grade III-IV hemorrhoids having stapled hemorrhoidopexy surgery
What they received
botulinum toxin injected into the anal sphincter muscle during surgery
Compared with
placebo injection into the anal sphincter during surgery
Main outcome
inability to urinate after surgery requiring a catheter
Quality
it was a randomized placebo-controlled trial but with a modest number of patients and was a secondary analysis of a trial designed for a different purpose.
Limitations
this was a secondary analysis of a trial originally designed to study pain, not hemorrhoid prolapse treatment itself, and focused on a surgical complication rather than hemorrhoid outcomes
Taken word for word from the abstract
- n 68 adult patients with grade III-IV hemorrhoids undergoing stapled hemorrhoidopexy
- population adult patients with grade III-IV hemorrhoids undergoing stapled hemorrhoidopexy at two tertiary hospitals
- intervention 50 units of BTX A
- comparator placebo injected into the internal anal sphincter intraoperatively
- primaryOutcome The primary outcome was POUR, defined as failure to void within six hours postoperatively with a bladder volume > 400 mL on ultrasound requiring catheterization.
- result The incidence was significantly lower in the BTX group compared with placebo (20.6% vs. 67.6%, P < 0.001).
Sci Rep · PMID 42143115 · 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 pain, not recurrenceRetrospectiveLow qualityRelated question
127 people12 months
patients who were anemic before surgery had more pain and worse sleep in the first week after surgery, but no difference in bleeding, infection, swelling, urinary retention, healing time, or hemorrhoid recurrence within 12 months
Who was studied
patients with mixed hemorrhoids who underwent hemorrhoid removal surgery
What they received
having anemia before surgery
Compared with
not having anemia before surgery
Main outcome
pain, complications, healing time, and recurrence after hemorrhoid surgery
Quality
this is a retrospective study comparing two groups without randomization, and the authors themselves say the findings need confirmation in larger, better-designed studies.
Limitations
retrospective observational design, exploratory analysis, no multivariable adjustment, authors say findings should be interpreted with caution
Taken word for word from the abstract
- n A total of 127 patients with mixed hemorrhoids who underwent Milligan-Morgan hemorrhoidectomy
- population 127 patients with mixed hemorrhoids who underwent Milligan-Morgan hemorrhoidectomy
- intervention 48 patients in the preoperative anemia group
- comparator 79 patients in the preoperative non-anemia group
- primaryOutcome Postoperative complications such as postoperative pain, delayed bleeding, wound infection, wound edema, urinary retention, insomnia severity index (ISI) within 7 days, wound healing time, and recurrence rates (prolapse or bleeding) within 12 months
- result 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.
- qualityWhy Given the observational design and the exploratory nature of the analysis, these findings should be interpreted with caution and require confirmation in larger, adequately powered studies with multivariable adjustment.
BMC Gastroenterol · PMID 42129663 · Read it on PubMed ↗
Gallo et al. 2026
Milligan-Morgan hemorrhoidectomy, mucopexy, and hybrid combination for grade III hemorrhoids: a large retrospective cohort study
Less pain but more recurrence with mucopexy.RetrospectiveLow quality
686 people2 years
mucopexy alone caused less pain and better scores soon after surgery, but had a much higher recurrence rate (14.5%) than hemorrhoidectomy alone (4.2%), which had the best long-term results
Who was studied
adults with symptomatic grade III prolapsing hemorrhoids
What they received
surgery combining tissue removal (Milligan-Morgan hemorrhoidectomy) and/or stitching the prolapsed tissue back up (mucopexy), in different combinations
Compared with
different groups compared against each other: hemorrhoidectomy alone, mucopexy alone, or a mix of both
Main outcome
hemorrhoid recurrence and patient-reported pain/satisfaction scores
Quality
it looked back at past patient records rather than randomly assigning treatments, so differences between groups could be due to other factors.
Limitations
Retrospective analysis.
Taken word for word from the abstract
- n A total of 686 consecutive patients with III-degree HD were included in the analysis.
- population Symptomatic grade III HD treated between 2016 and 2018.
- intervention group 2 received mucopexy on one pile combined with MM on the remaining two; group 3 underwent mucopexy on two piles with MM on the remaining one; and group 4 was treated with mucopexy alone
- comparator group 1 included patients treated with MM alone
- primaryOutcome Recurrence rates and patient-reported outcome measures (PROMs) using a visual-analogic scale (VAS) at 2 years, postoperative pain at 7 days, early complication rates at 30 days, and PROMs at 30 days.
- result Group 4 had the lowest pain scores and the highest 30-day PROM (p < 0.001), whereas group 1 showed the best long-term results, with the lowest recurrence rate (4.2% versus 14.5% in group 4) and highest long-term PROM.
- limitations Retrospective analysis.
Tech Coloproctol · PMID 42026233 · Read it on PubMed ↗
Lv et al. 2026
Case Report: Endoscopic anal papillectomy combined with ligation: a new approach for the treatment of grade IV hemorrhoids (with video)
New scope technique, good early results.Case seriesVery low quality
1 people8-month follow-up
minimal bleeding, less pain, faster recovery, and no complications over 8 months
Who was studied
a woman with grade IV prolapsed hemorrhoids for three years
What they received
endoscopic removal of the prolapsed hemorrhoid and papillae with snare, plus ligation of loose mucosa
Compared with
none (no comparison group)
Main outcome
bleeding, pain, recovery time, and complications like anal narrowing or recurrence
Quality
This is a single patient case report with no comparison group, so it cannot show whether this works better than other treatments.
Limitations
Only one patient, no control group, and follow-up was limited to 8 months; abstract calls for larger comparative studies.
Taken word for word from the abstract
- population a female patient suffering from Grade IV hemorrhoids for three years
- intervention the prolapsed hemorrhoid and hypertrophic anal papillae were progressively excised with a snare, followed by the application of a ligator to ligate the lax mucosa above the dentate line at multiple sites
- comparator This report introduces an innovative endoscopic technique employed to treat a female patient
- primaryOutcome minimal bleeding, reduced postoperative pain, a shorter recovery period, and the patient experienced no complications such as anal stenosis or recurrent prolapse during the 8-month follow-up
- result The procedure resulted in minimal bleeding, reduced postoperative pain, a shorter recovery period, and the patient experienced no complications such as anal stenosis or recurrent prolapse during the 8-month follow-up.
- n a female patient suffering from Grade IV hemorrhoids for three years
Front Gastroenterol (Lausanne) · PMID 42022142 · Read it on PubMed ↗
Alsalaumy 2026
Open haemorrhoidectomy combined with lateral internal sphincterotomy versus conventional haemorrhoidectomy: a prospective randomized comparative study
Less pain and bleeding with sphincterotomy added.Randomised trialLow quality
120 peopletwo weeks
adding the sphincterotomy led to much less pain and less early bleeding than hemorrhoidectomy alone
Who was studied
adults with grade III or IV prolapsed hemorrhoids
What they received
open hemorrhoidectomy surgery plus a cut in the anal sphincter muscle (lateral internal sphincterotomy)
Compared with
open hemorrhoidectomy surgery alone
Main outcome
pain and bleeding after surgery over the first two weeks
Quality
it was randomized but came from a single hospital, was not blinded given the surgical difference, and the trial was registered only after the study had already been completed, raising concern about selective reporting.
Limitations
single-center study, likely no blinding of patients or assessors to which surgery they had, and retrospective trial registration after the study period ended
Taken word for word from the abstract
- population 120 patients with Grade III or IV haemorrhoids
- intervention open haemorrhoidectomy with lateral internal sphincterotomy
- comparator open haemorrhoidectomy alone
- primaryOutcome Pain and postoperative bleeding were compared during the first 24 h, 48 h, one week and two weeks thereafter
- result At 1 week, 81.6% of patients in Group A were pain-free compared to none in Group B (risk difference 81.7%, 95% CI 71.9%–91.5%; p < 0.001)
- result Bleeding occurred in 5% of patients in Group A compared to 41.6% in Group B at 24 h (p < 0.001)
- n A total of 120 patients with Grade III or IV haemorrhoids were randomly divided into two groups
BMC Surg · PMID 41992176 · Read it on PubMed ↗
Huang et al. 2026
Evaluation of short-term outcomes of Endoscopic Super-Hemorrhoidal Banding for mixed hemorrhoids with prolapsed internal hemorrhoids: a retrospective study
Similar cure, faster recovery, less painRetrospectiveLow quality
480 people2026
similar cure rates but shorter surgery, shorter hospital stay, less pain, and fewer urinary retention complications with ESHB
Who was studied
patients with mixed hemorrhoids with grade II-IV internal hemorrhoid prolapse
What they received
Endoscopic Super-hemorrhoidal Banding (ESHB)
Compared with
Milligan-Morgan hemorrhoidectomy (MMH) surgery
Main outcome
cure rate, operative time, hospital stay, pain scores, and complications
Quality
This was a retrospective study comparing two groups without randomization, so other differences between patients could explain the results.
Limitations
Retrospective design, no randomization, and only short-term follow-up with long-term efficacy not yet validated.
Taken word for word from the abstract
- n 245 patients underwent Milligan-Morgan hemorrhoidectomy (MMH) and 235 patients underwent ESHB.
- population patients with mixed hemorrhoids treated in our hospital from June 2021 to June 2024
- intervention Endoscopic Super-hemorrhoidal Banding (ESHB)
- comparator Milligan-Morgan hemorrhoidectomy (MMH) as the control group
- primaryOutcome Treatment outcomes included efficacy measurement, operative time, hospital stay, postoperative anal pain scores, and incidence of complications like bleeding and urinary retention were compared.
- result The cure rates were 69.36% in the ESHB group and 72.65% in the MMH group, with no statistically significant difference between the two groups (P > 0.05). The observation group had significantly shorter operative time and hospital stay (P < 0.01), lower postoperative anal pain scores and incidence of urinary retention (P < 0.01).
BMC Surg · PMID 41987169 · Read it on PubMed ↗
Li et al. 2026
Comparing the effectiveness and safety of different surgical procedures for haemorrhoids: a protocol for systematic evaluation and network meta-analysis of randomised controlled trials
No results yet; protocol only.Registered trial, no results postedLow qualityRelated question
size not given2026
This is a study protocol; no results are reported yet
Who was studied
adults with hemorrhoids needing surgery
What they received
various surgical and office-based hemorrhoid procedures
Compared with
different hemorrhoid procedures compared to each other
Main outcome
cure rate, recurrence, complications, pain, healing time, anal function
Quality
This is only a plan for future research, not an actual study with findings.
Limitations
No results are available yet; this describes planned methods only.
Taken word for word from the abstract
- population Haemorrhoidal disease affects 25-40% of adults worldwide
- intervention Milligan-Morgan open haemorrhoidectomy, Ferguson closed haemorrhoidectomy, stapled haemorrhoidopexy, Doppler-guided haemorrhoidal artery ligation, transanal haemorrhoidal dearterialisation and laser haemorrhoidoplasty
- comparator Randomised controlled trials evaluating haemorrhoid interventions/procedures for haemorrhoidal disease will be included
- primaryOutcome outcomes encompassing cure rate, recurrence, complications, postoperative pain, wound-healing time, anal function and operative duration
- result This protocol aims to determine the most effective and safest haemorrhoid interventions (office-based and operative) through systematic review and network meta-analysis
BMJ Open · PMID 41985960 · Read it on PubMed ↗
Kement et al. 2026
Determinants influencing decision-making for operative and perioperative management of grade III and IV hemorrhoidal disease: secondary analysis of a multicenter nationwide prospective cohort study
Treatment choice varies by hospital and thrombosis.Prospective cohortModerate qualityRelated question
315 people2026
Thrombosis and hospital category were the strongest factors influencing which surgery and perioperative care patients received, with significant variation between hospitals
Who was studied
patients with grade III and IV hemorrhoid disease
What they received
choice of surgical technique and perioperative management (e.g., excisional vs non-excisional surgery, anesthesia, analgesia, outpatient care)
Compared with
patient and disease-related factors such as thrombosis, disease grade, and hospital type
Main outcome
which factors influenced the choice of surgical technique, anesthesia type, analgesia use, and outpatient management
Quality
It is a reasonably large multicenter study, but it only looks at what drives doctors' treatment choices, not whether those treatments actually work better.
Limitations
This is a secondary analysis of a cohort study focused on decision-making factors, not on comparing treatment outcomes or effectiveness.
Taken word for word from the abstract
- n The study included 315 patients diagnosed with Grade III (72%) and Grade IV (28%) HD
- population patients with Grade III and IV HD
- intervention Surgical techniques were classified as excisional or non-excisional, while anesthesia type, use of perianal or pudendal analgesia, and hospitalization duration were determined by the surgical teams.
- comparator Multivariable analyses were conducted to identify factors influencing the choice of surgical techniques, anesthesia, analgesia application, and the decision for outpatient procedures.
- primaryOutcome identifying factors that influence surgical and perioperative management decisions is essential, particularly in advanced cases
- result the presence of thrombosis significantly influenced the choice of surgical technique (OR: 7.2, CI: 2.8-12.7, p = 0.001), while hospital category also played an important role (OR: 5.1, CI: 2.7-9.7, p = 0.001)
Langenbecks Arch Surg · PMID 41981341 · Read it on PubMed ↗
Chen et al. 2026
Efficacy and safety of combined endoscopic rubber band ligation in the treatment of grade II-III prolapsed hemorrhoids: a retrospective study (with video)
High success treating prolapsed hemorrhoids.RetrospectiveLow quality
size not given2026
Complete resolution occurred in 91.85% of cases, partial resolution in 5.19%, and recurrence in 2.96%; ligating three hemorrhoids caused more pain than ligating two, but long-term success was similar between the two groups
Who was studied
patients with grade II-III prolapsed internal hemorrhoids
What they received
combined endoscopic rubber band ligation (ERBL)
Compared with
ligating two hemorrhoids versus ligating three hemorrhoids
Main outcome
resolution of hemorrhoids (complete, partial, or recurrence) and safety complications
Quality
This was a retrospective study without a comparison group other than itself, so it can't prove the treatment works better than doing nothing or another method.
Limitations
Retrospective design, no control group, and reliance on complications and male sex as the only identified risk factors for incomplete resolution.
Taken word for word from the abstract
- population Patients with grade II-III prolapsed internal hemorrhoids treated from January 2019 to June 2023 were reviewed.
- intervention combined endoscopic rubber band ligation (ERBL) in the treatment of grade II-III prolapsed internal hemorrhoids
- comparator the ligate three hemorrhoids group were significantly higher compared to the ligate two hemorrhoids group
- primaryOutcome Complete resolution was achieved in 124 cases (91.85%), partial resolution in 7 cases (5.19%), and recurrence in 4 cases (2.96%).
- result There was no significant difference in long-term efficacy between the two groups.
Front Med (Lausanne) · PMID 41958563 · Read it on PubMed ↗
Alam et al. 2026
Perioperative and Postoperative Complications Associated with Stapled Hemorrhoidopexy
Less pain, faster recovery, costs more.Prospective cohortLow quality
130 people2026
Stapled hemorrhoidopexy caused less pain, fewer urinary retention cases, shorter hospital stay, faster return to work, and no reactionary bleeding, but cost much more than open hemorrhoidectomy
Who was studied
Adults in Bangladesh with Grade III and IV hemorrhoids
What they received
Stapled hemorrhoidopexy surgery
Compared with
Open hemorrhoidectomy surgery
Main outcome
Postoperative pain, complications, hospital stay, return to work and cost
Quality
This was a prospective comparison, not a randomized trial, so differences between groups could be due to other factors besides the surgery type.
Limitations
Not randomized; abstract does not report blinding or long-term follow-up beyond return to work and short-term complications.
Taken word for word from the abstract
- n 130 patients (65 per group)
- population A prospective comparative study was conducted among 130 patients (65 per group) with Grade III and IV hemorrhoids.
- intervention Stapled hemorrhoidopexy (SH)
- comparator open hemorrhoidectomy (OH)
- primaryOutcome postoperative pain (VAS), complications, hospital stay, return to work and treatment cost
- result SH was associated with lower postoperative pain (80.0% mild; no severe cases), reduced urinary retention (13.8% vs. 40.0%, p=0.001) and shorter hospital stays (mean 2.89 vs. 7.12 days, p<0.001)
- result SH incurred significantly higher costs (mean Tk. 18,876.92 vs. Tk. 6,690.77, p<0.001)
Mymensingh Med J · PMID 41914085 · Read it on PubMed ↗
Prince et al. 2026
Spectrum and Management of Anorectal Disorders: A Retrospective Analysis From the United Arab Emirates
Surgery more common than conservative care.RetrospectiveLow qualityRelated question
176 people2026
Hemorrhoids were the most common problem, with many patients having advanced (grade III or IV) disease, and surgery (hemorrhoidectomy) was used more often than conservative treatment
Who was studied
176 patients diagnosed with anorectal disorders at a tertiary hospital in the UAE
What they received
various treatments used for hemorrhoids and other anorectal disorders, including hemorrhoidectomy and conservative care
Compared with
no direct comparison between treatments; this is a descriptive review of what was done
Main outcome
how common different anorectal disorders were and what treatments patients received
Quality
this is a single-center, retrospective chart review describing patterns of care without comparing treatment outcomes, so it cannot show whether one treatment works better than another
Limitations
Retrospective design, single tertiary center, no comparison of treatment outcomes or follow-up data on symptom resolution reported
Taken word for word from the abstract
- n A total of 176 patients were included
- population 176 patients diagnosed with anorectal disorders at a tertiary hospital in the UAE
- intervention hemorrhoidectomy performed in 75 (42.6%) cases, conservative treatment in 69 (39.2%), fissurectomy in 25 (14.2%), and fistulectomy in 7 (4.0%)
- comparator Surgical intervention was more common than conservative management
- primaryOutcome This study aimed to evaluate the distribution, symptoms, and treatment patterns of anorectal disorders in a tertiary care setting in the UAE
- result Hemorrhoids were the most common disorder, with 71 (40.8%) patients presenting with grade III and 26 (14.8%) with grade IV disease
Cureus · PMID 41909274 · Read it on PubMed ↗
Bilgiç et al. 2026
Clinical outcomes of arterial detection ligation technique for grade II/III versus grade IV hemorrhoidal disease
Similar success, more early pain if prolapsed.RetrospectiveLow quality
78 people1 month
both groups had similar recurrence and satisfaction, but grade IV patients had more pain, needed more painkillers, and recovered bowel function more slowly in the first week
Who was studied
adults with grade II/III or grade IV hemorrhoids (grade IV being prolapsed and not reducible) who had a type of hemorrhoid surgery
What they received
arterial detection ligation (ADL)-mucopexy surgery for grade IV (prolapsed) hemorrhoids
Compared with
same ADL-mucopexy surgery performed for less severe grade II/III hemorrhoids
Main outcome
pain after surgery and hemorrhoid recurrence
Quality
this was a small retrospective study with only 24 patients in the prolapsed (grade IV) group, so the findings are not very reliable.
Limitations
retrospective design, small number of patients especially in the grade IV group, short follow-up
Taken word for word from the abstract
- n Seventy-eight patients were included (grade II/III: n = 54; grade IV: n = 24).
- population Patients were classified into grade II/III and grade IV groups according to the Goligher classification.
- intervention ADL-mucopexy may be considered a potential minimally invasive surgical option in carefully selected patients with grade IV HD.
- comparator This study compared clinical outcomes of ADL-mucopexy between patients with grade II/III and grade IV HD.
- primaryOutcome Primary outcomes included postoperative pain and recurrence
- result Postoperatively, grade IV patients required more opioid analgesia, experienced longer times to first flatus and defecation, and reported higher 24-hour visual analog scale pain scores.
- result Despite these early differences, 1-month satisfaction scores were comparable between groups (8.8 vs 8.5). Recurrence was observed in 1 patient in each group during follow-up.
Medicine (Baltimore) · PMID 41894272 · Read it on PubMed ↗
Xu et al. 2026
Endoscopic excision for internal and mixed hemorrhoids: a retrospective case series of short-term outcomes
Surgery relieved symptoms, high satisfaction.Case seriesVery low quality
20 people6 months
all patients showed treatment success and satisfaction with no serious complications, though some had mild pain or temporary issues
Who was studied
patients with Grade II to IV internal or mixed hemorrhoids
What they received
endoscopic excision surgery for hemorrhoids
Compared with
none (no comparison group)
Main outcome
treatment effectiveness, patient satisfaction and complications after surgery
Quality
This is a small, uncontrolled case series of only 20 patients with no comparison group, so it cannot show whether this treatment works better than alternatives.
Limitations
Retrospective, no control group, small sample size, short follow-up.
Taken word for word from the abstract
- n A retrospective analysis was conducted on 20 patients
- population 20 patients with Grade II to Grade IV internal or mixed hemorrhoids who underwent endoscopic excision
- intervention endoscopic excision for the management of internal and mixed hemorrhoids
- comparator RESULTS: At 3 and 6 months after surgery, the treatment effectiveness rate was 100%
- primaryOutcome the treatment effectiveness rate was 100%, and both postoperative satisfaction and acceptance rates were 100%
- result No severe postoperative complications occurred, and no bleeding or infection was observed. Mild pain developed in three patients, a transient sensation of anal heaviness and distension occurred in one patient, and temporary urinary retention occurred in one patient
Front Physiol · PMID 41835152 · Read it on PubMed ↗
Marino et al. 2026
Ligasure versus voyant hemorrhoidectomy: comparison of 30-day postoperative complications
Similar complication rates, Voyant cheaper.Prospective cohortLow qualityRelated question
123 people30-day follow-up
no significant difference in bleeding, urinary retention, or anal stenosis between the two devices
Who was studied
patients with grade III and IV hemorrhoids
What they received
LigaSure radiofrequency hemorrhoid surgery
Compared with
Voyant radiofrequency hemorrhoid surgery
Main outcome
bleeding, urinary retention, and anal narrowing within 30 days after surgery
Quality
this was a non-randomized observational comparison of two surgical devices without blinding, limiting confidence in the equivalence finding.
Limitations
not randomized; observational design; excluded patients with other anal disorders or prior anal surgery
Taken word for word from the abstract
- n In total, 123 patients were enrolled (61 in group A and 62 in group B).
- population grade III and IV hemorrhoids
- intervention LigaSure hemorrhoidectomy
- comparator Voyant hemorrhoidectomy
- primaryOutcome bleeding, urinary retention, and anal stenosis
- result No statistical differences were observed between the two groups in terms of postoperative bleeding, urinary retention, and anal stenosis.
Minerva Surg · PMID 41804964 · Read it on PubMed ↗
Hamada et al. 2026
Pedicle Ligation Prior to Milligan-Morgan Hemorrhoidectomy for Advanced Grade IV Hemorrhoids: An Experience From a Specialized Proctology Unit
Safe surgery, smooth recovery.Case seriesVery low quality
1 people2026
surgery completed with no complications during the operation and a smooth recovery afterward
Who was studied
a 32-year-old man with severe (grade IV) prolapsed hemorrhoids that would not go back in and had not improved with non-surgical treatment
What they received
tying off the hemorrhoid's blood vessel stalk before surgically removing it (Milligan-Morgan hemorrhoidectomy)
Compared with
no comparison group; single case only
Main outcome
whether surgery was safe and recovery went well
Quality
this is a single patient case report, so it cannot show whether the technique works better than other approaches.
Limitations
only one patient was described, with no control group or comparison technique.
Taken word for word from the abstract
- n A 32-year-old man with no significant medical history presented with symptomatic, irreducible grade IV hemorrhoids refractory to conservative treatment.
- population A 32-year-old man with no significant medical history presented with symptomatic, irreducible grade IV hemorrhoids refractory to conservative treatment.
- intervention Open excisional hemorrhoidectomy using the Milligan-Morgan technique was performed following the systematic ligation of the hemorrhoidal pedicles.
- comparator We report a case highlighting the role of pedicle ligation prior to Milligan-Morgan hemorrhoidectomy in improving surgical safety.
- primaryOutcome The procedure was completed without intraoperative complications.
- result The procedure was completed without intraoperative complications. Postoperative recovery was uneventful, with excellent clinical and functional outcomes.
Cureus · PMID 41804401 · Read it on PubMed ↗
Alatout et al. 2026
Room for improvement? Evaluating the accuracy of referrals for rectal prolapse to three tertiary care medical centres
Hemorrhoids often misdiagnosed as rectal prolapseRetrospectiveLow qualityRelated question
480 people2026
Over a third of referrals for rectal prolapse were actually a different condition, most often hemorrhoids
Who was studied
patients referred to colorectal surgeons for suspected rectal prolapse
What they received
diagnosis of rectal prolapse made by the referring physician
Compared with
confirmed diagnosis made by the colorectal surgeon at the specialist centre
Main outcome
accuracy of the rectal prolapse diagnosis
Quality
This is a retrospective review of referral accuracy, not a treatment study, so it cannot show whether any treatment works.
Limitations
Retrospective design; abstract does not describe how the 'correct' diagnosis was confirmed or address treatment outcomes.
Taken word for word from the abstract
- n Rectal prolapse was inaccurately diagnosed in 38.7% (186/480) of patients.
- population patients referred for rectal prolapse to colorectal surgeons at the Mayo Clinic in Rochester, Jacksonville, and Phoenix from 2020 to 2024
- intervention The primary outcome is the accuracy of rectal prolapse diagnosis.
- comparator Among misdiagnosed patients, the correct diagnosis was haemorrhoids (68.0%, n = 134), pelvic floor dysfunction (24.3%, n = 48) and rectocele (18.7%, n = 37).
- primaryOutcome The primary outcome is the accuracy of rectal prolapse diagnosis.
- result Rectal prolapse was inaccurately diagnosed in 38.7% (186/480) of patients.
Colorectal Dis · PMID 41789560 · Read it on PubMed ↗
Talib et al. 2026
Comparative Study of Blood Loss and Hemostasis in Doppler-Guided Hemorrhoidal Artery Ligation Versus Open Hemorrhoidectomy
Less bleeding with Doppler-guided surgery.Prospective cohortLow qualityRelated question
140 people14 days
DGHAL caused less intraoperative bleeding, fewer bleeding complications, and smaller drop in blood counts than open hemorrhoidectomy
Who was studied
adults aged 18 to 65 with moderate to severe hemorrhoids (grade II to IV), some with symptomatic prolapse
What they received
Doppler-guided hemorrhoidal artery ligation (DGHAL)
Compared with
open hemorrhoidectomy
Main outcome
amount of blood loss during and after surgery
Quality
patients were not randomly assigned to treatments, so differences in bleeding could partly reflect why each surgery was chosen, not just the surgery itself.
Limitations
Non-randomized allocation based on disease severity and patient preference; authors note findings reflect short-term hemostatic advantages rather than overall procedural superiority.
Taken word for word from the abstract
- population Adults aged 18-65 years with grade II-IV hemorrhoids were enrolled
- n A total of 140 patients were analyzed, with 70 individuals in each treatment group.
- intervention Doppler-guided hemorrhoidal artery ligation (DGHAL)
- comparator open hemorrhoidectomy
- primaryOutcome This study aimed to compare intraoperative blood loss and bleeding-related outcomes between DGHAL and open hemorrhoidectomy.
- result The mean intraoperative blood loss was significantly lower in patients undergoing DGHAL compared with those treated by open hemorrhoidectomy (32.4 ± 14.8 mL vs 68.9 ± 22.6 mL; p < 0.001).
- followUp Clinically significant postoperative bleeding was recorded within 24 hours and 14 days.
Cureus · PMID 41737110 · Read it on PubMed ↗
Feng et al. 2026
Clinical efficacy and recurrence analysis of endoscopic rubber band ligation combined with external hemorrhoidectomy for mixed hemorrhoids
Fewer complications, less recurrence than standard surgery.RetrospectiveLow quality
330 people1 year
ERBL+EH had less blood loss, shorter surgery and healing time, less pain, fewer complications, and lower recurrence at 1 year (9.7% vs 31.0%) compared to MMH, though it cost more
Who was studied
patients with stage III-IV mixed hemorrhoids (internal and external combined)
What they received
endoscopic rubber band ligation combined with external hemorrhoidectomy (ERBL+EH)
Compared with
Milligan-Morgan hemorrhoidectomy (MMH)
Main outcome
1-year recurrence rate and perioperative outcomes/complications
Quality
This was a retrospective (not randomized) comparison, so differences between groups could be due to factors other than the treatment itself.
Limitations
Retrospective design; not randomized; higher treatment costs in the ERBL+EH group.
Taken word for word from the abstract
- population 330 patients with stage III-IV mixed hemorrhoids
- intervention endoscopic rubber band ligation combined with external hemorrhoidectomy (ERBL+EH)
- comparator Milligan-Morgan hemorrhoidectomy (MMH)
- primaryOutcome 1-year recurrence
- result At 1 year, recurrence was significantly reduced with ERBL+EH (9.7% vs. 31.0%, P < 0.001), with longer time to recurrence (10 vs. 6 months, P = 0.025).
- n A retrospective analysis was conducted on 330 patients
Am J Transl Res · PMID 41676261 · Read it on PubMed ↗
Öner et al. 2026
Effect of Doppler-guided Hemorrhoidal Artery Ligation Technique and Mucopexy on Posttreatment Symptoms in Hemorrhoidal Disease
Good relief, but more failures in severe cases.RetrospectiveLow qualityRelated question
94 peopleyear 1
92.6% had symptoms resolve and recurrence occurred in 9.6% overall, but recurrence was much higher in grade IV disease (31.25%) than grade III (8.16%)
Who was studied
adults with grade II to IV hemorrhoid disease that didn't improve with medical treatment
What they received
Doppler-guided hemorrhoidal artery ligation, with or without mucopexy
Compared with
none; outcomes compared before and after treatment within the same group
Main outcome
symptom improvement, hemorrhoid recurrence, and pain scores after surgery
Quality
this was a retrospective study of one treatment with no comparison group, so it can't show whether another treatment would have done better or worse.
Limitations
Retrospective design, no control group, and results pooled across hemorrhoid grades II-IV rather than focusing specifically on prolapse.
Taken word for word from the abstract
- population patients with symptomatic grade II to IV hemorrhoidal disease
- intervention Doppler-guided hemorrhoidal artery ligation (DG-HAL) technique, with or without concomitant mucopexy
- n A total of 94 patients (59 males, 35 females; mean age: 47.8 ± 12.4 y) underwent the procedure.
- primaryOutcome Treatment efficacy was evaluated based on changes in symptom severity and hemorrhoid grade across follow-up periods.
- result Overall symptom resolution was achieved in 92.6% of patients, and 90.4% reported high satisfaction with the treatment.
- result Recurrence rates were 8.16% (4/49) in grade III and 31.25% (5/16) in grade IV hemorrhoids.
- comparator A retrospective analysis was conducted using a prospectively maintained database of patients who underwent DG-HAL ± mucopexy between January 2018 and January 2023 for medically refractory hemorrhoidal disease.
- followUp Patients were followed up by a general surgery specialist on postoperative day 1, week 1, month 1, and year 1.
Surg Laparosc Endosc Percutan Tech · PMID 41635963 · Read it on PubMed ↗
Fan et al. 2026
Comparison of Mayinglong musk hemorrhoids ointment and musk hemorrhoids suppository on postoperative pain and healing in mixed hemorrhoids after PPH or RPH
Mixed results, no clear winnerRetrospectiveLow qualityRelated question
131 people2026
Suppository group had lower pain and wound scores, but ointment group had better anal muscle function, less swelling, and faster wound healing time; overall healing effect and complication rates were similar
Who was studied
patients with mixed hemorrhoids who had surgery (PPH or RPH)
What they received
Mayinglong Musk Hemorrhoids Ointment applied after surgery
Compared with
Musk Hemorrhoids Suppository applied after surgery
Main outcome
pain scores and wound healing time/effect after surgery
Quality
This was a retrospective study without randomization, so differences between groups could be due to other factors, not just the treatment.
Limitations
Retrospective design without randomization; compares two post-surgical wound treatments rather than treatment of the prolapse itself
Taken word for word from the abstract
- n after exclusions, 131 were analyzed
- population 139 mixed hemorrhoid patients who underwent PPH/RPH at the hospital from Jan to Dec 2024
- intervention Mayinglong Musk Hemorrhoids Ointment
- comparator Musk Hemorrhoids Suppository
- primaryOutcome Main outcomes included VAS, wound healing time/effect
- result Compared with Group A, Group B had lower VAS, WCS and wound granulation morphology scores (all P<0.05); Group A showed higher ADP, ARP, AMSP (all P<0.05), lower HZL and anal edema/exudation scores (all P<0.05) and superior wound healing time (P=0.047). No significant differences were found in wound healing effect or postoperative complication rate between the two groups
Pak J Pharm Sci · PMID 41620904 · Read it on PubMed ↗
Yin et al. 2026
Preliminary Results of Open Excisional Hemorrhoidectomy Combined With 3% Polidocanol Foam Sclerotherapy in Patients With Grade IV Hemorrhoidal Disease: A Randomized Controlled Open-Label Single-Center Study
Faster recovery, less bleeding with added treatment.Randomised trialLow quality
36 people1 to 2 months
patients who got the added sclerotherapy returned to normal activities about 6 days sooner, with less bleeding and less pain medicine use
Who was studied
adults aged 18 to 75 with grade IV hemorrhoids (prolapsed hemorrhoids)
What they received
standard hemorrhoid removal surgery plus polidocanol foam injection (sclerotherapy)
Compared with
standard hemorrhoid removal surgery alone
Main outcome
time to return to daily activities
Quality
Very small study of only 36 patients, not blinded, done at one hospital, with short follow-up, so results could easily change with more research.
Limitations
Small sample size, nonblinded, single-center design, and short follow-up period.
Taken word for word from the abstract
- population Thirty-six patients aged 18 to 75 years with grade IV hemorrhoidal disease were enrolled and randomized equally to 2 groups.
- intervention The experimental group underwent Milligan-Morgan hemorrhoidectomy combined with 3% polidocanol foam sclerotherapy
- comparator the control group underwent Milligan-Morgan hemorrhoidectomy with no additional therapy.
- primaryOutcome The primary outcome was the time to return to daily activities.
- result The experimental group demonstrated a mean 5.78-day earlier return to normal activities and work than the control group (mean ± SD: 19.28 ± 8.35 vs 25.06 ± 7.85 days; 95% CI, -11.27 to -0.29 days; p = 0.04), reduced postoperative bleeding (0-3 scale; estimate -0.45; 95% CI, -0.72 to -0.16; p = 0.002), lower analgesic use (0-3 scale; estimate -0.38; 95% CI, -0.66 to -0.09; p = 0.009)
- n Thirty-six patients aged 18 to 75 years with grade IV hemorrhoidal disease were enrolled
Dis Colon Rectum · PMID 41603644 · Read it on PubMed ↗
Golezar et al. 2026
Arterial Embolization for the Internal Hemorrhoids Management: A Systematic Review
Fewer symptoms, some recurrence.Systematic reviewLow qualityRelated question
size not given2026
improved quality of life and reduced bleeding, with some recurrence requiring repeat treatment
Who was studied
adults with internal hemorrhoids
What they received
arterial embolization of hemorrhoid blood vessels (emborrhoid)
Compared with
none reported
Main outcome
effectiveness and complications of embolization treatment
Quality
This is a systematic review of mostly small, non-comparative studies without a control group, so the true benefit is hard to confirm.
Limitations
No control/comparator group reported; studies included are heterogeneous case series type data; quality assessed only with a reporting checklist, not bias risk tools.
Taken word for word from the abstract
- population Hemorrhoids are common vascular structures that can become symptomatic when prolapsed
- intervention endovascular artery embolization in hemorrhoids
- primaryOutcome evaluate the efficacy, clinical outcomes, and morbidity of endovascular artery embolization in hemorrhoids
- result QoL score has improved after emborrhoid, and most cases had a lower bleeding score.
- result In 11.79% (n = 27/229) of patients re-embolization and after-treatment surgery were due to surgical failure and symptom recurrence, such as bleeding.
- comparator This systematic review aimed to evaluate the efficacy, clinical outcomes, and morbidity of endovascular artery embolization in hemorrhoids.
Health Sci Rep · PMID 41503542 · Read it on PubMed ↗
Seow-En et al. 2025
Cryotherapy reduces pain post-hemorrhoidectomy (CYPHER): a randomized, controlled, superiority trial of intra-anal ice after surgery for grade III hemorrhoids
Less pain after bowel movements.Randomised trialModerate quality
50 people2025
no significant difference in pain at rest on day 1, but less pain after bowel movements and lower pain on day 2
Who was studied
patients with grade III hemorrhoids undergoing hemorrhoidectomy surgery
What they received
intra-anal cryotherapy (ice) for 1 minute after surgery
Compared with
standard postoperative care
Main outcome
pain at rest on the first day after surgery
Quality
it was a randomized trial, but small with only 50 patients and its main pain measure did not reach significance.
Limitations
small sample size of 25 patients per group; primary outcome did not reach statistical significance
Taken word for word from the abstract
- n A total of 50 patients were randomized (25 per group).
- population Patients with symptomatic grade III hemorrhoids
- intervention 1 minute of intra-anal cryotherapy
- comparator standard postoperative care
- primaryOutcome The primary outcome was pain at rest on postoperative day (POD) 1.
- result did not demonstrate superiority of cryotherapy compared with standard care (median 3.0 vs. 4.0, P=0.062). However, the POD 1 pain score after defecation was significantly lower with cryotherapy than without (3.0 vs. 4.0, P=0.046).
Ann Coloproctol · PMID 41486911 · Read it on PubMed ↗
Hua et al. 2025
Transverse incision with longitudinal ligation procedure: Innovation, pitfalls, and clinical perspectives
Less pain, faster healing short-termNarrative reviewLow quality
size not given2025
TILL showed less pain, quicker healing, and lower risk of anal stenosis than Milligan-Morgan hemorrhoidectomy
Who was studied
people with circumferential prolapsed hemorrhoids
What they received
TILL (transverse incision with longitudinal ligation) procedure
Compared with
traditional Milligan-Morgan hemorrhoidectomy
Main outcome
short-term results including pain, healing time, and anal stenosis risk
Quality
The study being discussed was retrospective, done at one hospital, with few patients and only short follow-up, so the findings may not generalize.
Limitations
retrospective, single-center design, small sample size, and short follow-up; cannot assess long-term outcomes like recurrence
Taken word for word from the abstract
- population The transverse incision with longitudinal ligation (TILL) procedure is a new method for treating circumferential prolapsed hemorrhoids.
- intervention The transverse incision with longitudinal ligation (TILL) procedure is a new method for treating circumferential prolapsed hemorrhoids.
- comparator 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.
- primaryOutcome 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 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.
- limitations However, 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 ↗
Gomes et al. 2025
Hemorrhoidal elastic band ligation during routine colonoscopy: A comparative study between flexible video endoscopy and rigid proctoscopy
Fewer prolapse recurrences, better symptom control.RetrospectiveLow quality
171 people2025
EBL controlled symptoms in more patients after one session, with less prolapse, less bleeding, less pain, and higher satisfaction than RPBL
Who was studied
patients with anal bleeding and hemorrhoid prolapse referred for colonoscopy
What they received
band ligation done during flexible video colonoscopy (EBL)
Compared with
band ligation done with a rigid proctoscope (RPBL)
Main outcome
control of bleeding, prolapse recurrence, pain, and satisfaction
Quality
This was a retrospective study comparing two procedures, not a randomized trial, so other differences between groups could explain the results.
Limitations
Retrospective cohort design; not randomized.
Taken word for word from the abstract
- n This retrospective cohort study included 171 patients with previous anal bleeding and hemorrhoidal prolapse complaints who underwent routine colonoscopy who were referred for band ligation treatment.
- population patients referred for colonoscopy to evaluate bowel bleeding, many present with hemorrhoidal disease-associated bleeding and prolapse
- intervention endoscopic band ligation (EBL)
- comparator rigid proctoscope band ligation (RPBL)
- primaryOutcome Control of bleeding, prolapse recurrence, pain, tenesmus, overall satisfaction, and cost were analyzed.
- result EBL achieved hemorrhoid symptom control in 92% of patients after a single session, compared with 63.5% for RPBL, which typically required three to four sessions (P < 0.01). Short-term prolapse was significantly lower with EBL (13.3%) than with RPBL (55.2%, P < 0.01), and long-term prolapse recurrence remained lower (8% vs 36.5%, P < 0.01).
World J Gastrointest Endosc · PMID 41479928 · Read it on PubMed ↗
Liao et al. 2025
[Endoscopic rubber band ligation and injection therapy for grade I - III internal hemorrhoids: analysis of clinical efficacy and safety]
Similar cure rates; EIS less painful, fewer complications.RetrospectiveLow qualityRelated question
313 people3 months
both treatments had similar cure rates, but EIS caused less pain and fewer complications, while ERBL showed a trend toward lower recurrence in grade III hemorrhoids
Who was studied
adults with grade I-III internal hemorrhoids who had failed conservative treatment or couldn't have surgery
What they received
endoscopic rubber band ligation (ERBL)
Compared with
endoscopic injection sclerotherapy (EIS)
Main outcome
effective/cure rate within 3 months after treatment, recurrence, pain, and complications
Quality
this was a retrospective, non-randomized study at a single hospital, so differences could be due to other factors despite statistical matching
Limitations
retrospective design; only one center; higher-grade (III) subgroup recurrence difference lost significance after correction for multiple comparisons
Taken word for word from the abstract
- population patients with grade I to III internal hemorrhoids who underwent ERBL or EIS
- intervention endoscopic rubber band ligation (ERBL)
- comparator endoscopic injection sclerotherapy (EIS)
- primaryOutcome Statistical analysis revealed no statistically significant difference in efficacy between the two groups within 3 months after the operation
- result The cure rates of the ERBL group and the EIS group were 64.0% (128/200) and 62.8% (71/113), respectively.
- result the EIS group had a lower pain score on the first day after operation
- result The total incidence of complications in the ERBL group was significantly higher than that in the EIS group [29.5% (59/200) vs. 4.4% (5/113)
- n a total of 313 patients were included, including 200 in the ERBL group and 113 in the EIS group
Zhonghua Wei Chang Wai Ke Za Zhi · PMID 41397826 · Read it on PubMed ↗
Tin et al. 2025
The aCute HemORrhoidal disease evALuation International Study (CHORALIS): Subanalysis of the effectiveness of conservative treatment during the acute phase of hemorrhoidal disease in Vietnam
Symptoms and quality of life improvedProspective cohortLow qualityRelated question
202 peoplefour weeks
symptoms dropped sharply over four weeks and quality-of-life scores improved significantly, with high patient and doctor satisfaction
Who was studied
adults with acute hemorrhoidal disease (symptoms starting within 48 hours) in Vietnam, most with grade I-II hemorrhoids
What they received
conservative treatment, mainly a venoactive drug (micronized purified flavonoid fraction)
Compared with
no comparison group reported
Main outcome
improvement in hemorrhoid symptoms and quality of life
Quality
this was a single-group observational study with no comparison group, so it cannot show whether the improvement was due to the treatment itself.
Limitations
No control group; most patients had grade I-II (not fully prolapsed) hemorrhoids, with only 12.4% grade III and 5.4% grade IV disease; short follow-up.
Taken word for word from the abstract
- n Among the 202 patients, 53% were male
- population adult patients (≥18 years) diagnosed with acute hemorrhoidal disease (≤48 h since onset) who received conservative treatment and did not require surgical intervention
- intervention Conservative treatment, particularly micronized purified flavonoid fraction-based therapy
- comparator At week one, the venoactive drug group showed symptom improvement rates of 63% for pain, 56.8% for discomfort, and 68.2% for bleeding.
- primaryOutcome assess the effectiveness of conservative treatment in improving symptoms and quality of life in patients with acute hemorrhoids in Vietnam
- result The mean number of symptoms per patient decreased from 4.6 ± 1.9 at baseline to 1.0 ± 1.5 at week four.
- result The Hemorrhoid and Fissure Quality of Life significantly decreased across all domains (p < 0.05).
- result Patient and physician satisfaction with conservative treatment was high, at 88.7% and 87.7%, respectively.
J Int Med Res · PMID 41299195 · 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 than LigaSure surgery.RetrospectiveLow quality
232 peoplepostoperative week 6
less urinary retention, lower pain scores, and less pain medication needed with laser plus excisional surgery compared to LigaSure surgery
Who was studied
patients with grade IV (prolapsed) hemorrhoids
What they received
laser hemorrhoidoplasty plus excisional hemorrhoidectomy
Compared with
LigaSure hemorrhoidectomy
Main outcome
surgical results and 30-day complications
Quality
This was a retrospective comparison using historical controls from different time periods, not a randomized trial, so bias is likely.
Limitations
retrospectively included and historically compared with patients undergoing LigaSure hemorrhoidectomy; Further prospective with large numbers of patients are needed to verify the topic
Taken word for word from the abstract
- population Patients with grade IV hemorrhoid undergoing LHP plus EH
- intervention LHP plus excisional hemorrhoidectomy (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.
- 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
Mixed resultsRetrospectiveLow qualityRelated question
158 people1 month
similar effectiveness in both groups, but carbon dioxide foam caused fewer cases of anal pain and swelling
Who was studied
adults with internal hemorrhoids treated with endoscopic sclerotherapy
What they received
polidocanol carbon dioxide foam injection
Compared with
polidocanol air foam injection
Main outcome
treatment success rate and complications one month after surgery
Quality
This was a retrospective, non-randomized study comparing two foam types, so it carries less weight than a controlled trial.
Limitations
Retrospective design; no randomization; focuses on internal hemorrhoids broadly rather than specifically prolapsed hemorrhoids.
Taken word for word from the abstract
- n A retrospective analysis was conducted on 158 patients who received endoscopic polidocanol foam sclerotherapy for internal hemorrhoids between October 2022 and September 2023.
- population patients who received endoscopic polidocanol foam sclerotherapy for internal hemorrhoids
- intervention polidocanol carbon dioxide foam
- comparator 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 Both groups exhibited comparable clinical effects, surgical costs, hospitalization durations, and dosages of polidocanol, with no statistically significant differences observed (all P > 0.05).
- result The study group exhibited significantly fewer patients with anal pain and anal swelling compared to the control group (P < 0.05)
PeerJ · PMID 41282992 · Read it on PubMed ↗
Wang et al. 2025
Comparative effectiveness and recurrence rates of endoscopic sclerotherapy, ligation, and combined therapy for grades I-III internal hemorrhoids
Combined treatment worked best, fewer recurrencesRetrospectiveLow qualityRelated question
253 people3 months for efficacy; recurrence assessed beyond 3 months
combined therapy had the highest success rate and lowest recurrence rate, especially for more severe grade III hemorrhoids, with similar safety and satisfaction across treatments
Who was studied
adults with grade I to III internal hemorrhoids treated at one hospital
What they received
endoscopic sclerotherapy, rubber band ligation, or combined ligation-sclerotherapy
Compared with
the three endoscopic treatments compared against each other
Main outcome
treatment success within 3 months and symptom recurrence after 3 months
Quality
it is a retrospective, non-randomized comparison from a single hospital, so differences between groups could be due to other factors rather than the treatment itself
Limitations
retrospective design, unequal and relatively small group sizes (especially only 24 in the combined group), single-center setting
Taken word for word from the abstract
- population patients who underwent endoscopic minimally-invasive treatment for internal hemorrhoids at Wuhu First People's Hospital from January 2020 to December 2024
- intervention endoscopic sclerotherapy (ES), endoscopic rubber band ligation (RBL), and combined ligation - sclerotherapy (CT)
- comparator Patients were divided into ES, RBL, and CT groups.
- primaryOutcome Efficacy was assessed within 3 months post-treatment, and recurrence was defined as symptom reappearance > 3 months post-treatment.
- result CT showed the highest efficacy, especially for grade III hemorrhoids (95.0% [19/20]).
- result For recurrence rates, CT had the lowest rate (4.3% [1/23]), followed by RBL (9.7% [11/113]) and ES (11.6% [11/95]), particularly evident in higher-grade hemorrhoids.
- n A total of 253 patients were included (168 males, 85 females; mean age 46.2 ± 12.8 years), with 107 in the ES group, 122 in the RBL group, and 24 in the CT group.
BMC Surg · PMID 41239416 · 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
Faster healing, less pain than standard surgery.RetrospectiveLow quality
180 people2025
TILL showed better overall treatment effects, faster healing, and less pain, edema, and stenosis than MMH
Who was studied
patients with circumferential prolapsed hemorrhoids requiring surgery
What they received
transverse incision with longitudinal ligation procedure (TILL)
Compared with
Milligan-Morgan hemorrhoidectomy (MMH)
Main outcome
clinical efficacy after wound healing
Quality
This was a retrospective comparison, not a randomized trial, so differences between groups could be due to factors other than the surgery itself.
Limitations
Retrospective review; no mention of randomization or blinding.
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 transverse incision with longitudinal ligation procedure (TILL)
- comparator Milligan-Morgan hemorrhoidectomy (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 ↗
Vyčítal et al. 2025
Emergencies in proctology
No treatment outcome reported.Narrative reviewVery low qualityRelated question
size not given2025
not specified
Who was studied
people with sudden anorectal problems like hemorrhoid crisis, anal fissure, or abscess
What they received
diagnosis and treatment of anorectal emergencies including hemorrhoidal crisis
Quality
This is a general review describing conditions and management approaches without any study data or outcome results.
Limitations
The abstract gives no study design details, patient numbers, or outcome data; it is a broad descriptive review of several different anorectal emergencies, not a focused study on prolapsed hemorrhoid treatment.
Taken word for word from the abstract
- population Acute conditions in proctology refer to anorectal disorders presenting with symptoms such as acute anal pain and bleeding that may require immediate treatment.
- intervention This pub-lication discusses the diagnosis and management of common anorectal emergencies such as hemorrhoidal crisis, bleeding anorectal varices, anal fissure, anorectal abscess, strangulated rectal prolapse, Fournier gangrene and retained anorectal foreign bodies.
- result Although many acute complications occurring in emergency cases are not life-threat-ening and can be successfully treated in an outpatient setting, accurate diagnosis and proper treatment can prevent serious complications such as sepsis or permanent func-tional impairment.
Rozhl Chir · PMID 41109750 · Read it on PubMed ↗
de Oliveira et al. 2026
Laser Hemorrhoidoplasty for Grade III Hemorrhoidal Disease: Safety and Efficacy in a Brazilian Multicenter Retrospective Cohort Study
Early pain relief, symptoms resolved by one month.RetrospectiveLow quality
100 people1 year
pain peaked at day 7 then resolved by day 14, symptoms improved to zero by day 30, with a 44% cumulative complication rate (mostly mild)
Who was studied
adults with grade III prolapsed hemorrhoids
What they received
laser hemorrhoidoplasty (LHP)
Compared with
none (single-arm cohort, before/after comparison over time)
Main outcome
postoperative pain, proctological symptoms, and complications
Quality
This was a retrospective study without a comparison group, so it cannot show if laser treatment works better than other options.
Limitations
Retrospective design, no control group, data pooled from six different centers which may vary in technique.
Taken word for word from the abstract
- population 100 patients with symptomatic grade III hemorrhoids treated with LHP across six Brazilian centers
- intervention Laser hemorrhoidoplasty (LHP)
- comparator This multicenter retrospective cohort included 100 patients with symptomatic grade III hemorrhoids treated with LHP
- primaryOutcome Primary outcomes were postoperative pain (Visual Analog Scale-VAS), proctological symptoms (Proctological Symptoms Scale-PSS), and complications.
- result Median VAS peaked at 3.0 on day 7 and declined to near-complete remission by day 14, remaining minimal up to 1 year. PSS scores improved in parallel, reaching zero from day 30. The 30-day complication rate averaged 19.7%, peaking at 27% on day 14, with a cumulative per-patient rate of 44%.
- n This multicenter retrospective cohort included 100 patients
Photobiomodul Photomed Laser Surg · PMID 41091564 · Read it on PubMed ↗
Huang et al. 2025
Liposomal bupivacaine versus ropivacaine perianal infiltration for postoperative analgesia of haemorrhoidectomy: a multicentre, randomised controlled trial
Less pain after hemorrhoid surgery.Randomised trialModerate qualityRelated question
264 people72 hours
Liposomal bupivacaine group had lower pain scores at rest and with movement, and needed rescue painkillers less often, with similar side effects
Who was studied
Adults having surgery for grade III-IV mixed hemorrhoids
What they received
Liposomal bupivacaine injected around the anus after surgery
Compared with
Ropivacaine injected around the anus after surgery
Main outcome
Pain scores at rest after hemorrhoid surgery
Quality
It was a well-designed multicentre randomised trial with a reasonable number of patients, but it studies pain control after surgery rather than how to treat the prolapse itself.
Limitations
The abstract does not mention blinding of patients or assessors, and it focuses on postoperative analgesia rather than comparing surgical or non-surgical treatments for the prolapse itself.
Taken word for word from the abstract
- n A total of 264 patients (male, n=162; mean age, 43.1±12.2 years) were enrolled and completed the study, with 132 randomised to each group.
- population Eligible patients were aged 18-75 years undergoing elective external dissection and internal ligation for mixed haemorrhoids (grade III and IV mixed haemorrhoids).
- intervention liposomal bupivacaine (226 mg in 20 mL) through local infiltration at the end of surgery
- comparator ropivacaine (100 mg in 20 mL)
- primaryOutcome The primary outcomes were the resting numerical rating scale (NRS) pain scores (0-10) at postoperative 1, 5, 7, 9, 11, 24, 36, 48 and 72 hours.
- result Resting NRS pain scores were significantly lower in the liposomal bupivacaine group at all time points (median, 0-2.0 vs 2.0-4.0 for ropivacaine, p<0.001).
- result Fewer patients in this group required rescue analgesics (43.9% vs 83.3%, p<0.001).
BMJ Open · PMID 41067778 · Read it on PubMed ↗
Li et al. 2025
Refining postoperative quality metrics: risk factors for emergency department visits within 3 days after hemorrhoidectomy
Thrombosis, more pain meds raise ER-visit risk.RetrospectiveLow qualityRelated question
662 people3 days
having thrombosed hemorrhoids or needing 2 or more pain medicines after surgery predicted early ER visits
Who was studied
patients who had surgery (hemorrhoidectomy) for grade III or IV hemorrhoids
What they received
conventional hemorrhoidectomy surgery
Compared with
no separate comparator group; risk factors compared within same surgical cohort
Main outcome
return to the emergency department within 3 days after discharge
Quality
single-center retrospective chart review without a comparison treatment group, so it can show risk factors but not prove what treatment works best.
Limitations
retrospective design, single hospital, only looked at post-surgery ER visits rather than comparing treatments for prolapsed hemorrhoids
Taken word for word from the abstract
- n 662 patients who underwent conventional hemorrhoidectomy for grade III or IV hemorrhoids
- population patients who underwent conventional hemorrhoidectomy for grade III or IV hemorrhoids at Lotung Poh-Ai Hospital between 2021 and 2023
- intervention conventional hemorrhoidectomy for grade III or IV hemorrhoids
- comparator Clinical, operative, and postoperative variables were analyzed using multivariate logistic regression.
- primaryOutcome The primary outcome was return to the emergency department (ED) within 3 days of discharge.
- result Multivariate analysis identified thrombosed hemorrhoids (adjusted odds ratio [aOR], 3.05; 95% CI, 1.56-5.96; p = 0.001) and use of ≥ 2 postoperative analgesics (aOR, 3.96; 95% CI, 1.99-7.84; p < 0.001) as independent predictors of early ED revisit.
Perioper Med (Lond) · PMID 41029419 · Read it on PubMed ↗
Hu et al. 2025
Remimazolam reduces State-Trait Anxiety Inventory-State Scale scores in hemorrhoid surgery with spinal-epidural anesthesia: A randomized trial
Less anxiety with added sedative drugRandomised trialLow qualityRelated question
60 people24 hours post-operation
adding remimazolam lowered anxiety scores, gave deeper sedation, and kept blood pressure more stable at the start of surgery than spinal-epidural anesthesia alone
Who was studied
patients having surgery for prolapsed hemorrhoids (PPH surgery)
What they received
remimazolam added to combined spinal-epidural anesthesia
Compared with
combined spinal-epidural anesthesia alone
Main outcome
anxiety score (STAI-S), sedation depth, and blood pressure/heart rate
Quality
small single-center trial of 60 patients looking at anesthesia-related measures, not at hemorrhoid treatment outcomes themselves
Limitations
small sample size from a single center; focuses on anesthesia/sedation measures rather than hemorrhoid-specific surgical outcomes
Taken word for word from the abstract
- n 60 eligible patients were randomly assigned
- population procedure for prolapse and hemorrhoids (PPH) surgery
- intervention remimazolam-combined CSE anesthesia group
- comparator CSE anesthesia group
- primaryOutcome To compare remimazolam-CSE vs CSE alone on State-Trait Anxiety Inventory-State scale (STAI-S) scores, sedation, and hemodynamics in PPH surgery.
- result The Combined group demonstrated significantly lower STAI-S scores before leaving the operating room [mean: 28.80 vs 54.03, mean difference (95%CI): 25.23 (21.24-29.23), P < 0.001] and 24 hours post-operation
- followUp 24 hours post-operation
World J Gastrointest Surg · PMID 41024814 · Read it on PubMed ↗
Tan et al. 2025
Evaluating Laser Haemorrhoidoplasty as a Short-Term Approach to Advanced Haemorrhoidal Disease
Fewer prolapse and pain symptoms short-term.RetrospectiveLow quality
57 peopletwo months
significant improvement in pain, itching, bleeding, soiling, and prolapse symptoms after laser treatment
Who was studied
patients with advanced (grade 3 and 4) symptomatic hemorrhoids
What they received
laser haemorrhoidoplasty (LHP)
Compared with
patients' own symptoms before surgery (pre- vs post-treatment)
Main outcome
severity of pain and frequency of symptoms (bleeding, prolapse, itching, soiling) two months after surgery
Quality
This was a small retrospective study without a control group, so it cannot prove the laser itself caused the improvement.
Limitations
Retrospective design, no comparator group, short follow-up, authors call for larger prospective multicentre studies with long-term outcomes
Taken word for word from the abstract
- n A total of 57 patients were interviewed.
- population symptomatic Grade 3 and Grade 4 haemorrhoids
- intervention Laser haemorrhoidoplasty (LHP) is a less invasive non-excisional surgical technique
- comparator two months before and after LHP
- primaryOutcome severity of pain on the Visual Analogue Scale and frequency of symptoms based on the Haemorrhoidal Severity Score
- result Patients reported an improvement of their pre-existing symptoms, including pain (p < 0.00001), itching and discomfort (p = 0.0001), bleeding (p < 0.00001), soiling (p = 0.00007), and prolapse (p < 0.00001) based on HSS.
Cureus · PMID 41018464 · Read it on PubMed ↗
Licona et al. 2025
Anorectal Myiasis Caused by Cochliomyia hominivorax in a Septic Tank Worker
Full recovery after surgery plus antibiotics.Case seriesVery low qualityRelated question
1 people2025
the patient fully recovered after combined surgery and medical treatment
Who was studied
a 55-year-old male septic tank worker with prolapsed hemorrhoids and anorectal maggot infestation complicated by newly diagnosed diabetes
What they received
surgical removal of hemorrhoids and larvae plus antibiotics, wound care, glucose control and ivermectin
Compared with
none - single case treated, no comparison group
Main outcome
recovery from infestation and hemorrhoid prolapse
Quality
this is a single patient case report, so it cannot show whether this treatment works better than others for prolapsed hemorrhoids in general.
Limitations
single case with an unusual complicating infection, not representative of typical prolapsed hemorrhoid cases
Taken word for word from the abstract
- n a 55-year-old male septic tank worker
- population The patient presented with hyperglycemia, perianal pain, discharge, and prolapsed hemorrhoids.
- intervention The treatment included submucosal hemorrhoidectomy, larval extraction, systemic antibiotics, outpatient wound care, glycemic control, and a dose of ivermectin, all of which led to a full recovery.
- comparator We present the case of a 55-year-old male septic tank worker
- primaryOutcome all of which led to a full recovery
- result all of which led to a full recovery
Cureus · PMID 40995290 · Read it on PubMed ↗
Suzuki 2025
High-intensity focused ultrasound rectoanal lifting (HIFU-RAL) for prolapsed hemorrhoids: a case series
Prolapse shrank, no complications seenCase seriesVery low quality
10 people9 days to 3 months
prolapsed lesions shrank or disappeared immediately after treatment, with no prolapse seen for 9 days to 3 months and no adverse events
Who was studied
patients with grade IV prolapsed hemorrhoids
What they received
high-intensity focused ultrasound rectoanal lifting (HIFU-RAL)
Compared with
none
Main outcome
shrinkage or disappearance of prolapsed hemorrhoid and recurrence of prolapse
Quality
This was a very small, uncontrolled case series with only 10 patients and short follow-up, so it cannot reliably show the treatment works.
Limitations
Small sample size, no comparison group, short follow-up period
Taken word for word from the abstract
- population 10 patients with grade IV hemorrhoids
- intervention high-intensity focused ultrasound rectoanal lifting (HIFU-RAL)
- comparator This study explored the effectiveness of high-intensity focused ultrasound rectoanal lifting (HIFU-RAL) in 10 patients with grade IV hemorrhoids.
- primaryOutcome Immediately afterward, the prolapsed lesions visibly shrank or disappeared.
- result No prolapse was observed between 9 days and 3 months following HIFU-RAL, and no adverse events were reported.
- n 10 patients with grade IV hemorrhoids
J Surg Case Rep · PMID 40979427 · Read it on PubMed ↗
Panzer et al. 2025
Assessing Colorectal Care Capacity at an Urban Tertiary Hospital in Ghana
Not studied here.RetrospectiveVery low qualityRelated question
2,992 people2025
the abstract describes hospital capacity and procedure counts, not treatment outcomes for prolapsed hemorrhoids specifically
Who was studied
patients at a Ghanaian teaching hospital needing colorectal procedures
What they received
colorectal surgical care infrastructure and procedures (e.g., hemorrhoidectomy)
Main outcome
availability of infrastructure, resources, and case volume for colorectal procedures
Quality
this is a descriptive capacity assessment, not a study comparing treatments or outcomes for prolapsed hemorrhoids.
Limitations
retrospective, single-center, no outcome or efficacy data reported, does not define or address prolapsed hemorrhoids specifically
Taken word for word from the abstract
- population Retrospective, de-identified data were collected on all colorectal procedures performed at KBTH from January 1, 2022, to December 31, 2022.
- n 2,992 colorectal procedures were performed
- intervention excisional hemorrhoidectomy (n = 64)
- primaryOutcome assessing relevant infrastructure, resources, and case volume at a Ghanaian teaching hospital
- result Some common colorectal services were not provided, including banding of internal hemorrhoids, seton placement for perianal fistulas, rectopexy for rectal prolapse, and pelvic floor evaluations.
Ann Glob Health · PMID 40951912 · Read it on PubMed ↗
Erkek et al. 2025
Analysis of recurrence after stapled hemorrhoidopexy in grade IV hemorrhoid disease
High recurrence after stapling in grade IV.RetrospectiveLow quality
77 people2025
23.6% of grade IV patients had recurrence versus none of the grade III patients
Who was studied
patients with grade III or IV hemorrhoids
What they received
stapled hemorrhoidopexy (a surgical stapling procedure for hemorrhoids)
Compared with
grade III hemorrhoids compared with grade IV hemorrhoids after the same procedure
Main outcome
recurrence of hemorrhoids after surgery
Quality
This was a small, retrospective single-center study without a comparison to another treatment, so its findings are not strong evidence.
Limitations
Retrospective design, single center, small sample size, no comparison group receiving a different surgical technique.
Taken word for word from the abstract
- n This retrospective, single-center study enrolled a total of 77 patients with grade III/IV hemorrhoids for analysis.
- population patients with grade III and IV hemorrhoids
- intervention Stapled hemorrhoidopexy (SH) is one of the most commonly used surgical techniques for hemorrhoidal disease
- comparator Patients were categorized by hemorrhoid grade and showed no differences in demographic data between the two groups.
- primaryOutcome To evaluate recurrence rates and factors influencing surgical outcomes following SH in patients with grade III and IV hemorrhoids.
- result Recurrence was observed in 4 patients (23.6%) with grade IV hemorrhoids, and no recurrence was noted in patients with grade III hemorrhoids.
World J Gastrointest Surg · PMID 40949368 · 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 improved, no recurrence seenCase seriesVery low quality
10 people16.0 months
prolapse was visibly reduced or resolved in all cases immediately, with no recurrences or adverse events during follow-up
Who was studied
adults with prolapsed hemorrhoids or rectal mucosal prolapse causing discomfort
What they received
combined HIFU rectoanal lifting (HIFU-RAL) and ALTA sclerotherapy
Compared with
none (no comparison group)
Main outcome
reduction or resolution of prolapsed lesions and recurrence/adverse events over time
Quality
this is a tiny uncontrolled case series of only 10 patients with no comparison group, so it cannot reliably show the treatment works better than alternatives
Limitations
small sample size, no control group, case series design
Taken word for word from the abstract
- n This case series included 10 symptomatic patients, consisting of 5 men and 5 women.
- population Clinical examination identified 8 cases of prolapsed hemorrhoids (Goligher grade III-IV) and 2 cases of rectal mucosal prolapse.
- intervention we applied a transanal high-intensity focused ultrasound (HIFU) technique, namely HIFU rectal lifting (HIFU-RAL), combined with aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy for treating prolapsed hemorrhoids
- comparator This case series included 10 symptomatic patients
- primaryOutcome The combined efficacy of HIFU-RAL and ALTA sclerotherapy was evaluated over time.
- result In all cases, the prolapsed lesions were visibly reduced or resolved immediately after the procedure. During the follow-up period (median: 16.0 months; interquartile range: 10.5-25.8 months), no adverse events or recurrences were observed.
- followUp median: 16.0 months; interquartile range: 10.5-25.8 months
Medicine (Baltimore) · PMID 40922264 · Read it on PubMed ↗
Gosavi et al. 2025
Doppler-Guided Haemorrhoidal Artery Ligation and Rectoanal Repair (HAL-RAR): An Institutional Experience
Safe, effective for grade II-III hemorrhoids.RetrospectiveLow quality
128 people2025
Day-case completion in 76.6%, recurrence in 17.6%, urinary retention in 3.9%, return to theatre in 0.8%, 30-day readmission in 7.0%; Grade IV disease linked to more recurrence and conversion to excisional surgery
Who was studied
Adults with Grade II–IV haemorrhoids undergoing elective surgery
What they received
Doppler-guided haemorrhoidal artery ligation with rectoanal repair (HAL-RAR)
Compared with
No comparison group; outcomes stratified by haemorrhoid grade
Main outcome
Postoperative complications, recurrence, and day-case completion rates
Quality
This was a retrospective, single-institution review without a comparison group, so results may not hold up as strongly as a controlled trial.
Limitations
Retrospective design, single institution, no control group, and the authors say longer-term prospective studies are needed.
Taken word for word from the abstract
- n 128 consecutive patients
- population 77.3% had Grade II or III haemorrhoids
- intervention Doppler-guided haemorrhoidal artery ligation with rectoanal repair (HAL-RAR)
- comparator Outcomes were stratified by haemorrhoid grade.
- primaryOutcome Data on demographics, operative details, postoperative outcomes, and recurrence were collected.
- result HAL-RAR was completed as a day case in 76.6% of patients. Postoperative urinary retention occurred in 3.9%, return to theatre in 0.8%, and 30-day readmission in 7.0%. The symptomatic recurrence rate was 17.6%.
- result Grade IV haemorrhoids were independently associated with increased recurrence (aOR 3.64, 95% CI 1.03-12.84), reduced likelihood of day-case management (aOR 0.14, 95% CI 0.03-0.93), and higher conversion to excisional haemorrhoidectomy (aOR 7.23, 95% CI 1.13-46.40).
- limitations longer-term prospective studies are needed to assess durability
J Clin Med · PMID 40807017 · Read it on PubMed ↗
Campos et al. 2025
A modified stapled hemorrhoidectomy technique to optimize mucosectomy specimen and improve outcomes
New surgical technique proposed, untested.Case seriesVery low quality
size not given2025
the abstract describes the technique and reasons it may give a more uniform, taller strip of tissue, but reports no measured patient outcomes
Who was studied
people with hemorrhoidal disease undergoing stapled hemorrhoid surgery
What they received
a modified stapled hemorrhoidopexy technique using two traction points in the purse-string suture
Compared with
the classical stapled hemorrhoidopexy technique
Main outcome
height of the removed mucosal tissue strip and reduction of mucosal prolapse/recurrence
Quality
this is a description of a new surgical technique with no patient outcome data, just a proposed idea still to be tested.
Limitations
no outcome data, no comparison group, and the authors state the hypothesis still needs to be tested in a future randomized study
Taken word for word from the abstract
- population Surgical treatment of hemorrhoidal disease has undergone numerous modifications in recent decades.
- intervention the modification consists of establishing two traction points from the pursestring suture
- comparator a randomized study comparing the mucosectomy height and postoperative outcomes of both technical options (classical and present)
- primaryOutcome increasing the height of the mucosal specimen to be resected, thereby reducing long-term recurrence
- result the retrieved mucosal strip will present a greater height. These features may play a role in effectively reducing mucosal prolapse and alleviating the symptoms.
Sao Paulo Med J · PMID 40802349 · Read it on PubMed ↗
Garg et al. 2025
TONEFACT: Can even advanced hemorrhoids be treated without surgery? A paradigm shift in the management of hemorrhoids
May avoid surgery, unproven.Narrative reviewVery low qualityRelated question
size not given2025
improved defecation time and reduced prolapse symptoms in early-stage hemorrhoids, leading to fewer surgical interventions
Who was studied
people with advanced or prolapsed hemorrhoids
What they received
a non-surgical treatment concept called TONEFACT
Compared with
surgery for advanced hemorrhoids
Main outcome
need for surgery and prolapse symptoms
Quality
this is an opinion piece based mainly on the authors' own experience and observational data, not a controlled trial.
Limitations
Evidence comes from observational studies and one small non-randomized study, and the authors state it lacks validation from larger randomized controlled trials.
Taken word for word from the abstract
- population advanced hemorrhoids are usually treated with surgery
- intervention a treatment concept (TONEFACT)
- comparator advanced hemorrhoids are usually treated with surgery
- primaryOutcome leading to fewer surgical interventions
- result This has been shown to improve defecation time and reduce prolapse symptoms in early-stage hemorrhoids, leading to fewer surgical interventions.
- limitations Although promising, these observations lack validation from more extensive randomized controlled trials to draw firm conclusions.
World J Gastrointest Surg · PMID 40740911 · Read it on PubMed ↗
Liu et al. 2025
Is Injectable Sclerotherapy with Polidocanol Foam Effective for Treating Hemorrhoids in Patients with Severe Anemia?
Less bleeding, anemia improved, but some prolapse recurred.RetrospectiveLow qualityRelated question
size not given1-year
bleeding stopped and anemia improved, but two patients had prolapse come back and needed surgery
Who was studied
patients with hemorrhoids and severe anemia
What they received
injectable sclerotherapy using Polidocanol foam
Compared with
none (no comparison group)
Main outcome
bleeding symptoms and hemorrhoid severity scores (HDSS, SHS)
Quality
It was a retrospective study with no comparison group and the number of patients was not stated, so it can't prove the treatment caused the improvement.
Limitations
Retrospective design, no control group, number of patients not reported, focus on anemia/bleeding rather than prolapse specifically.
Taken word for word from the abstract
- population patients with severe anemia and hemorrhoids who underwent injectable sclerotherapy
- intervention injectable sclerotherapy using Polidocanol foam
- comparator A retrospective analysis was conducted on patients with severe anemia and hemorrhoids who underwent injectable sclerotherapy using Polidocanol foam
- primaryOutcome utilizing the Hemorrhoidal Disease Severity Score (HDSS) in conjunction with Short Health Scale (SHS) for assessment
- result The bleeding symptoms in all patients resolved immediately after treatment. Hemoglobin levels increased rapidly within one month after treatment
- result Two patients experienced recurrence of prolapse symptoms during the one-year follow-up period and subsequently underwent hemorrhoidectomy.
- followUp during the one-year follow-up
J Anus Rectum Colon · PMID 40740753 · 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
Better pain control after surgeryRandomised trialModerate qualityRelated question
71 people48 h
pudendal nerve block gave lower pain scores at 6, 12, and 18 hours after surgery, less need for extra pain medicine, and better recovery scores, with no difference in pain at 24 and 48 hours
Who was studied
patients undergoing surgery for prolapse and hemorrhoids
What they received
ultrasound-guided pudendal nerve block
Compared with
local anesthetic infiltration
Main outcome
postoperative pain scores in the first 48 hours
Quality
it was a randomized, double-blinded trial but small and only indirectly relevant since it studied pain control after surgery rather than how to treat a prolapsed hemorrhoid itself
Limitations
small sample size of 71 patients after dropouts; focuses on a surgical pain-control technique rather than hemorrhoid treatment itself
Taken word for word from the abstract
- n The trial ultimately involved 71 patients.
- population 78 patients undergoing procedure for prolapse and hemorrhoids (PPH)
- intervention ultrasound-guided 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), with no significant differences noted at 24 and 48 h.
Int J Colorectal Dis · PMID 40676415 · Read it on PubMed ↗
Zhang et al. 2025
Secondary rectal perforation following procedure for prolapsed hemorrhoids: a case report
Rare rectal perforation after hemorrhoid surgery.Case seriesVery low quality
1 people2025
patient developed a rectal perforation as a complication after PPH surgery
Who was studied
a patient who had surgery for prolapsed hemorrhoids
What they received
procedure for prolapse and hemorrhoids (PPH) surgery
Compared with
traditional excisional hemorrhoidectomy (described generally, not directly compared in this case)
Main outcome
development of rectal perforation after surgery
Quality
This is a single patient case report, which cannot show how often this happens or compare treatments reliably.
Limitations
Only one patient described; no comparison group; cannot show how common this complication is.
Taken word for word from the abstract
- n This case report presents a patient who developed rectal perforation following PPH
- population This case report presents a patient who developed rectal perforation following PPH
- intervention The procedure for prolapse and hemorrhoids (PPH) is designed to reposition displaced anal cushions by circumferential resection of the distal rectal mucosa.
- comparator PPH offers advantages over traditional excisional hemorrhoidectomy, including less postoperative pain and a shorter hospital stay.
- primaryOutcome complications such as anastomotic dehiscence and rectal perforation may occur and require prompt management
- result This case report presents a patient who developed rectal perforation following PPH
J Surg Case Rep · PMID 40661710 · Read it on PubMed ↗
Huang et al. 2025
Tissue selecting therapy stapler minimally invasive surgery to treat severe hemorrhoids
Fewer complications, faster recovery than other surgeries.Randomised trialLow quality
141 people3 months
TST had higher success rate, shorter hospital stay and operation time, less blood loss, and fewer complications than PPH or EPH
Who was studied
patients with severe hemorrhoids
What they received
tissue selecting therapy (TST) stapler minimally invasive surgery
Compared with
PPH stapled surgery and EPH (rubber band ligation and dislocation) surgery
Main outcome
treatment success rate, complications, and anal muscle function
Quality
Although randomized, the abstract gives little detail on blinding, dropout, or statistical testing, limiting confidence.
Limitations
Abstract does not report blinding, loss to follow-up, or statistical significance testing details.
Taken word for word from the abstract
- n 141 patients with severe hemorrhoids were included into three groups
- population patients with severe hemorrhoids
- 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, postoperative complications, and anal dynamics
- result The total effective rate in the TST group was 93.62%, which was higher than the 74.47% and 72.34% in the PPH and EPH groups, respectively, after treatment.
- result the complication rate in the TST group was 10.64%, which was lower than the 27.66% and 31.91% reported in the PPH and EPH groups, respectively.
BMC Surg · PMID 40634906 · Read it on PubMed ↗
Schwandner 2025
[Hemorrhoidal disease and stage-dependent treatment (including anal prolapse)]
Treat by stage; prolapse managed conservatively.Narrative reviewLow quality
size not given2025
treatment choice depends on stage; early stages use conservative/interventional methods, advanced stages need surgery, acute prolapse treated conservatively and topically
Who was studied
people with hemorrhoidal disease, including different stages and anal prolapse
What they received
stage-based treatment: conservative care, sclerotherapy, rubber band ligation, surgery (hemorrhoidectomy or minimally invasive techniques)
Compared with
different treatments compared across disease stages
Main outcome
symptom control and avoiding recurrence
Quality
this is a narrative review describing treatment approaches rather than reporting new study results or data.
Limitations
no patient numbers, outcomes data, or comparative results are reported; it is a descriptive overview rather than an original study.
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)
- comparator "conventional" hemorrhoidectomy procedures are increasingly in competition with minimally invasive techniques (e.g. hemorrhoidal artery ligation, laser hemorrhoidoplasty, radiofrequency ablation)
- primaryOutcome The ultimate goal of all treatment strategies for hemorrhoidal disease is symptom control and long-term absence of recurrence.
- result In cases of acute anal prolapse, a conservative and topical approach is indicated.
Chirurgie (Heidelb) · PMID 40586790 · Read it on PubMed ↗
di Schiano di Visconte 2025
Laser Hemorrhoidoplasty: Procedure, Outcomes and Future Directions
Works early, worse for advanced casesNarrative reviewLow quality
size not given2025
Laser treatment worked well for early-grade hemorrhoids but had higher recurrence and worse long-term results than surgery for advanced (grade IV) cases
Who was studied
people with hemorrhoidal disease of different severity grades (II-IV)
What they received
laser hemorrhoidoplasty (LHP)
Compared with
traditional excisional surgery for hemorrhoids
Main outcome
efficacy, safety, and long-term outcomes of the laser procedure
Quality
This is a narrative review without a described systematic search or pooled data, so its conclusions are a summary of existing evidence rather than new rigorous proof.
Limitations
The abstract does not describe how studies were selected or appraised, and calls for standardized protocols and large-scale long-term studies, suggesting current evidence is limited.
Taken word for word from the abstract
- population across different grades of hemorrhoids
- intervention Laser hemorrhoidoplasty (LHP)
- comparator excisional methods remain superior for managing advanced HD
- primaryOutcome critically evaluated the efficacy, safety, and long-term outcomes of LHP
- result Although LHP demonstrates clear benefits in the management of early-grade hemorrhoids, particularly grades II and III, its limitations are more apparent in advanced cases.
- result higher recurrence rates, especially for Grade IV HD, remain a clinical limitation
- result excisional methods remain superior for managing advanced HD, particularly in terms of long-term symptom resolution
ANZ J Surg · PMID 40586452 · Read it on PubMed ↗
Zhang et al. 2025
The Comparison Between Endoscopic Ligation and Sclerotherapy on the Treatment Effect and Anorectal Function in Patients With Internal Hemorrhoids
Both treatments worked, no clear winner.Prospective cohortLow quality
32 people3-month follow-up
no significant difference overall between the two treatments, but each had specific advantages (ligation better for prolapse/constipation, sclerotherapy better for bleeding and pain)
Who was studied
patients with internal hemorrhoids
What they received
endoscopic ligation
Compared with
cap-assisted endoscopic sclerotherapy (CAES)
Main outcome
symptom relief (bleeding, prolapse, constipation), complication rate, psychological condition, and anorectal function
Quality
Very small, non-randomized comparison of only 32 patients with short 3-month follow-up, so findings are not very reliable.
Limitations
Small sample size (14 vs 18 patients), not described as randomized, and only 3 months of follow-up.
Taken word for word from the abstract
- n Thirty-two patients who underwent minimally invasive endoscopic treatment for internal hemorrhoids were recruited
- population patients with internal hemorrhoids
- intervention Group A undergoing endoscopic ligation (n=14)
- comparator Group B receiving CAES (n=18)
- primaryOutcome treatment effect of postoperative bleeding, prolapse, constipation, and complications
- result There was no significant difference in the treatment effect of postoperative bleeding, prolapse, constipation, and complications between the 2 groups. However, Group A has certain advantages in the treatment of prolapse and constipation before and after treatment, and Group B has certain advantages in bleeding.
- followUp with a 3-month follow-up
Surg Laparosc Endosc Percutan Tech · PMID 40530787 · Read it on PubMed ↗
van Oostendorp et al. 2025
Cost-Effectiveness of Rubber Band Ligation Versus Hemorrhoidectomy for the Treatment of Grade III Hemorrhoids: Analysis Using Evidence From the HOLLAND Randomized Controlled Trial
Surgery works better but costs more.Randomised trialModerate quality
79 people24 months
Hemorrhoidectomy gave better quality of life and fewer recurrences than rubber band ligation, but cost more; whether it was worth the extra cost depended on how much society is willing to pay
Who was studied
Adults with symptomatic grade III hemorrhoids (hemorrhoids that prolapse)
What they received
rubber band ligation
Compared with
hemorrhoidectomy (surgical removal)
Main outcome
cost per quality-adjusted life year gained and cost per recurrence avoided over 24 months
Quality
It used real randomized trial data but had a small sample size, which limits how confident we can be and may miss rare complications.
Limitations
The small sample size may limit generalizability and the ability to detect rare but costly complications; procedural costs were based on average hospital prices, a less detailed pragmatic approach.
Taken word for word from the abstract
- population Adults with symptomatic grade III hemorrhoids randomly assigned to receive rubber band ligation or hemorrhoidectomy treatment.
- intervention Rubber band ligation (up to 2 sessions)
- comparator excisional hemorrhoidectomy
- primaryOutcome Cost per quality-adjusted life year gained and cost per recurrence avoided over 24 months from a societal perspective.
- n Seventy-nine patients were analyzed (33 for hemorrhoidectomy and 46 for rubber band ligation).
- result Hemorrhoidectomy resulted in better clinical outcomes with a quality-adjusted life year difference of 0.08 (95% CI, 0.04-0.13) and a recurrence difference of 33.5% (95% CI, 15.3%-51.7%).
- result Hospital costs were higher for hemorrhoidectomy (€1364; 95% CI, 895-1834; p < 0.001), as were societal costs (€1984; 95% CI, -132 to 4101; p = 0.066).
- limitations The small sample size may limit generalizability and the ability to detect rare but costly complications.
Dis Colon Rectum · PMID 40492557 · Read it on PubMed ↗
Gallo et al. 2025
Real-world use of polidocanol foam sclerotherapy for hemorrhoidal disease: insights from an international survey and systematic review with clinical practice recommendations
Experts favor foam over banding.Systematic reviewVery low qualityRelated question
size not given2025
experts perceived polidocanol foam as more successful and less likely to recur than rubber band ligation
Who was studied
adults with hemorrhoidal disease, mostly grade II and some grade III
What they received
polidocanol foam sclerotherapy
Compared with
rubber band ligation
Main outcome
success rate and recurrence rate of treatment, based on expert survey and literature review
Quality
the comparison numbers come from an expert opinion survey and non-controlled studies, not a trial directly comparing the two treatments
Limitations
abstract does not describe how success/recurrence rates were measured or whether confounders were controlled; findings are based on expert perception and heterogeneous studies
Taken word for word from the abstract
- population Most experts (90%) reported using polidocanol foam sclerotherapy primarily for Goligher grade II HD, with 67% extending its use to grade III cases.
- intervention Polidocanol foam sclerotherapy has gained increasing attention as a minimally invasive treatment for hemorrhoidal disease (HD).
- comparator Compared to rubber band ligation, polidocanol foam was perceived as having higher success rates (88.3% vs. 66.7%) and lower recurrence rates (16.1% vs. 41.2%).
- primaryOutcome polidocanol foam was perceived as having higher success rates (88.3% vs. 66.7%) and lower recurrence rates (16.1% vs. 41.2%)
- result Compared to rubber band ligation, polidocanol foam was perceived as having higher success rates (88.3% vs. 66.7%) and lower recurrence rates (16.1% vs. 41.2%).
- n A total of 20 studies met the inclusion criteria.
Updates Surg · PMID 40481245 · Read it on PubMed ↗
Tsai et al. 2025
Preoperative enema for anal surgery: randomized clinical trial
Enema before surgery mostly no help.Randomised trialModerate qualityRelated question
266 peoplepostoperative day 0 to day 7
no significant difference overall, but patients having Milligan-Morgan hemorrhoidectomy had less pain with enema on days 2-4
Who was studied
patients with grade III or IV hemorrhoids or anal fistulas having anal surgery
What they received
preoperative enema before surgery
Compared with
no preoperative enema
Main outcome
pain scores and painkiller use after surgery, days 0 to 7
Quality
it was a randomized trial but done at one hospital with a positive finding only in a smaller subgroup analysis
Limitations
single center study; positive finding limited to a subgroup (Milligan-Morgan hemorrhoidectomy) rather than the whole study population
Taken word for word from the abstract
- n A total of 266 patients were enrolled in this study, with 133 allocated to the enema group and 133 to the control group.
- population Patients diagnosed with grade III or IV haemorrhoids and anal fistulas at the Taipei Medical University Shuang-Ho Hospital, Taiwan, between 2022 and 2023, were enrolled
- intervention preoperative enema (intervention)
- comparator versus no preoperative enema (control)
- primaryOutcome The primary outcome measures included postoperative visual analogue scale scores and analgesic usage from postoperative day 0 to day 7.
- result No significant differences were observed in postoperative visual analogue scale scores, analgesic consumption and postoperative complications between the two groups.
- result in the subgroup of patients undergoing Milligan-Morgan haemorrhoidectomy, the mean(s.d.) visual analogue scale score was significantly higher in the control group than in the enema group on day 2 (5.69(2.14) versus 3.77(2.45), P = 0.021), day 3 (5.85(2.61) versus 3.92(2.73), P = 0.042) and day 4 (5.23(2.55) versus 3.42(2.18), P = 0.027).
BJS Open · PMID 40455826 · Read it on PubMed ↗
Grossi et al. 2025
SHAPE-skin-sparing hemorrhoidectomy and PExy: a novel technique for the surgical treatment of hemorrhoidal disease
Fast symptom relief after surgery.Prospective cohortLow quality
21 people1-month
Symptom scores dropped sharply after surgery, from a median HDSS of 16 to 0 and SHS from 20 to 4, with short hospital stay and no persistent pain, though some patients had urinary retention or bleeding complications
Who was studied
patients with grade III-IV hemorrhoidal disease (prolapsed hemorrhoids)
What they received
SHAPE surgery (skin-sparing hemorrhoidectomy combined with suture fixation/mucopexy)
Compared with
none (before-and-after comparison within same patients)
Main outcome
change in hemorrhoid symptom severity scores (HDSS and SHS) at 1 month
Quality
This was a small study of only 21 patients with no comparison group and just one month of follow-up, so it can't show how well this works compared to other treatments or over time.
Limitations
Very small sample size, no control group, only short-term (1-month) follow-up, and need for long-term data on recurrence.
Taken word for word from the abstract
- population 21 consecutive patients with grade III-IV HD
- intervention Skin-Sparing Hemorrhoidectomy and Pexy (SHAPE), a novel hybrid technique that integrates the excisional approach of closed hemorrhoidectomy with the tissue-sparing and fixation benefits of suture ligation with mucopexy
- comparator A prospective analysis was conducted on 21 consecutive patients with grade III-IV HD who underwent SHAPE on 3 hemorrhoidal columns.
- primaryOutcome 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 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).
- n 21 consecutive patients with grade III-IV HD
Updates Surg · PMID 40399727 · Read it on PubMed ↗
Niedritis et al. 2025
Rectal Diverticulum as a Rare Complication Following the Longo Procedure: A Case Report and Review of Therapeutic Challenges
Rare late complication, successfully surgically corrected.Case seriesVery low qualityRelated question
1 peoplefour years
developed a rare rectal diverticulum at the staple site four years after surgery, which was surgically removed with full recovery
Who was studied
60-year-old woman with grade III hemorrhoids and rectocele
What they received
stapled hemorrhoidopexy (Longo procedure)
Main outcome
late complication after surgery (rectal diverticulum)
Quality
This is a single patient case report, so it cannot show how often this happens or how treatments generally compare.
Limitations
Single case report; no comparison group; cannot establish how common this complication is or generalize findings.
Taken word for word from the abstract
- population A 60-year-old woman underwent the Longo procedure in 2021 for symptomatic Grade III hemorrhoidal disease and rectocele.
- intervention the Longo procedure (stapled hemorrhoidopexy)
- primaryOutcome Iatrogenic rectal diverticulum is an exceptionally rare complication following the Longo procedure
- result four years later, she presented with rectal discomfort but no other significant symptoms. Diagnostic evaluation, including colonoscopy and rectal ultrasonography, revealed a large diverticulum at the site of the previous stapled anastomosis, at five o'clock position.
- result The patient recovered well postoperatively, with resolution of symptoms and no further complications at follow-up.
- n A 60-year-old woman underwent the Longo procedure in 2021
Cureus · PMID 40385836 · Read it on PubMed ↗
Long et al. 2025
Milligan-Morgan hemorrhoidectomy combined with rubber band ligation and polidocanol foam sclerotherapy for the management of grade III/IV hemorrhoids: a retrospective study
Fewer recurrences, less pain, faster healing.RetrospectiveLow quality
255 people12 months
lower recurrence, higher satisfaction, less pain, fewer complications, faster healing with combined surgery; no difference in hemorrhoid severity score
Who was studied
patients with grade III/IV hemorrhoids
What they received
Milligan-Morgan hemorrhoidectomy combined with rubber band ligation and polidocanol foam sclerotherapy
Compared with
Milligan-Morgan hemorrhoidectomy alone
Main outcome
recurrence rate, hemorrhoid severity score, and patient satisfaction 12 months after surgery
Quality
This was a retrospective, single-center study without randomization, so bias and confounding cannot be ruled out.
Limitations
Retrospective design from a single center
Taken word for word from the abstract
- n A total of 255 patients with grade III/IV hemorrhoids who underwent MMH + RBL + PFS (n = 128) or MMH (n = 127) between May 2022 and June 2023 were included in the study.
- population A total of 255 patients with grade III/IV hemorrhoids who underwent MMH + RBL + PFS (n = 128) or MMH (n = 127) between May 2022 and June 2023 were included in the study.
- intervention This study aimed to retrospectively evaluate the efficacy and safety of a MMH combined with rubber band ligation and polidocanol foam sclerotherapy (MMH + RBL + PFS) for the management of grade III/IV hemorrhoids.
- comparator A total of 255 patients with grade III/IV hemorrhoids who underwent MMH + RBL + PFS (n = 128) or MMH (n = 127) between May 2022 and June 2023 were included in the study.
- primaryOutcome The primary outcomes included recurrence rates, hemorrhoid severity score (HSS), and patient satisfaction 12 months after surgery.
- result At the 12-month follow-up after surgery, the recurrence rate was lower in the MMH + RBL + PFS group (0.78%) than in the MMH group (7.09%) (p < 0.05). The patient satisfaction score was higher in the MMH + RBL + PFS group (91.41%) than in the MMH group (81.10%) (p < 0.05), and there was no significant difference in the HSS between the two groups (p > 0.05).
- followUp Follow-up was conducted by telephone or outpatient visit 12 months after surgery.
BMC Gastroenterol · PMID 40346473 · Read it on PubMed ↗
Tavani et al. 2025
The Complications of Hemorrhoidectomy From Patients' Perspective: A Qualitative Study
Many physical, emotional, social complications reported.Case seriesVery low qualityRelated question
27 people2025
patients reported physical, psychological, and social complications including pain, bleeding, fear, embarrassment, and social withdrawal
Who was studied
patients who previously had hemorrhoid removal surgery
What they received
hemorrhoidectomy (surgical removal of hemorrhoids)
Compared with
none reported
Main outcome
patients' reported complications after hemorrhoidectomy
Quality
This is a small qualitative interview study without a comparison group, so it can only describe patient experiences, not prove cause and effect.
Limitations
Qualitative design with convenience/purposive sampling of only 27 patients, no control group, and reliance on subjective interview data.
Taken word for word from the abstract
- n 27 patients with a history of hemorrhoidectomy
- population 27 patients with a history of hemorrhoidectomy
- intervention Hemorrhoidectomy is a common general surgical procedure with numerous and intensive complications.
- comparator This study sought to investigate the complications of hemorrhoidectomy from the patients' perspective.
- primaryOutcome This study sought to investigate the complications of hemorrhoidectomy from the patients' perspective.
- result Physical complications (PhCs) included nutritional problems, pain, sleep disturbances, physical weakness, bleeding, fecal incontinence, excretion problems, infection, fissures, anal prolapse, urinary retention, and disease recurrence.
Health Sci Rep · PMID 40303913 · Read it on PubMed ↗
Al-Kubati 2025
Chronic Khat Chewing Induced High-Grade Hemorrhoidal Disease and Post-Operative Bleeding in Yemen
Khat chewing linked to worse hemorrhoids, more bleeding.Prospective cohortLow qualityRelated question
1,896 peoplethree months
khat chewers had far higher rates of severe hemorrhoids needing surgery and more post-operative bleeding than non-chewers
Who was studied
Patients aged 16 to 85 in Yemen with anorectal disease, divided into chronic khat chewers and non-chewers
What they received
chronic khat chewing
Compared with
non-khat chewers
Main outcome
association between khat chewing and high-grade (including prolapsed, grade IV) hemorrhoidal disease and post-operative bleeding/pain
Quality
it is an observational cross-sectional study without randomization, so other differences between khat chewers and non-chewers could explain the results.
Limitations
abstract states future research should focus on establishing causality, identifying confounders, and dose-response relationships, indicating these were not controlled for
Taken word for word from the abstract
- n This prospective cross-sectional study included 1,896 patients aged 16-85 years
- population Chronic khat chewers (n=1,492) and non-khat chewers (n=404)
- intervention Chronic khat chewing was strongly associated with thrombosed grade IV hemorrhoidal disease.
- comparator compared to 25% in non-chewers, where half underwent hemorrhoidopexy
- primaryOutcome This study evaluates the relationship between chronic khat chewing and high-grade hemorrhoidal disease, as well as post-operative complications such as bleeding and pain.
- result Among khat chewers, 90% had hemorrhoids, with 75% requiring hemorrhoidectomy or hemorrhoidopexy, compared to 25% in non-chewers
- result Post-operative complications, including bleeding and severe pain, were significantly higher in male khat chewers (p < 0.05)
Ther Clin Risk Manag · PMID 40303315 · Read it on PubMed ↗
Niedritis et al. 2025
Modified Circular Hemorrhoidectomy for Stage IV Hemorrhoids With Terminal Prolapse: A Case Series
Surgery resolved prolapsed hemorrhoids completely.Case seriesVery low quality
3 people2025
all patients had complete symptom resolution with no recurrence or major complications
Who was studied
patients with severe stage IV hemorrhoids with terminal prolapse
What they received
modified circular hemorrhoidectomy (mucosal bridge preserving surgery)
Compared with
none
Main outcome
resolution of symptoms and complications after surgery
Quality
Only three patients were studied with no comparison group, so results could be due to chance.
Limitations
Very small case series of three patients without a control group or long-term data specified.
Taken word for word from the abstract
- n in three patients with severe circumferential hemorrhoidal disease
- population three patients with severe circumferential hemorrhoidal disease
- intervention modified circular hemorrhoidectomy, a refined technique incorporating mucosal bridge preservation
- comparator adapted from the traditional Whitehead hemorrhoidectomy
- primaryOutcome All three patients experienced complete resolution of complaints, with no recurrence or major complications during follow-up.
- result All three patients experienced complete resolution of complaints, with no recurrence or major complications during follow-up.
Cureus · PMID 40296923 · Read it on PubMed ↗
Ke et al. 2025
Single-nucleus RNA sequencing and spatial transcriptomics reveal the mechanism by which Xiaozhiling injection treats internal hemorrhoids
Shows how injection may shrink hemorrhoidsAnimal studyVery low qualityRelated question
size not givenOne week after injection
the injection activated the Sphk1-S1P pathway and increased collagen production by fibroblasts, suggesting it promotes fibrosis
Who was studied
rats with lab-induced internal hemorrhoids
What they received
Xiaozhiling injection (a Chinese medicine treatment)
Compared with
untreated modeling group (control) rats
Main outcome
molecular changes in fibroblast genes and fibrosis-related pathways
Quality
this is a small animal study looking only at cell and gene changes, not at whether hemorrhoids actually improved, and it doesn't report how many animals were used.
Limitations
study is in rats with an induced model, looks only at molecular mechanism, and does not report clinical outcomes like prolapse resolution or complication rates in patients
Taken word for word from the abstract
- population An internal hemorrhoid model was established in rats
- intervention Xiaozhiling injection
- comparator control group (CK group)
- primaryOutcome To investigate the molecular mechanism underlying the therapeutic effect of Xiaozhiling injection in the treatment of internal hemorrhoids
- result Fibroblast activation and the expression of key genes of the Sphk1-S1P pathway could be observed at the injection site, suggesting that after Xiaozhiling intervention, the Sphk1-S1P pathway could be activated to promote fibrosis
- followUp One week after injection
World J Gastrointest Surg · PMID 40291892 · Read it on PubMed ↗
Fišere et al. 2025
Utilisation of Deep Neural Networks for Estimation of Cajal Cells in the Anal Canal Wall of Patients with Advanced Haemorrhoidal Disease Treated by LigaSure Surgery
Surgery reduced pain and bleeding overall.Laboratory studyLow qualityRelated question
size not given2025
Pain and bleeding were significantly reduced after surgery, and patients with more of these cells were more likely to have bleeding afterward, especially in the most severe disease stage
Who was studied
patients with advanced (grade III and IV) hemorrhoidal disease
What they received
LigaSure surgery (haemorrhoidectomy) for hemorrhoids
Compared with
before versus after surgery (no separate control group)
Main outcome
pain and bleeding after surgery, and amount of special nerve-like cells (ICCs) in hemorrhoid tissue
Quality
This is a small, mechanistic lab and imaging study using an AI model on tissue samples, without a comparison treatment group, so it says little about how well the surgery works versus other options.
Limitations
No total patient number given, no comparator treatment, focus is on cell biology and an AI detection model rather than direct treatment comparison
Taken word for word from the abstract
- population one-third of grade III HD patients and 60% of grade IV HD patients had a high ICC density
- intervention Haemorrhoidectomy specimens were collected from patients undergoing surgery with the LigaSure device.
- primaryOutcome Preoperatively, pain was reported in 35% of grade III HD patients and 41% of grade IV patients, with a significant reduction following surgery.
- result A significant decrease in bleeding (p < 0.0001) was also noted postoperatively.
- result patients with postoperative bleeding, diagnosed with stage IV HD, had high ICC density in their anorectal tissues (p = 0.0041)
- comparator Preoperatively, pain was reported in 35% of grade III HD patients and 41% of grade IV patients, with a significant reduction following surgery.
Cells · PMID 40214502 · Read it on PubMed ↗
Liu et al. 2025
The comparison of doppler-guided haemorrhoidal artery ligation and the tissue selecting technique for patients with grade III/IV haemorrhoids: a retrospective cohort study
Less pain early, more recurrence laterRetrospectiveLow quality
251 people3 years
DG-HAL caused less pain and fewer complications early on, but had a higher rate of prolapse coming back after 3 years, especially in grade IV cases
Who was studied
patients with grade III or IV hemorrhoids
What they received
Doppler-guided hemorrhoid artery ligation (DG-HAL)
Compared with
tissue-selecting technique (TST)
Main outcome
post-operative pain, complications, and recurrence of prolapse/bleeding
Quality
This was a retrospective, non-randomized comparison, so differences between groups could be due to factors other than the treatment itself.
Limitations
Retrospective design without randomization; comparison limited to two surgical techniques only.
Taken word for word from the abstract
- population patients with grade III/IV hemorrhoids
- intervention Doppler-guided hemorrhoid artery ligation (DG-HAL)
- comparator tissue-selecting technique (TST)
- primaryOutcome post-operative visual analog scale (VAS) for pain, post-operative bleeding, post-operative defecation, urinary retention, and recurrence rate (prolapse and bleeding)
- result DG-HAL had fewer complications, lower bleeding rates, and less early post-operative pain but showed a higher recurrence rate than TST at the 3-year follow-up, especially in grade IV patients.
- n We conducted a retrospective analysis of 251 patients with grade III/IV hemorrhoids between January 2019 and January 2021.
Updates Surg · PMID 40210842 · Read it on PubMed ↗
Quinn et al. 2025
Botulinum toxin injection for management of post-haemorrhoidectomy pain: an updated systematic review and meta-analysis of randomised clinical trials
Less pain short-term, no lasting benefitMeta-analysisLow quality
340 people14 days
less pain on days 1, 2 and 4 after surgery, but no difference by day 14
Who was studied
people who had surgery to remove grade III-IV hemorrhoids
What they received
botulinum toxin injection given during hemorrhoid surgery
Compared with
placebo
Main outcome
post-operative pain scores
Quality
pooled from only seven small trials totaling 340 patients, so findings are not very precise or robust.
Limitations
Further, more robust randomised controlled trials are needed to strengthen these findings
Taken word for word from the abstract
- n seven studies (n = 340) found significant reduction in pain
- population 340 patients who underwent an excisional haemorrhoidectomy
- intervention Botulinum toxin injection
- comparator compared with placebo
- primaryOutcome daily post-operative pain scores assessed using an analogue scale (0-10)
- result found significant reduction in pain post-procedure with botulinum toxin use on day 1
- result the analgesic effects were not seen on subsequent analyses up to day 14
- limitations Further, more robust randomised controlled trials are needed to strengthen these findings
Tech Coloproctol · PMID 40192825 · Read it on PubMed ↗
Ponte et al. 2025
Treatment of Hemorrhoidal Disease in Patients with Liver Cirrhosis: A Systematic Review
Hemorrhoid treatments seemed safe and effective in cirrhosis.Systematic reviewLow qualityRelated question
size not given3 months
all treatment methods showed symptom improvement and were considered safe, with varying recurrence and complication rates depending on technique
Who was studied
people with liver cirrhosis who also have hemorrhoidal disease
What they received
various hemorrhoid treatments (rubber band ligation, injection sclerotherapy, hemorrhoidopexy, emborrhoid technique)
Compared with
different techniques compared across separate studies, no single head-to-head comparison for most
Main outcome
symptom improvement, patient satisfaction, prolapse reduction, recurrence, and adverse events
Quality
it combines only six small studies of mixed, mostly weak designs (just one randomized trial, with cohorts and case series) specifically in cirrhosis patients, so it cannot strongly prove which treatment is best.
Limitations
small number of studies (six), mostly non-randomized designs, heterogeneous techniques and agents, short follow-up in some studies
Taken word for word from the abstract
- population The incidence of hemorrhoidal disease (HD) in cirrhotic patients is similar to that of general population
- intervention The considered techniques encompassed rubber band ligation (RBL), injection sclerotherapy (IS) using 3 agents - aluminum potassium sulfate and tannic acid (ALTA), ethanolamine oleate 5% (EAO), or N-butyl-cyanoacrylate, hemorrhoidopexy, and emborrhoid technique.
- comparator Data from each study were initially described individually, followed by a comparative analysis for procedures applied in multiple studies.
- primaryOutcome Efficacy (symptomatic improvement, patient satisfaction, quality of life improvement, disease recurrence/need for surgery and/or hemorrhoidal prolapse reduction in anoscopy) and safety (reported adverse events) outcomes were evaluated.
- result All the treatment methods assessed in the included studies appear to be effective and safe in cirrhotic patients.
- followUp 80% of the patients showed clinical improvement at a 3-month follow-up
GE Port J Gastroenterol · PMID 40171091 · Read it on PubMed ↗
Eray et al. 2025
Comparative analysis of Ferguson hemorrhoidectomy combined with doppler-guided hemorrhoidal artery ligation and Ferguson hemorrhoidectomy in hemorrhoidal disease treatment
Less bleeding, slower return to activity.RetrospectiveLow quality
45 people2025
The combined DG-HAL plus Ferguson group had less intraoperative bleeding and needed fewer days of pain medication, but took longer to return to normal activities and had a higher (though not statistically significant) recurrence rate, while pain scores and complication rates were similar between groups.
Who was studied
adults with grade III prolapsed hemorrhoids undergoing surgery
What they received
Doppler-guided hemorrhoidal artery ligation combined with Ferguson hemorrhoidectomy
Compared with
Ferguson hemorrhoidectomy alone
Main outcome
surgical outcomes including bleeding, pain, analgesic use, recovery time, and recurrence
Quality
This was a small, retrospective comparison of only 45 patients without randomization, limiting confidence in the findings.
Limitations
Retrospective design, small sample size, and some differences (recurrence, complications) did not reach statistical significance.
Taken word for word from the abstract
- n data from a total of 45 patients who underwent DG-HAL + FH (n = 24) and FH (n = 21) for grade III hemorrhoidal disease between 2020 and 2022 were analyzed
- population for grade III hemorrhoidal disease between 2020 and 2022 were analyzed
- intervention In this retrospective cohort, data from a total of 45 patients who underwent DG-HAL + FH (n = 24) and FH (n = 21) for grade III hemorrhoidal disease between 2020 and 2022 were analyzed.
- comparator In this retrospective cohort, data from a total of 45 patients who underwent DG-HAL + FH (n = 24) and FH (n = 21) for grade III hemorrhoidal disease between 2020 and 2022 were analyzed.
- primaryOutcome Demographic and clinical data, surgical duration, intraoperative blood loss, hospital stay, postoperative analgesic consumption, pain scores using the Visual Analog Scale (VAS), complications, time to return to normal activities, and the recurrence rate were compared in both groups.
- result The need for postoperative analgesics was lower in the DG-HAL + FH group (2 vs 4 days, P < 0.05), while the FH group showed a shorter time to return to normal activities (9.5 vs 6.0 days, P = 0.02). The recurrence rate (16.7% vs 0%) and Clavien-Dindo Score-1 complications (20.8% vs 9.5%, P = 0.29) were higher in the DG-HAL + FH group but were insignificant.
World J Gastrointest Surg · PMID 40162427 · Read it on PubMed ↗
Alsaleh et al. 2025
Cat Scratch Colon: A Case Report and Review of the Literature
Conservative care didn't stop bleeding returning.Case seriesVery low qualityRelated question
1 people6 months later
bleeding initially resolved but patient had intermittent rectal bleeding again, with prolapsed hemorrhoids still seen on repeat colonoscopy 6 months later
Who was studied
63-year-old woman with alcoholic cirrhosis and chronic kidney disease with rectal bleeding
What they received
conservative management of hemorrhoids
Compared with
referral to colorectal surgeon for other treatment options
Main outcome
resolution of rectal bleeding
Quality
This is a single patient case report, so it cannot show whether a treatment generally works.
Limitations
Single case report; hemorrhoids were an incidental finding alongside another colon condition (cat scratch colon), not the main focus of the study.
Taken word for word from the abstract
- n a 63-year-old woman
- population a 63-year-old woman with a history of compensated alcoholic cirrhosis and chronic kidney disease (CKD) who presented with a 3-day history of hematochezia
- intervention The patient was educated on conservative management of hemorrhoids and discharged in stable condition.
- comparator The patient was referred to a colorectal surgeon to discuss other treatment options for her hemorrhoids.
- primaryOutcome The patient reported resolution of bleeding and tolerated diet advancement.
- result During follow-up, the patient reported intermittent episodes of rectal bleeding. A repeat CSP conducted 6 months later revealed diffuse mild diverticulosis and non-bleeding prolapsed hemorrhoids were also observed.
Cureus · PMID 40109828 · Read it on PubMed ↗
Dutta 2025
Multilayered numerical modelling of bio-thermal aspects during laser assisted treatment of internal haemorrhoid developed in rectum
Computer model of laser heat effects.Laboratory studyVery low qualityRelated question
size not given2025
the model showed temperature drops at the boundaries between tissue layers, matching previous published models
Who was studied
people with internal hemorrhoids in the rectum (modeled tissue, not patients)
What they received
laser-assisted therapy using a mathematical/numerical heat model
Compared with
published numerical model used for verification
Main outcome
temperature changes in the layers of rectal tissue during laser treatment
Quality
this is a computer simulation of tissue heating, not a study on actual patients, so it can't show whether the treatment helps people.
Limitations
this is a theoretical/numerical modelling study, not a clinical study on patients with hemorrhoids
Taken word for word from the abstract
- population Internal haemorrhoids are generally not visible from outside due to its growth inside the rectum
- intervention A Gaussian laser beam is considered as heat source to destroy the abnormal growth inside the rectum.
- comparator The research outcome is verified with the published numerical model with negligible variation.
- primaryOutcome Temperature variation in multi-layered tissue is investigated for laser heat input and absorption radius along the temporal and spatial coordinate.
- result Temperature drop has been evidenced in the interfaces of multi-layered rectum tissue.
Lasers Med Sci · PMID 39969619 · 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
Faster recovery, less pain, better quality of lifeRetrospectiveLow quality
120 people12 weeks
RPH had shorter surgery time, less blood loss, less pain, shorter hospital stay, lower cost, and better quality of life at 12 weeks than PPH; no difference in bowel control scores, and readmission rates were not significantly different
Who was studied
patients with mixed hemorrhoids (internal and external, often prolapsing)
What they received
Ruiyun procedure for hemorrhoids (RPH), a type of hemorrhoid surgery
Compared with
procedure for prolapse and hemorrhoids (PPH), another type of hemorrhoid surgery
Main outcome
surgical recovery measures (pain, blood loss, hospital stay, cost) and quality of life after surgery
Quality
This was a retrospective study from a single hospital, so bias and chance effects cannot be ruled out even though patients were matched statistically.
Limitations
Retrospective design, single-center, matched groups rather than randomized, no mention of blinding
Taken word for word from the abstract
- 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
- population patients with mixed hemorrhoids who visited the Third Affiliated Hospital of Gansu University of Chinese Medicine
- intervention automatic Ruiyun procedure for hemorrhoids
- comparator procedure for prolapse and hemorrhoids
- primaryOutcome postoperative medical humanistic evaluation, clinical efficacy evaluation, subjective evaluation of patients, the occurrence of complications and the rate of unplanned readmission were compared
- result Surgical time, intraoperative blood loss, duration of postoperative pain, length of hospital stay and hospitalization expenses between the two groups presented statistically significant differences (p < 0.001).
- result The European Quality of Life-5 Dimensions, 5-Level Version (EQ-5D-5L) score in the RPH group was lower than that in the PPH group at the 12th week of follow-up (p < 0.001), signifying an improved level of quality of life.
- result There was no difference in Vaizey's Fecal Incontinence Rating Scale score between the RPH group and the PPH group at the 12th week of follow-up (p > 0.05).
- followUp at the 12th week of follow-up
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 symptoms.Case seriesLow qualityRelated question
28 people3 months
Most symptoms resolved and most patients rated treatment as excellent, but over half had complications afterward
Who was studied
patients with bleeding from hemorrhoids
What they received
colonoscopic rubber band ligation
Compared with
no comparison group
Main outcome
symptom resolution (bleeding, prolapse, irritation, discharge, pain) and patient satisfaction
Quality
Small single-group study of only 28 patients with no comparison treatment and over half had complications, so it can't show how this compares to other options.
Limitations
Single-center, single-arm study with only 28 of 108 eligible patients included, short follow-up, and no comparator group.
Taken word for word from the abstract
- n We included 28 among 108 patients presenting to the surgical outpatient department with Lower gastrointestinal bleeding.
- population patients presenting to the surgical outpatient department with Lower gastrointestinal bleeding
- intervention Colonoscopic Rubber band ligation for lower Lower gastrointestinal bleeding due to hemorrhoids
- comparator This study, conducted in a tertiary care center of Nepal over one year, explores the immediate, late complications, efficacy and treatment satisfaction of patients undergoing Colonoscopic Rubber band ligation for lower GI bleeding due to hemorrhoids.
- primaryOutcome Symptoms of irritation, discharge, pain resolved in all patients at 3 months and that of bleeding and prolapse in 96.4% and 92% respectively.
- result Symptoms of irritation, discharge, pain resolved in all patients at 3 months and that of bleeding and prolapse in 96.4% and 92% respectively. 75% were able to resume work the day after the procedure. Post-procedure complications were reported in 53.5% of cases. 78.6% of patients rated Colonoscopic Rubber band ligation treatment as "excellent help".
J Nepal Health Res Counc · PMID 39923169 · Read it on PubMed ↗
Huang et al. 2025
Clinical observation on prognosis of mixed hemorrhoids treated with polidocanol injection combined with automatic elastic thread ligation operation
Faster healing, less pain, fewer complications.Randomised trialLow quality
100 people1 year
higher effective rate, faster healing, less pain, better quality of life, fewer complications; no difference in bleeding, anal stenosis, or recurrence
Who was studied
patients with mixed hemorrhoids
What they received
polidocanol foam injection combined with automatic elastic thread ligation (RPH)
Compared with
procedure for prolapse and hemorrhoids (PPH)
Main outcome
treatment effectiveness, pain, healing time, quality of life, complications, recurrence
Quality
randomization method (dice rolling) is unreliable and the abstract does not describe blinding or other safeguards against bias.
Limitations
Randomization by dice rolling, single center, no blinding mentioned.
Taken word for word from the abstract
- n A total of 100 patients with mixed hemorrhoids who visited our hospital from October 2022 to September 2023 were selected and randomly divided into the control group (n = 50) and the treatment group (n = 50)
- population patients with mixed hemorrhoids
- intervention polidocanol foam injection + RPH was adopted in the treatment group
- comparator The procedure for prolapse and hemorrhoids (PPH) was adopted in the control group
- primaryOutcome The therapeutic effects, operation time, wound healing time, hospital stay, pain situation (24 hours post-operative pain score, first defecation pain score), quality of life (QOL), incidence of complications (post-operative hemorrhage, edema, infection), incidence of anal stenosis 3 months post-operatively and recurrence rate 1 year post-operatively of the two groups were compared.
- result the therapeutic effect achieved by using polidocanol injection combined with RPH was better. The wounds of the patients healed faster, the postoperative pain was milder, QOL improved, and the incidence of complications was lower, and the short-term and long-term prognosis was good.
World J Gastrointest Surg · PMID 39872768 · Read it on PubMed ↗
Ghanem Atalla et al. 2024
Surgical approach for lower postoperative anal stenosis
Less anal narrowing with modified stapling.Narrative reviewLow qualityRelated question
size not given2024
modified technique led to less anal narrowing after surgery compared with the standard technique
Who was studied
people with grade III or IV (advanced) hemorrhoids, including some who had prior hemorrhoid treatments
What they received
modified stapled hemorrhoidopexy with staple removal at the 3- and 9-o'clock positions
Compared with
standard stapled hemorrhoidopexy
Main outcome
rate of anal narrowing (stenosis) and complications after surgery
Quality
This abstract is a commentary discussing another study that itself had a small sample size, so the evidence is weak and not yet confirmed by larger trials.
Limitations
The underlying study has a limited sample size, and the commentary notes long-term effects are not yet evaluated.
Taken word for word from the abstract
- population patients with grade III or IV hemorrhoids
- population this technique also showed reduced anal stenosis rates in patients with prior hemorrhoid treatments
- intervention staple removal at the 3- and 9-o'clock positions following modified stapled hemorrhoidopexy (SH)
- comparator standard or modified SH
- primaryOutcome Key metrics assessed included hospital stay duration, blood loss, operation time, and the incidence of minor or major complications
- result resulting in a lower rate of postoperative anal stenosis compared to standard SH
- result the modified SH method appears to significantly reduce the incidence of postoperative anal stenosis
World J Gastrointest Surg · PMID 39734464 · Read it on PubMed ↗
Mustapha et al. 2025
LigaSure versus conventional Milligan MORGAN hemorrhoidectomy in Nigerian patients with symptomatic hemorrhoids
Faster surgery, less bleeding, less pain.Randomised trialModerate quality
52 people3 months
LigaSure had less blood loss, less pain at 2 weeks, and shorter surgery time than Milligan-Morgan
Who was studied
adults with grade III and IV symptomatic hemorrhoids
What they received
LigaSure hemorrhoidectomy
Compared with
conventional Milligan-Morgan hemorrhoidectomy
Main outcome
blood loss, pain, and duration of surgery
Quality
It was a randomized trial but small, from a single center, with only short-term (3 month) follow-up.
Limitations
Small sample size and short-term follow-up of only 3 months for recurrence.
Taken word for word from the abstract
- population patients with grade III and grade IV hemorrhoids
- intervention LigaSure hemorrhoidectomy
- comparator conventional Milligan-Morgan hemorrhoidectomy
- primaryOutcome duration of the procedure, estimated blood loss, and resolution of symptoms
- result The median blood loss in the LigaSure group was 10.0 mL, whereas the median blood loss in the Milligan-Morgan group was 26.5 mL, (p = 0.0001)
- result The median postoperative pain at 2 weeks using the VAS was 5.5 in the LigaSure group, and in the Milligan-Morgan group, it was 6.0 (p = 0.002)
- result The mean duration of surgery in the LigaSure group was 18.04 min and 34.19 min in the Milligan-Morgan group (p = 0.0001)
- n Fifty-two patients were randomized equally into the two arms.
World J Surg · PMID 39578689 · Read it on PubMed ↗
Mou et al. 2024
Endoscopic polidocanol foam sclerobanding for treatment of internal hemorrhoids: A novel outpatient procedure
New method may help, unconfirmed.Narrative reviewVery low qualityRelated question
size not givenone-year follow-up
EFSB described as a novel therapy for internal hemorrhoids, with larger confirmatory studies still needed
Who was studied
patients with grades II and III internal hemorrhoids
What they received
Endoscopic polidocanol foam sclerobanding (EFSB)
Compared with
Endoscopic rubber band ligation (ERBL)
Main outcome
long-term relief from prolapse recurrence and reduced post-procedural pain
Quality
This is a commentary/editorial discussing another study rather than original research, with no new data of its own and small, preliminary basis for conclusions.
Limitations
The abstract itself says future studies with a larger sample, multiple treatment sessions, and long-term follow-up are required to confirm these 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
- 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 ↗
Islam et al. 2024
Outcomes of laser hemorrhoidoplasty for grade II-IV hemorrhoidal disease in Bangladesh
Smaller hemorrhoids, less pain, high satisfaction.Case seriesVery low qualityRelated question
86 people6th week
all patients had substantial reduction in hemorrhoid size, high satisfaction, and significantly lower pain scores, with a 19.8% complication rate at 6 weeks
Who was studied
patients with grade II-IV hemorrhoids
What they received
laser hemorrhoidoplasty
Compared with
none (no comparison group)
Main outcome
pain, satisfaction, hemorrhoid size reduction, and complications
Quality
This was a single group of patients followed over a short time with no comparison group, so it can't show whether laser treatment works better than other options.
Limitations
No control or comparator group; short 6-week follow-up; single-center study in one country.
Taken word for word from the abstract
- n 86 patients with grade II-IV hemorrhoids underwent laser hemorroidoplasty
- population 86 patients with grade II-IV hemorrhoids underwent laser hemorroidoplasty
- intervention Laser hemorrhoidoplasty is a minimally invasive procedure to treat hemorrhoids
- comparator 86 patients with grade II-IV hemorrhoids underwent laser hemorroidoplasty
- primaryOutcome Follow up was assessed on 1st week, 2nd week, and 6th week including pain, satisfaction, symptom improvement, incapacity for work, complications, reduction, and recurrence.
- result All individuals experienced substantial decreases in the size of their hemorrhoids (100%) and reported high levels of satisfaction after the operation (97.7%).
- result The 6th week complication rate was 19.8%.
Ann Med Surg (Lond) · PMID 39525773 · Read it on PubMed ↗
Abe et al. 2024
Efficacy and Safety of a New Technique Combining Injection Sclerotherapy and External Hemorrhoidectomy for Prolapsed Hemorrhoids: A Single-center Observational Study
Fewer complications, good long-term results.RetrospectiveLow quality
3,403 people26.4 months
3.5% had complications, 4.0% needed reoperation for recurrence, and 5- and 10-year recurrence-free rates were 92.5% and 67.2%
Who was studied
patients with grade II-IV mixed internal and external hemorrhoids (prolapsed hemorrhoids)
What they received
external hemorrhoidectomy combined with ALTA (aluminum potassium sulfate and tannic acid) sclerotherapy, called EA
Compared with
conventional hemorrhoidectomy (referenced for comparison, not a concurrent study arm)
Main outcome
postoperative complications and recurrence/reoperation rates
Quality
This was a single-center retrospective study without a true comparison group, so it can't firmly prove it's better than standard surgery.
Limitations
No concurrent control group; single-center design; retrospective observational study.
Taken word for word from the abstract
- n This study included 3,403 patients who underwent EA for grade II-IV mixed hemorrhoids.
- population 3,403 patients who underwent EA for grade II-IV mixed hemorrhoids
- intervention external hemorrhoidectomy combined with ALTA sclerotherapy (EA)
- comparator EA is as curative as conventional hemorrhoidectomy and reduces postoperative complications.
- primaryOutcome Postoperative complications occurred in 120 (3.5%) patients and increased with the number of EAs
- result The 5- and 10-year cumulative recurrence-free rates were 92.5% and 67.2%, respectively.
- followUp The mean postoperative follow-up period was 26.4 months
J Anus Rectum Colon · PMID 39473713 · Read it on PubMed ↗
Khan et al. 2024
Management of Acute Hemorrhoidal Crisis: Evaluation, Treatment, and Special Considerations
Reviews treatment options, no outcome data.Narrative reviewLow quality
size not given2024
Who was studied
people with acute hemorrhoid flare-ups involving severe bleeding, prolapse, or thrombosis
What they received
range of treatments from symptom-control measures to surgical removal of hemorrhoids
Main outcome
best approach to evaluating and treating acute hemorrhoidal crisis
Quality
this is a narrative review describing general management approaches rather than presenting new study data or comparative results.
Limitations
The abstract does not describe study methods, data sources, or specific limitations.
Taken word for word from the abstract
- population Acute presentation related to significant thrombosis or bleeding is referred to as acute hemorrhoidal crisis.
- intervention Management of this pathology varies from nonoperative intervention for symptom control to definitive incisional or excisional hemorrhoidectomy.
- primaryOutcome Here we will explore the approach to evaluating and treating acute hemorrhoidal crises.
Clin Colon Rectal Surg · PMID 39399139 · Read it on PubMed ↗
Liu et al. 2024
Modified stapled hemorrhoidopexy for lower postoperative stenosis: A five-year experience
Fewer anal narrowing complications after surgery.RetrospectiveLow quality
500 people2024
Fewer patients in the modified surgery group developed anal narrowing afterward compared to standard surgery
Who was studied
adults with grade III or IV prolapsed internal hemorrhoids (mixed hemorrhoids) undergoing surgery
What they received
modified stapled hemorrhoidopexy (removing staples at 3- and 9-o'clock positions)
Compared with
standard stapled hemorrhoidopexy
Main outcome
rate of anal narrowing (stenosis) after surgery
Quality
This was a retrospective, single-center study comparing two surgical groups without randomization, so other differences between groups could explain the results.
Limitations
Retrospective, single-center, observational design; groups differed in prior surgical history (54% vs 40.3% had prior hemorrhoid surgery).
Taken word for word from the abstract
- population Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1, 2015, and January 1, 2020, were included.
- intervention staple removal at the 3- and 9-o'clock positions during modified SH
- comparator standard or modified SH
- primaryOutcome To compare outcomes of staple removal at the 3- and 9-o'clock positions during modified SH in patients with mixed hemorrhoids.
- result The modified SH group included five (2.7%) patients with anal stenosis, while 21 (6.7%) patients in the standard SH group had complications of anal stenosis.
- n We investigated 187 patients (mean age, 50.9 years) who had undergone our modified SH and 313 patients (mean age, 53.0 years) who had undergone standard SH.
World J Gastrointest Surg · PMID 39351563 · Read it on PubMed ↗
Moreira 2024
[Anal Pathology in General Practice: A Syndromic Approach to Diagnosis]
General guide, no treatment results given.Narrative reviewVery low qualityRelated question
size not given2024
The review describes diagnosis and management approaches but does not report a specific treatment result or outcome measure
Who was studied
people seen in general practice with anal symptoms
Main outcome
not reported
Quality
This is a narrative review describing diagnostic approaches, not a study testing a treatment, so it provides no evidence of effect.
Limitations
No study design, no patient outcomes, no data on treatment effectiveness are reported; it is a general guide covering many anal conditions, not focused specifically on prolapsed hemorrhoids.
Taken word for word from the abstract
- population Anal pathologies represent a common reason for consultation in general and specialized medical practice
- result Therapeutic options are briefly discussed.
- primaryOutcome This review provides practical tools to improve diagnostic accuracy and treatment effectiveness.
Acta Gastroenterol Latinoam · PMID 41341550 · Read it on PubMed ↗
Brillantino et al. 2024
The Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colonproctologia) guidelines for the management of acute and chronic hemorrhoidal disease
Treatment choice depends on prolapse gradeGuidelineLow quality
size not given2024
Different procedures recommended depending on severity: outpatient laser or sclerotherapy for grade 1; nonexcisional procedures as first-line for grade 2; stapled hemorrhoidopexy or hemorrhoidectomy for grades 3 and 4, with stapled hemorrhoidopexy as gold standard for grade 3
Who was studied
people with hemorrhoidal disease (prolapse grades 1 to 4)
What they received
various treatments: outpatient procedures, laser, sclerotherapy, artery ligation, stapled hemorrhoidopexy, hemorrhoidectomy
Compared with
different treatment options compared across prolapse grades
Main outcome
best treatment choice by hemorrhoid prolapse grade
Quality
This is an expert consensus guideline based on panel discussion and literature review, not new trial data, so it reflects opinion more than direct evidence.
Limitations
Based on expert consensus (Delphi method) rather than original trial results; no patient numbers or outcome data given.
Taken word for word from the abstract
- population the diagnosis and management of hemorrhoidal disease
- intervention outpatient procedures including hemorrhoidal laser procedure and sclerotherapy
- comparator nonexcisional procedures including outpatient treatments, hemorrhoidal artery ligation and mucopexy, laser hemorrhoidoplasty, the Rafaelo procedure, and stapled hemorrhoidopexy
- primaryOutcome to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colon-Proctologia, SIUCP) on the diagnosis and management of hemorrhoidal disease, with the goal of guiding physicians in the choice of the best treatment option
- result In cases of grade 1 hemorrhoidal prolapse, outpatient procedures including hemorrhoidal laser procedure and sclerotherapy may be considered the preferred surgical options.
- result stapled hemorrhoidopexy represents the gold-standard treatment for grade 3 hemorrhoidal prolapse
Ann Coloproctol · PMID 39228195 · Read it on PubMed ↗
Zhou et al. 2024
[Clinical analysis of percutaneous superselective superior rectal artery embolization for grades Ⅱ-Ⅲ internal hemorrhoids]
Improved bleeding and prolapse scores.RetrospectiveLow quality
22 people12 months
bleeding, quality of life, and prolapse scores all significantly improved after treatment compared to before
Who was studied
patients with grade II-III internal hemorrhoids
What they received
superselective superior rectal artery embolization (a minimally invasive procedure blocking blood flow to hemorrhoid vessels)
Compared with
before-and-after comparison within same patients (no control group)
Main outcome
bleeding score, quality of life score, and prolapse score
Quality
This was a small study of 22 patients with no comparison group, just measuring change before and after treatment.
Limitations
Retrospective analysis, small sample size, no control group for comparison
Taken word for word from the abstract
- n 22 patients with grades Ⅱ-Ⅲ internal hemorrhoids
- population grades Ⅱ-Ⅲ internal hemorrhoids
- intervention percutaneous superselective superior rectal artery embolization
- comparator The clinical scores before and after treatment were compared
- primaryOutcome French bleeding score,quality of life score,prolapse score
- result the French bleeding score,quality of life score,and prolapse score were significantly improved (all P<0.05)
- followUp followed up for 12 months
Zhonghua Nei Ke Za Zhi · PMID 39183158 · Read it on PubMed ↗
J et al. 2024
A Hospital-Based Longitudinal Study of Rubber Band Ligation and Sclerotherapy Treatment for Internal Hemorrhoids From South India
Sclerotherapy had fewer complications than banding.Prospective cohortLow qualityRelated question
200 peoplenine weeks
sclerotherapy had less pain, fewer complications, and better treatment response than rubber band ligation
Who was studied
patients with grade one and two internal hemorrhoids at a tertiary care hospital in Madurai, India
What they received
rubber band ligation
Compared with
sclerotherapy
Main outcome
postoperative pain, complications, and treatment outcome
Quality
this was a non-randomized observational comparison, so differences between groups could be due to factors other than the treatment itself
Limitations
not randomized; abstract does not describe blinding or how patients were assigned to groups
Taken word for word from the abstract
- n We conducted a one-year longitudinal survey among 200 patients with internal hemorrhoids in a tertiary care center in Madurai.
- population symptomatic grade one and two internal hemorrhoids in a tertiary care hospital
- intervention rubber band ligation
- comparator sclerotherapy
- primaryOutcome Intraoperative and immediate postoperative pain was higher in the rubber band ligation group than in the sclerotherapy group.
- result Overall, the sclerotherapy group was associated with fewer postoperative complications, more excellent patient response, and a more complete response to treatment than the rubber band ligation group.
- followUp after three, six, and nine weeks postoperatively
Cureus · PMID 39144877 · 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
Less pain and recurrence with combo treatmentRandomised trialModerate quality
195 people12 months
lower symptom scores, less prolapse recurrence, and less pain with combined foam sclerobanding vs banding alone
Who was studied
adults with grade II-III internal hemorrhoids
What they received
endoscopic polidocanol foam sclerobanding (combined foam sclerotherapy and rubber band ligation)
Compared with
endoscopic rubber band ligation alone
Main outcome
hemorrhoid symptom severity, prolapse recurrence, and post-procedure pain
Quality
randomized, multicenter study with reasonable follow-up, but moderate size and no blinding mentioned.
Limitations
no mention of blinding; only internal hemorrhoid grades II-III studied
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 an ERBL group
- primaryOutcome Symptom-based severity and post-procedural pain were assessed using a hemorrhoid severity score (HSS) and a visual analog scale (VAS).
- result 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.
- result The prolapse recurrence rate was lower in the EFSB group at 12 months (11.2% vs 21.6%, P = 0.038).
- n A total of 195 consecutive patients diagnosed with grade II-III internal hemorrhoids were enrolled from four tertiary hospitals
World J Gastroenterol · PMID 39086750 · Read it on PubMed ↗
Jee et al. 2024
Conventional Excisional Haemorrhoidectomy versus Transanal Haemorrhoidal Dearterialization for Haemorrhoids: A Systematic Review and Meta-Analysis
More recurrence but faster recovery with THD.Meta-analysisModerate qualityRelated question
465 people2024
THD had higher recurrence than CEH, but patients recovered faster after THD
Who was studied
patients with hemorrhoids undergoing surgery
What they received
transanal hemorrhoidal dearterialization (THD)
Compared with
conventional excisional hemorrhoidectomy (CEH)
Main outcome
hemorrhoid recurrence after surgery
Quality
It pools six randomized trials but recurrence finding is based on relatively few patients and a wide confidence interval.
Limitations
Only 6 RCTs with 465 patients total; subgroup analysis showed similar results but overall evidence base is limited.
Taken word for word from the abstract
- n A total of 6 RCTs encompassing 465 patients were captured.
- intervention Transanal Haemorrhoidal Dearterialization
- comparator Conventional Excisional Haemorrhoidectomy
- primaryOutcome The primary objective was recurrence.
- result THD had a higher recurrence rate (odds ratio = 2.76, 95% confidence interval [CI] = 1.03-7.38, p = 0.04) albeit a shorter return to baseline compared to CEH (mean difference = -14.05 days, 95% CI = -20.38 to -7.72, p < 0.0001).
- population Haemorrhoids
Dig Surg · PMID 39084191 · Read it on PubMed ↗
Bek et al. 2024
Demography of Haemorrhoids in Jamhuriat Hospital, Kabul
Describes who gets hemorrhoids, not treatment results.RetrospectiveLow qualityRelated question
252 people2024
most patients were male, low income, aged 30-40; common symptoms were bleeding, prolapse, and pain; surgery was used for over half of patients with third- or fourth-degree hemorrhoids
Who was studied
patients diagnosed with hemorrhoids at a hospital in Kabul, Afghanistan
What they received
none - descriptive study of patient records, though surgery was noted as common treatment
Main outcome
demographic characteristics and frequency of hemorrhoids, including symptoms and treatment type used
Quality
this is a retrospective, single-hospital record review describing patient characteristics, not a comparison of treatments, so it cannot show whether any treatment works.
Limitations
retrospective design, single center, no comparison between treatments, no outcomes after treatment reported
Taken word for word from the abstract
- n Two hundred and fifty-two patients who were diagnosed with hemorrhoids were included.
- population patients who were diagnosed with hemorrhoids
- intervention Surgical management was common for third- and fourth-degree hemorrhoids (51.6%).
- primaryOutcome This retrospective investigation aimed to assess the frequency and demography of hemorrhoids in Kabul, Afghanistan.
- result Males composed 83.7% of the patients, and 32.9% were aged 30-40 years. A lower socioeconomic status was common (61.1%). Bleeding, prolapse, and pain were frequent symptoms. Surgical management was common for third- and fourth-degree hemorrhoids (51.6%).
Int J Gen Med · PMID 39070221 · Read it on PubMed ↗
Chen et al. 2024
Stapled hemorrhoidopexy for hemorrhoids: A overview of systematic reviews and meta-analysis
Less pain, but more bleeding, recurrence.Systematic reviewLow quality
23 people2024
Stapled hemorrhoidopexy reduced postoperative pain but increased bleeding and prolapse recurrence
Who was studied
people with hemorrhoids undergoing surgery
What they received
stapled hemorrhoidopexy
Compared with
other hemorrhoid surgery methods (pooled from meta-analyses)
Main outcome
postoperative pain, complications and recurrence
Quality
This is an overview of mostly low and critically low quality reviews, so its conclusions are not very reliable
Limitations
Most of the included meta-analyses and reviews were rated low or critically low quality, and the overview authors say caution should be exercised interpreting findings
Taken word for word from the abstract
- n The overview included 23 meta-analyses.
- result SH can reduce postoperative pain in hemorrhoid patients (odds ratio = 0.28, 95 % confidence interval [0.15,0.55], p = 0.0002; I2 = 74 %, p < 0.00001). But SH is associated with a higher risk of postoperative bleeding and recurrence of prolapse.
- primaryOutcome SH has been found to be an effective intervention for reducing postoperative pain, shortening procedure time, and promoting wound healing.
- intervention Stapled hemorrhoidopexy has been used for years to treat hemorrhoids.
- comparator We removed overlapping randomized controlled trials (RCTs) and conducted a new meta-analysis of the outcomes.
- population to identify MAs/SRs on the efficacy and complications of SH
- limitations Given that the reviews included in this overview were rated as low quality, caution should be exercised when interpreting the findings.
Asian J Surg · PMID 39009485 · Read it on PubMed ↗
Kavraal et al. 2024
Hemorrhoidal laser ablation procedure: a minimally invasive treatment for grades II, III, and IV using a 1470 nm diode laser
Fewer symptoms, low recurrence with laser.RetrospectiveLow quality
138 peopleup to five years
symptoms and hemorrhoid size improved with low recurrence and high satisfaction
Who was studied
patients with symptomatic grade II, III, and IV internal hemorrhoids
What they received
laser treatment to shrink hemorrhoids (1470 nm diode laser ablation)
Compared with
none (single group, before-after outcomes)
Main outcome
symptom relief, hemorrhoid size reduction, complications, and recurrence
Quality
This was a retrospective study without a comparison group, so results could be due to other factors over time.
Limitations
Retrospective design with no control group for comparison.
Taken word for word from the abstract
- n The cohort included 138 patients with symptomatic hemorrhoids who underwent Hemorrhoidal Laser Ablation at three different medical centers in 2017-2022.
- population symptomatic grade II, III, and IV internal hemorrhoids
- intervention Patients were treated with a 1470 nm diode laser.
- comparator This retrospective study aimed to present our experience with Hemorrhoidal Laser Ablation
- primaryOutcome evaluate the efficacy and safety of this relatively recent technique
- result The overall satisfaction rate was 95% with symptomatic relief.
- result the long-term recurrence rate was 5% over up to five years of follow-up
Pol Przegl Chir · PMID 38965992 · Read it on PubMed ↗
Al Amri 2024
Myrrh sitz bath for wound healing after hemorrhoidectomy: A retrospective study of adverse effects and treatment outcomes
Better healing but more complications.RetrospectiveVery low qualityRelated question
67 people2024
more high-grade wound healing but also more complications with myrrh compared to standard care
Who was studied
patients who had surgery to remove hemorrhoids
What they received
myrrh sitz bath used as self-treatment for wound care after hemorrhoid surgery
Compared with
standard wound care after hemorrhoid surgery
Main outcome
wound healing grade and complication rate
Quality
this was a small retrospective study where patients chose their own treatment, the myrrh group was older and sicker, and it looked at wound care after surgery rather than treatment of a prolapsed hemorrhoid itself.
Limitations
retrospective design, self-medication without medical advice, small myrrh group (15 patients), myrrh group was significantly older with more comorbidities, higher complication rate in myrrh group
Taken word for word from the abstract
- n The study included 67 patients who underwent hemorrhoidectomy.
- population patients who underwent hemorrhoidectomy
- intervention Group A for Myrrh-based wound care as a self-medication
- comparator Group B for standard wound care
- primaryOutcome to compare the safety, efficacy, and treatment outcomes of Myrrh sitz baths with standard clinical care in promoting wound healing after hemorrhoidectomy
- result The Myrrh group had significant Grade III wound healing outcomes 9/15 (60%) compared to the standard care group 2/52 (3.8%) (p < 0.001). However, despite the better healing outcomes, the Myrrh group had a significantly higher complication rate 7/15(46.7%) than the standard care group 1/52 (1.9%) (p < 0.001).
Health Sci Rep · PMID 38868538 · Read it on PubMed ↗
Xue et al. 2024
Effect of Pressure and Nonpressure Dressings on Postoperative Complications in Patients With Mixed Hemorrhoids: A Single-blind Controlled Study
Less pain and retention with nonpressure dressingRandomised trialModerate qualityRelated question
186 people2024
nonpressure dressings led to less urinary retention, less skin injury, less pain and anal distension, but no difference in edema, hospital stay or cost
Who was studied
patients with grade II to III mixed hemorrhoids undergoing hemorrhoidectomy surgery
What they received
nonpressure wound dressing after hemorrhoid surgery
Compared with
pressure wound dressing after hemorrhoid surgery
Main outcome
postoperative complications such as urinary retention, skin injury, and pain
Quality
it was a randomized trial but only single-blind and focused on a narrow aftercare detail rather than the surgery or hemorrhoid treatment itself
Limitations
single-blind design, limited to postoperative dressing type rather than the underlying hemorrhoid treatment
Taken word for word from the abstract
- n A total of 186 patients with grade II to III mixed hemorrhoids
- population patients with grade II to III mixed hemorrhoids who had been excluded from cardiovascular and cerebrovascular diseases and anorectal surgery
- intervention nonpressure dressings group
- comparator pressure dressings group
- primaryOutcome The incidence of acute urinary retention and medical adhesive-related skin injury, pain, hemostatic effect, anal distension, anal edema, use of analgesics, length of hospital stay, and hospitalization costs were compared between the two groups.
- result The incidence of acute urinary retention in both men and women was significantly lower in the nonpressure dressing group
- result there were no significant differences between both groups in terms of anal edema scores, length of stay, or hospitalization expenses
J Perianesth Nurs · PMID 38864797 · Read it on PubMed ↗
Soto Sánchez et al. 2024
Protocol of a clinical trial on the effectiveness of pudendal nerve block with and without neurostimulation in reducing posthemorroidectomy pain
No results yet, trial planned.Registered trial, no results postedLow qualityRelated question
size not given24 h
not yet available, this is a trial protocol
Who was studied
adults with hemorrhoids needing surgery
What they received
pudendal nerve block guided by neurostimulation
Compared with
pudendal nerve block guided by anatomical landmarks
Main outcome
pain level 24 hours after hemorrhoid surgery
Quality
this is only a study protocol with no results reported yet
Limitations
single-center study; results not yet available so effectiveness cannot be judged
Taken word for word from the abstract
- population Patients over 18 years old with hemorrhoids refractory to medical treatment, symptomatic grade III-IV and grade II hemorrhoids that do not respond to conservative procedures in a third level hospital in Spain and that are subsidiaries of surgery in major ambulatory surgery will be included.
- intervention pudendal nerve block guided by anatomical references and guided by neurostimulation
- comparator pudendal nerve block guided by anatomical references and guided by neurostimulation
- primaryOutcome to compare pain in the immediate postoperative period (24 h) after hemorrhoidectomy in patients with pudendal nerve block guided by anatomical references and guided by neurostimulation
- result RESULTS: Not avaliable until the end of the study.
Rev Esp Anestesiol Reanim (Engl Ed) · PMID 38821379 · 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
Fewer hemorrhoid symptoms overall.Prospective cohortLow qualityRelated question
60 people2024
symptom severity score significantly improved after treatment
Who was studied
adults with mild-to-moderate symptomatic non-bleeding hemorrhoids
What they received
sucralfate rectal ointment or suppositories
Compared with
no comparison group (before-and-after treatment only)
Main outcome
patient-reported hemorrhoid symptom severity score
Quality
This was a small, uncontrolled, observational study without a placebo or comparison group, so improvement cannot be clearly attributed to the treatment.
Limitations
No control group, open-label design, authors state larger controlled trials are needed to confirm results.
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 rectal ointment and suppositories containing sucralfate
- comparator prospective, observational study
- 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).
- n Five investigators enrolled 60 patients
Int J Colorectal Dis · PMID 38750150 · Read it on PubMed ↗
Morsi et al. 2024
Common design and data elements on rectal artery embolization for treatment of symptomatic internal hemorrhoidal disease: an interactive systematic review of clinical trials
Studied bleeding hemorrhoids, not prolapse.Systematic reviewLow qualityRelated question
size not given1 to 18 months
studies varied widely in criteria and outcomes; technical success ranged 72-100% and most reported no major complications, but rectal prolapse was an exclusion criterion, not a target condition
Who was studied
adults with symptomatic internal hemorrhoids (bleeding or discomfort), excluding those with rectal prolapse
What they received
rectal artery embolization (RAE)
Compared with
no single comparator; review compared design elements across 15 studies of RAE
Main outcome
common design and data elements (patient selection, technique, outcomes) used in RAE studies
Quality
this is a qualitative review of very different small studies (cohorts, one RCT, case series) with inconsistent methods, so it cannot show whether the treatment works.
Limitations
Great heterogeneity among included studies, particularly regarding inclusion criteria, exclusion criteria, outcomes measures and timeframe; qualitative only, no pooled statistics.
Taken word for word from the abstract
- n The initial search yielded 2000 studies, with 15 studies meeting the inclusion criteria after screening and assessment.
- population Internal hemorrhoids (IH) is a common medical condition that can result in morbidity secondary to bleeding and discomfort.
- population Exclusion criteria emphasized factors such as previous surgeries, colorectal cancer, rectal prolapse, acute hemorrhoidal complications, and contrast allergy.
- intervention rectal artery embolization (RAE) for symptomatic hemorrhoidal disease
- comparator The included studies comprised one RCT, one case series, one pilot study and 12 cohort studies.
- primaryOutcome We performed a common design and data element analysis of studies that report on RAE.
- result Procedural details included the use of metallic coils and detachable micro-coils, with a high technical success rate reported in most studies ranging from 72 to 100%.
- result The majority of studies reported no major immediate or post-procedural complications.
- limitations there was a great degree of heterogeneity among included studies, particularly regarding inclusion criteria, exclusion criteria, outcomes measures and timeframe
- followUp The follow-up ranged from 1 to 18 months.
CVIR Endovasc · PMID 38733497 · 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
Hemorrhoids common in pregnancy; treatment not tested for success.Prospective cohortLow qualityRelated question
1,422 people6 weeks after delivery
13% of pregnant women had hemorrhoidal disease, with risk factors including age ≥30, chronic constipation, newborn weight >3500 g, and prolonged fetal expulsion time; treatment described but not tested for efficacy
Who was studied
pregnant women in Bamako, Mali followed from first trimester through 6 weeks postpartum
What they received
general treatment for anal pathologies (hygiene/diet counseling, laxatives, topical treatments, analgesics, perineal rehabilitation)
Compared with
no comparator group; descriptive treatment approach only
Main outcome
rate and risk factors of anal pathologies including hemorrhoidal disease (external hemorrhoids with thrombosis or prolapse, and internal hemorrhoids)
Quality
This is a descriptive study of disease frequency and risk factors, not a trial testing whether a treatment works, so it can't show if the treatment actually helps.
Limitations
The abstract does not evaluate treatment outcomes or compare treatments, only describes general management alongside risk factor identification; no control group for treatment comparison.
Taken word for word from the abstract
- n we followed up 1,422 pregnant women
- population pregnant women admitted to the hospitals and who were followed up through the postpartum
- intervention The treatment was based on counseling on hygiene and diet, the use of laxatives, local topicals, and analgesics along perineal rehabilitation.
- comparator We carried out a prospective, multi-centric, and analytical study
- primaryOutcome Hemorrhoidal diseases were diagnosed in the case of external hemorrhoids (thrombosis or prolapse) or internal hemorrhoids.
- result we found 38.4% (546) with anal pathologies (hemorrhoidal diseases in 13% (192)
- result Risk factors for the hemorrhoidal disease were age of patient ≥30 years old aRR=5.77, 95% CI 4.57-7.34; p=0.000
Pan Afr Med J · PMID 38681103 · Read it on PubMed ↗
Liao et al. 2024
Effects of early warm water sitz bath on urinary retention and pain after haemorrhoidectomy: A randomized controlled trial
Less pain, no less urinary retention.Randomised trialModerate qualityRelated question
64 people2024
no difference in urinary retention between groups, but the early sitz bath group had significantly lower pain scores
Who was studied
adults with grade III or IV prolapsed hemorrhoids having hemorrhoid removal surgery
What they received
warm water sitz bath started 6 hours after hemorrhoidectomy
Compared with
warm water sitz bath started on day 1 after hemorrhoidectomy as usual
Main outcome
urinary retention and wound pain after hemorrhoidectomy
Quality
it was a randomized trial but small, single-center, and only looked at post-surgery care, not the hemorrhoid treatment itself.
Limitations
small sample of 64 patients from a single surgical ward, conducted over one year
Taken word for word from the abstract
- population Patients who received haemorrhoidectomy for grade III or IV haemorrhoids from January to December 2020 were enrolled.
- n A total of 64 participants (32 each in the experimental and control groups) were enrolled.
- intervention The experimental group started warm-water sitz bath 6 h after the surgery
- comparator the control group started warm water sitz bath on post-haemorrhoidectomy day 1 as usual
- primaryOutcome To investigate the effect of early warm water sitz bath on the day of haemorrhoidectomy surgery on preventing urinary retention and reducing wound pain.
- result There was no significant difference in the degree of change in the number of people with urinary retention between groups. A change in the wound pain index was noted; the study group had a statistically significant lower pain score than the control group (B = -0.81, 95 % CI: -1.44 to -0.18).
Int J Nurs Stud · PMID 38642473 · Read it on PubMed ↗
Fujimoto 2024
Manual Reduction of Strangulated Internal Hemorrhoids Using Sugar: A Case Report
Sugar helped shrink and reduce prolapse.Case seriesVery low quality
1 peopletwo weeks
after sugar was applied the swelling went down enough that manual reduction became possible and pain improved, avoiding emergency surgery
Who was studied
51-year-old woman with long-standing prolapsed internal hemorrhoids that became strangulated and hard to push back in
What they received
applying sugar directly to the swollen hemorrhoids to shrink them before manual reduction
Compared with
standard manual reduction with lidocaine jelly and hydrocortisone ointment alone
Main outcome
whether the prolapsed hemorrhoid could be manually pushed back in and pain relieved
Quality
this is a single patient case report, so it cannot show whether sugar reliably works better than usual care.
Limitations
only one patient was reported, with no comparison group, so results may not generalize.
Taken word for word from the abstract
- population a 51-year-old female patient
- population she experienced prolapsed internal hemorrhoids every time she defecated
- intervention we applied sugar directly to the hemorrhoids
- comparator After 10 minutes of applying Lidocaine Hydrochloride Jelly 2% and Escherichia coli culture suspension/hydrocortisone ointment, the manual reduction was still difficult.
- primaryOutcome manual reduction was still difficult
- result Ten minutes later, the number of prolapsed hemorrhoids decreased, and manual reduction was possible.
- result it was confirmed that there was no prolapse of the internal hemorrhoids and that her pain had improved
- n we present a 51-year-old female patient
- followUp Two weeks later, a grade III internal hemorrhoid was observed
Cureus · PMID 38601399 · Read it on PubMed ↗
Liu et al. 2024
Modified whitehead hemorrhoidectomy versus partial hemorrhoidectomy for fourth-degree circular mixed hemorrhoids: A retrospective analysis
Fewer recurrences, similar complication rates overall.RetrospectiveLow quality
366 people2024
No residual hemorrhoids or recurrence after modified Whitehead surgery, versus residues in 58 and recurrence in 19 patients after partial hemorrhoidectomy; rates of bleeding, pain, infection, incontinence, and urinary retention were similar between groups
Who was studied
patients with grade IV (fourth-degree) circular mixed hemorrhoids
What they received
modified Whitehead hemorrhoidectomy surgery
Compared with
partial hemorrhoidectomy surgery
Main outcome
surgical complications, residual hemorrhoids, and hemorrhoid recurrence
Quality
This was a retrospective, non-randomized comparison without statistical testing of key outcomes like recurrence, so it cannot reliably prove one surgery is better.
Limitations
Retrospective design, no randomization, and the abstract itself calls for prospective randomized trials to confirm results
Taken word for word from the abstract
- population Patients with grade Ⅳ circular hemorrhoids who underwent modified Whitehead hemorrhoidectomy and partial hemorrhoidectomy for fourth-degree circular mixed hemorrhoids were retrospectively reviewed.
- intervention modified Whitehead hemorrhoidectomy
- comparator partial hemorrhoidectomy
- n A total of 205 patients who received modified Whitehead hemorrhoidectomy and 161 who received partial hemorrhoidectomy were included.
- result There were no residual hemorrhoids in patients who received modified Whitehead hemorrhoidectomy, and none had hemorrhoid recurrence. Fifty-eight patients who received partial hemorrhoidectomy had hemorrhoidal residues, and 19 patients experienced hemorrhoid recurrence.
- result no statistically significant differences were found between the two groups
- primaryOutcome long-term postoperative complications were assessed through repeated outpatient examinations and telephonic communication
- limitations Prospective randomized controlled trials are needed to verify our results.
Heliyon · PMID 38596109 · Read it on PubMed ↗
Fathallah et al. 2024
Hemorrhoidal disease: Epidemiological study and analysis of predictive factors for surgical management
Surgery gave better relief and satisfaction.Prospective cohortLow quality
472 people2024
Surgery led to greater improvement in bleeding and prolapse scores and higher satisfaction (73% vs 54%) than non-surgical treatment, though only 17% of patients needed surgery
Who was studied
patients with hemorrhoidal disease seeking consultation
What they received
surgical treatment for hemorrhoids
Compared with
medical or instrumental (non-surgical) treatment
Main outcome
bleeding and prolapse scores, patient satisfaction after treatment
Quality
This is a single-center observational study without randomization, so differences between treatment groups could be due to disease severity rather than treatment itself.
Limitations
Single-center, non-randomized, patients not randomly assigned to treatment groups which may bias comparisons.
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), but improvement was more marked in the surgery group with a better rate of "very good satisfaction" (73% vs. 54%, P=0.003).
- result improvement was more marked in the surgery group with a better rate of "very good satisfaction" (73% vs. 54%, P=0.003).
J Visc Surg · PMID 38580520 · Read it on PubMed ↗
Sun et al. 2024
Analysis of factors impacting postoperative pain and quality of life in patients with mixed hemorrhoids: A retrospective study
Pain faded, quality of life improved after surgery.RetrospectiveLow qualityRelated question
164 people28 d
Pain steadily decreased after surgery and was gone in all patients by 28 days; quality-of-life scores were significantly higher at 28 days than at 14 days
Who was studied
patients with mixed hemorrhoids (grade III or IV) who had surgery
What they received
Milligan-Morgan hemorrhoidectomy surgery
Compared with
no separate comparison group; pain and quality of life compared across different days after the same surgery
Main outcome
pain scores and quality-of-life scores after surgery
Quality
This was a retrospective study of one surgery type with no comparison treatment, so it can't show whether another approach would do better or worse.
Limitations
Retrospective design, no control/comparator group, and the abstract focuses on 'mixed hemorrhoids' grade III/IV rather than a precisely defined 'prolapsed hemorrhoid'.
Taken word for word from the abstract
- n A total of 164 patients were enrolled.
- population patients with mixed hemorrhoids who underwent Milligan-Morgan hemorrhoidectomy
- intervention Milligan-Morgan hemorrhoidectomy has been widely used since 1937 for the treatment of grade III and IV hemorrhoids.
- comparator Comparing the World Health Organization Quality of Life - BREF self-reporting questionnaire scores of patients between 14 and 28 d after surgery
- primaryOutcome To assess the factors influencing pain scores and quality of life (QoL) in patients with mixed hemorrhoids post-surgery.
- result Twenty-eight days after the surgery, none of the patients experienced any pain.
- result The mean QoL score 28 d after surgery (4.79 ± 0.46) was higher than that at 14 d post-surgery (3.79 ± 0.57).
World J Gastrointest Surg · PMID 38577073 · 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.RetrospectiveLow qualityRelated question
size not given2024
PPH reduced pain after surgery but caused anal stenosis more often than traditional surgery; rat studies showed more scarring and inflammation with PPH-like tension
Who was studied
people with high-grade hemorrhoids who had surgery
What they received
stapled procedure for prolapse and hemorrhoids (PPH)
Compared with
traditional hemorrhoidectomy surgery
Main outcome
postoperative pain and anal stenosis (narrowing) complications
Quality
this is a small retrospective review combined with animal experiments, with no patient numbers given, so it cannot reliably show how well PPH works in people.
Limitations
abstract does not report number of patients, is retrospective, and relies partly on a rat model rather than human outcomes
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
- 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 ↗
Manaki et al. 2024
Aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy for hemorrhoidal disease: a systematic review and meta-analysis
Moderate recurrence, low complication rate.Meta-analysisLow qualityRelated question
4,249 people2024
About 10% of patients had recurrence and about 5% had complications after ALTA sclerotherapy, with no significant link between recurrence and hemorrhoid grade
Who was studied
patients with hemorrhoidal disease
What they received
ALTA (aluminum potassium sulfate and tannic acid) sclerotherapy injection
Compared with
none (pooled single-arm outcomes across studies)
Main outcome
recurrence of hemorrhoids and complications after treatment
Quality
It pooled data from different studies without a comparison group, so it cannot show how ALTA compares to other treatments.
Limitations
No control group; abstract calls for long-term follow-up and high-quality randomized trials to clarify ALTA's place in treatment
Taken word for word from the abstract
- n Twelve studies with 4249 patients met all the inclusion criteria
- population patients with hemorrhoidal disease
- intervention Aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy
- primaryOutcome Primary endpoints included overall recurrence and type of recurrence
- result The crude and pooled estimates of the overall recurrence and complications by the end of follow-up were 10% (95% CI, 6.52%-14.08%) and 5.20% (95% CI, 2.59%-8.52%), respectively.
- comparator Twelve studies with 4249 patients met all the inclusion criteria and were eventually included.
Acta Chir Belg · PMID 38428446 · Read it on PubMed ↗
Capece et al. 2024
Hemorrhoidectomy: Does Age Make a Difference?
Younger patients chose surgery more often.RetrospectiveLow qualityRelated question
961 people2024
younger patients and those with grade III hemorrhoids were more likely to choose surgery first, but time from diagnosis to surgery did not differ by age or grade
Who was studied
adults aged 18 to 75 with grade II or III internal hemorrhoids
What they received
hemorrhoidectomy (surgical removal), compared with in-office procedures or medical management
Compared with
different age groups (18-30, 31-50, 51-75) and hemorrhoid grade (II vs III)
Main outcome
which treatment patients chose first and how long until hemorrhoidectomy, based on age and hemorrhoid grade
Quality
this is a retrospective study looking only at what treatment people chose, not whether treatments worked, and the authors note personal biases could affect the results.
Limitations
Data only looked at age groups and their treatment selection. Personal biases of surgeon and patient may alter results.
Taken word for word from the abstract
- n A total of 961 patients met inclusion criteria for grade II (n = 442) and III (n = 519) hemorrhoids.
- population Patients aged 18 to 75 years with grade II or grade III internal hemorrhoids between 2015 and 2020 were included.
- intervention Treatments included hemorrhoidectomy, in-office procedures, and/or medical management.
- comparator Baseline demographics, treatment choices, and time to hemorrhoidectomy (if applicable) were stratified and analyzed on the basis of hemorrhoid grade (grade II and III) and age groupings that were predetermined by the authors (18-30, 31-50, and 51-75 years).
- primaryOutcome determine progression to hemorrhoidectomy based on age and the time interval between diagnosis and surgical intervention
- result Patients in the age groups of 18 to 30 and 30 to 50 years were more likely to choose hemorrhoidectomy as the initial treatment management compared to those in the age group of 51 to 75 years (23.5% and 22% vs 12.8%).
- result no significant differences in the length of time to hemorrhoidectomy were noted on the basis of hemorrhoid grade or age
Dis Colon Rectum · PMID 38408874 · Read it on PubMed ↗
Medkova et al. 2024
Efficacy of Micronized Purified Flavonoid Fraction in the Posthemorrhoidectomy Period Trial: Open-Label Randomized Controlled Trial
Fewer complications, but no less painRandomised trialLow qualityRelated question
50 people60 days
lower rate of thrombosis/swelling and better patient-rated treatment effect with flavonoid fraction, but no difference in pain scores
Who was studied
patients who had surgery to remove grade III-IV hemorrhoids
What they received
micronized purified flavonoid fraction added to standard post-surgery care
Compared with
standard post-surgery care alone
Main outcome
thrombosis or swelling of tissue bridges after surgery, and pain scores
Quality
Small, single-center study where both patients and doctors knew who got which treatment, which can bias results.
Limitations
Single-center, open-label design (not blinded)
Taken word for word from the abstract
- n The data from 50 patients were analyzed (25 in each group).
- population Patients who underwent hemorrhoidectomy for grade III and IV hemorrhoids.
- intervention standard treatment with micronized purified flavonoid fraction
- comparator standard treatment (peroral nonsteroid anti-inflammatory drugs and local anesthetics, topical steroids, psyllium, warm sitz baths, and nifedipine gel), referred to as the control group
- primaryOutcome Thrombosis or edema of mucocutaneous bridges and pain intensity on a visual analog scale
- result The visual analog scale demonstrated no differences between groups in each follow-up point. Compared to the control group, the patients in the study group had a significantly higher patient-assessed treatment effect оn postoperative days 1, 3, 7, 21, and 30 and a significantly lower rate of thrombosis or edema of mucocutaneous bridges оn postoperative days 1-7 and 14.
- limitations Unicenter open-label design.
- followUp followed up for 60 days
Dis Colon Rectum · PMID 38380823 · 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
Fewer recurrences, better satisfaction long-term.Randomised trialModerate quality
124 people36 months (interval, 24-47)
fewer patients had recurrent prolapse and better long-term satisfaction with the added ligation procedure, while short-term outcomes were similar between groups
Who was studied
patients with grade III and IV prolapsed 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
randomized trial but from a single center with no mention of blinding of outcome assessors beyond initial allocation, limiting confidence.
Limitations
It was a single-center experience, so longer follow-up was needed.
Taken word for word from the abstract
- population patients with grade III and IV hemorrhoids
- 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)
- n One hundred twenty-four patients were blindly randomly assigned to 2 equal groups
- followUp Following a mean follow-up of 36 months (interval, 24-47)
Dis Colon Rectum · PMID 38380816 · Read it on PubMed ↗
Lembo et al. 2024
Clinical Outcomes Before and After Prucalopride Treatment: An Observational Study in Patients With Chronic Idiopathic Constipation in the United States
Fewer hemorrhoid complications after constipation treatment.RetrospectiveLow qualityRelated question
690 people6 months
hemorrhoids and rectal bleeding were less common after starting prucalopride, along with several other constipation symptoms and complications
Who was studied
adults with chronic idiopathic constipation
What they received
prucalopride treatment
Compared with
same patients' symptoms before treatment vs after treatment
Main outcome
constipation-related symptoms and complications, including hemorrhoids and rectal bleeding
Quality
This was a retrospective claims-data study with no comparison group, just before-and-after comparisons in the same patients, so other changes over time could explain the improvement.
Limitations
Retrospective cohort design using insurance claims data; no untreated control group; relies on diagnosis codes rather than direct clinical assessment.
Taken word for word from the abstract
- n This study included 690 patients
- population adults with chronic idiopathic constipation (CIC)
- intervention prucalopride initiation
- comparator 6 months before and after prucalopride initiation
- primaryOutcome constipation-related symptoms (abdominal pain, abdominal distension [gaseous], incomplete defecation, and nausea) and constipation-related complications (anal fissure and fistula, intestinal obstruction, rectal prolapse, hemorrhoids, perianal venous thrombosis, perianal/perirectal abscess, and rectal bleeding)
- result hemorrhoids [10.7% vs 7.0%, P < 0.05]; and rectal bleeding [4.1% vs 1.7%, P < 0.05]
- followUp 6 months after prucalopride initiation
Clin Transl Gastroenterol · PMID 38357940 · Read it on PubMed ↗
Koley et al. 2024
Efficacy of Individualized Homeopathic Medicines in the Treatment of Hemorrhoids: Double-Blind, Randomized, Placebo-Controlled Trial
Better symptom relief than placeboRandomised trialLow qualityRelated question
140 people3 months
homeopathy group had significantly better symptom and quality-of-life scores than placebo
Who was studied
adults aged 18 to 65 with hemorrhoids grades I to III for at least 3 months
What they received
individualized homeopathic medicines plus standard supportive care
Compared with
placebo pills plus standard supportive care
Main outcome
anorectal symptom severity and quality-of-life questionnaire score
Quality
This was a single small trial of an implausible treatment with short follow-up and the authors themselves say it needs larger confirmatory trials.
Limitations
Single-center trial, short 3-month follow-up, included only grades I-III (not prolapsed grade IV), and authors say findings need confirmation by phase 3 trials.
Taken word for word from the abstract
- population Patients were 140 women and men, aged between 18 and 65 years, with a diagnosis of primary hemorrhoids grades I-III for at least 3 months.
- intervention Group 1 (n = 70; IHMs plus concomitant care; verum)
- comparator Group 2 (n = 70; placebos plus concomitant care; control)
- primaryOutcome Primary-the anorectal symptom severity and quality-of-life (ARSSQoL) questionnaire
- result Statistically significant between-group differences were elicited in the ARSSQoL total (Mann-Whitney U [MWU]: 1227.0, p < 0.001) and EQ-5D-5L VAS (MWU: 1228.0, p = 0.001) favoring homeopathy against placebos.
- n Out of the 140 randomized patients, 122 were protocol compliant. Intention-to-treat sample (n = 140) was analyzed.
J Integr Complement Med · PMID 38301138 · Read it on PubMed ↗
Nakao et al. 2023
Horseshoe Abscess as a Rare Complication After Transanal Hemorrhoid Dearterialization With Mucopexy: A Case Report
Rare abscess complication after hemorrhoid surgery.Case seriesVery low quality
1 people2023
Patient developed a rare horseshoe-shaped abscess around the anus after surgery, requiring drainage and antibiotics, then recovered well
Who was studied
72-year-old man with rectal prolapse and internal hemorrhoids
What they received
Transanal hemorrhoidal dearterialization (THD) surgery to cut off blood supply to hemorrhoids
Compared with
None
Main outcome
Development of complications after surgery
Quality
This is a single patient case report, so it cannot show how common this problem is or whether the surgery works overall.
Limitations
Single case, exact cause of the complication unclear, no established incidence or risk factors
Taken word for word from the abstract
- population A 72-year-old male underwent THD for rectal prolapse with internal hemorrhoids
- intervention Transanal hemorrhoidal dearterialization (THD) is a minimally invasive procedure that has gained popularity as a treatment for symptomatic hemorrhoids. It involves ligating the arterial blood supply to the hemorrhoidal plexus.
- comparator Compared to conventional ligation or resection, THD is associated with less postoperative bleeding and pain
- primaryOutcome presented to the hospital on postoperative day 6 with severe rectal pain
- result A computed tomography (CT) scan revealed a large complex horseshoe perirectal abscess with fluid and air and significant rectal wall thickening.
- result The patient received antibiotics and analgesics and experienced a favorable recovery.
- n A 72-year-old male underwent THD
Cureus · PMID 38283447 · 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
Harmonic scalpel surgery had fewer complications.Randomised trialLow quality
70 people1 year
Stapled hemorrhoidopexy was faster and caused less pain early on, but harmonic scalpel surgery had less bleeding, fewer recurrences at 1 year, and higher patient satisfaction after 2 weeks
Who was studied
adults with grade III and IV prolapsed hemorrhoids (piles)
What they received
stapled hemorrhoidopexy (SH)
Compared with
harmonic scalpel hemorrhoidectomy (HSH)
Main outcome
procedure time, postoperative pain, patient satisfaction, wound infection, bleeding, incontinence, and recurrence within 1 year
Quality
This was a single-center, single-blind randomized trial with only 70 patients and one year of follow-up, so the findings may not generalize widely.
Limitations
Single-center, single-blind design with relatively small sample size and only 1 year of follow-up.
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 The mean time of the procedure was 24.42 min ± 2.367 for SH and 31.48 min ± 2.21 for HSH.
- result Postoperative pain in group I was lower than in group II during the first 2 weeks, but there was persistent mild pain in most patients in group I at the 2‑week follow-up.
- result In group II there was significant improvement in pain after 2 weeks, with higher patient satisfaction.
- 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 The patients were divided into two groups of 35 patients each.
Chirurgie (Heidelb) · PMID 38157069 · Read it on PubMed ↗
Ihle et al. 2024
Transanal open haemorrhoidopexy: a well-tolerated, minimally invasive surgical method for haemorrhoids grade II to IV
Low recurrence, brief postoperative pain.RetrospectiveLow quality
135 people1 year
15% of patients had recurrent prolapsing hemorrhoids at one year, and 17% needed a repeat operation; most had pain for up to two weeks and no serious complications occurred
Who was studied
adults with prolapsed hemorrhoids (grade II to IV)
What they received
transanal open haemorrhoidopexy surgery
Compared with
no control group; retrospective study without comparison
Main outcome
rate of hemorrhoid recurrence one year after surgery
Quality
This was a small, single-center retrospective study with no comparison group and only 65% of patients responding to follow-up, so it can't reliably show whether the surgery works better than alternatives.
Limitations
No control group; only 65% of the original 135 patients consented to participate in the outcome survey; retrospective chart review for early complications.
Taken word for word from the abstract
- population 135 consecutive patients with haemorrhoids Goligher grades II-IV were operated with transanal open haemorrhoidopexy
- intervention transanal open haemorrhoidopexy
- comparator Single-centre retrospective observational study without control group
- primaryOutcome The primary outcome was recurrence rate after 1 year postoperatively
- result The recurrence rate of prolapsing haemorrhoids was 15% (13 patients) 1 year postoperatively
- result 15 patients (17%) needed a second transanal open haemorrhoidopexy for residual haemorrhoidal prolapse
- n 135 consecutive patients with haemorrhoids Goligher grades II-IV were operated with transanal open haemorrhoidopexy
ANZ J Surg · PMID 38115561 · Read it on PubMed ↗
Li et al. 2023
[The occurrence, precaution and treatment strategies of postoperative fecal incontinence in rectal and anal diseases]
Review on preventing bowel control problems after surgery.Narrative reviewVery low qualityRelated question
size not given2023
article summarizes literature on causes and strategies to prevent/treat fecal incontinence after anorectal surgery, without quantitative findings
Who was studied
patients undergoing surgery for hemorrhoids, rectal prolapse, rectal cancer, anal fissures, or anal fistulas
What they received
various prevention and treatment strategies for postoperative fecal incontinence (e.g. biofeedback, pelvic floor exercises, nerve stimulation, surgery)
Main outcome
occurrence and management of postoperative fecal incontinence
Quality
This is a narrative literature summary with no original data, controls, or outcome measurements, so it cannot show whether any treatment works.
Limitations
No original study data, no defined population of prolapsed hemorrhoid patients, and no measured outcomes—purely a literature-based discussion.
Taken word for word from the abstract
- population In the surgical treatment of hemorrhoids, rectal prolapse, rectal cancer, anal fissures, or anal fistulas, inadvertent damage to the nerves or muscles responsible for bowel control may potentially lead to varying degrees of fecal incontinence (FI).
- intervention clinical practitioners can adopt such methods as biofeedback, pelvic floor muscle exercise, sacral nerve stimulation, percutaneous tibial nerve stimulation, acupuncture, injectable bulking agents, anal or vaginal inserts, transanal irrigation, surgical interventions, psychological support, etc., to individualized treatment for patients' conditions.
- primaryOutcome It elaborates on strategies for the prevention and treatment of postoperative FI, aiming to serve as a reference for peers in the field.
- result This article, combining the literature, summarizes the current status of common diseases that may lead to postoperative FI.
Zhonghua Wei Chang Wai Ke Za Zhi · PMID 38110284 · Read it on PubMed ↗
Anorectal Branch of Chinese Medical Doctor Association et al. 2023
[Chinese expert consensus on the treatment of hemorrhoids by injection(2023 edition)]
Expert guideline on injection treatment, no outcome data.GuidelineLow qualityRelated question
size not given2023
expert consensus document giving recommendations on drug types and methods for injection treatment, not a study of outcomes
Who was studied
people with hemorrhoids, usually aged 25-65
What they received
injection therapy for hemorrhoids
Compared with
other hemorrhoid treatments (conservative, ligation, surgery)
Main outcome
effectiveness and safety of injection treatment
Quality
This is an expert consensus statement summarizing recommendations, not a study measuring treatment outcomes in patients.
Limitations
No original patient data, outcomes, or comparative results are reported; it is a consensus guideline based on review of existing evidence.
Taken word for word from the abstract
- population Hemorrhoids is a common anorectal disease, usually occurring in middle-aged people aged 25-65 years old
- intervention Injection therapy with a history of more than 150 years is simple to operate
- comparator The treatment of hemorrhoids includes conservative, injection, ligation, and various surgical procedures.
- primaryOutcome so as to improve the effectiveness and safety of clinical application of hemorrhoidal injection treatment
- result This paper attempts to make detailed recommendations on the types and application methods of the preparations commonly used in the injection treatment of hemorrhoids at home and abroad, and form the Chinese Expert Consensus on the Treatment of hemorrhoids by anal injection (2023 edition)
Zhonghua Wei Chang Wai Ke Za Zhi · PMID 38110270 · Read it on PubMed ↗
He et al. 2023
The comparison of an accessible C-shaped partial stapled hemorrhoidopexy (C-PSH) versus circular stapled hemorrhoidopexy (CSH) in patients with grade IV hemorrhoids: a retrospective cohort study
Less pain, similar recurrence rateRetrospectiveLow quality
222 peoplefive-year
Recurrence rates were similar between groups, but C-PSH had less pain, less fecal urgency, and fewer major complications
Who was studied
adults with grade IV hemorrhoids
What they received
C-shaped partial stapled hemorrhoidopexy (C-PSH)
Compared with
circular stapled hemorrhoidopexy (CSH)
Main outcome
five-year recurrence rate of hemorrhoids
Quality
This was a retrospective, non-randomized comparison, so differences could be due to patient selection rather than the surgery itself.
Limitations
Retrospective design with propensity score matching, not randomized
Taken word for word from the abstract
- population patients with grade IV hemorrhoids
- n After propensity score matching, 222 patients (111 in C-PSH group and 111 in CSH group) were ultimately analyzed.
- intervention accessible C-shaped partial stapled hemorrhoidopexy (C-PSH)
- comparator circular stapled hemorrhoidopexy (CSH)
- primaryOutcome The primary outcome was the five-year recurrence rate of hemorrhoids.
- result fecal urgency incidence and numeric rating scale (NRS) score at first defecation were lower in the C-PSH group (p < 0.05). Major complication rate in the CSH group was higher than that in the C-PSH group (p = 0.03). Five-year recurrence rate between the C-PSH group and CSH group was comparable (p > 0.05).
BMC Gastroenterol · PMID 38104065 · Read it on PubMed ↗
Pata et al. 2023
Sclerobanding in the treatment of second and third degree hemorrhoidal disease in high risk patients on antiplatelet/anticoagulant therapy without suspension: a pilot study
Safe, low-risk treatment in high-risk patientsCase seriesLow qualityRelated question
51 people23 months
no serious complications; 13.7% had mild issues like pain or clot in a hemorrhoid, all resolved with simple treatment; 4% needed another procedure for bleeding; no deaths
Who was studied
adults with grade II or III hemorrhoids not responding to conservative treatment, who were also on blood-thinning or antiplatelet medication
What they received
sclerobanding (combined rubber band ligation with polidocanol foam sclerotherapy), done without stopping blood thinners
Compared with
none - all patients received the same procedure, compared to their own outcomes over time
Main outcome
safety, complications, hospital readmission, death, and need for repeat treatment
Quality
this was a small pilot study with no comparison group, so it shows the treatment seems safe but can't prove it works better than other options
Limitations
small pilot study, no control group, authors say larger multicentre studies and controlled trials are needed to confirm results
Taken word for word from the abstract
- n Fifty-one patients were recruited
- population Patients affected by second-third-degree haemorrhoids unresponsive to conservative treatment and under anticoagulant/antiplatelet were enrolled
- intervention sclerobanding (Combined Rubber Band Ligation with 3% Polidocanol Foam Sclerotherapy)
- intervention without suspension
- comparator Postoperative complications, readmission, mortality and reintervention during the follow-up were evaluated.
- primaryOutcome Postoperative complications, readmission, mortality and reintervention during the follow-up were evaluated.
- result No intraoperative complications were recorded. The rate of complications in the first postoperative month was 13.7%, represented by mild complications: 6 cases of moderate to severe pain and 1 case (2%) of thrombosis of a residual haemorrhoidal nodule, all regressing after conservative therapy. No severe complications were reported.
- result 2 patients (4%) required a new procedure for recurrent bleeding
- result No cases of intraoperative or postoperative mortality occurred.
- followUp The mean follow-up was 23 months.
- limitations Observational multicentre studies with a larger number of patients and controlled clinical trials will be needed to confirm these results.
Front Surg · PMID 38026482 · 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
Faster healing, less pain, fewer complications.RetrospectiveLow quality
size not given2023
combined treatment healed faster, had less pain, higher success rate, and fewer complications than PPH alone
Who was studied
adults aged 18-65 with grade III or IV (severe) hemorrhoids
What they received
combined Doppler-guided hemorrhoidal artery ligation plus procedure for prolapse and hemorrhoids (PPH)
Compared with
standard PPH alone
Main outcome
treatment success rate, pain scores, wound healing, complications
Quality
this was a retrospective study comparing two surgery groups without randomization, so other differences between patients could explain the results.
Limitations
retrospective design; abstract states long-term efficacy requires 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 observation group demonstrated significantly faster postoperative wound healing and shorter hospital stay (P < .01). 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 ↗
Puigdollers et al. 2024
Haemorrhoidal artery distribution in patients with grade III and IV haemorrhoids treated with artery ligation and rectoanal repair. Assessment of Doppler guidance
Artery locations vary; Doppler guidance needed.Case seriesLow qualityRelated question
146 people2024
on average 7 ligatures and 3 mucopexies were needed per patient, with artery locations varying between patients and more needed on the right side of the rectum
Who was studied
adults with grade III and IV prolapsed hemorrhoids undergoing surgery
What they received
Doppler-guided hemorrhoidal artery ligation with rectoanal repair
Compared with
none - single group study
Main outcome
number and clock-position locations of artery ligatures needed to stop the Doppler signal
Quality
this is a single-group case series with no comparison group and it reports anatomical findings rather than symptom outcomes, so it cannot show whether the treatment actually works.
Limitations
no control group, no reported symptom or recurrence outcomes, and no randomization or blinding
Taken word for word from the abstract
- population patients diagnosed with Goligher grade III and IV haemorrhoids, who had undergone Doppler-guided haemorrhoidal artery ligation (DG-HAL) and rectoanal repair (RAR)
- intervention Doppler-guided haemorrhoidal artery ligation (DG-HAL) and rectoanal repair (RAR)
- comparator The study included consecutive patients diagnosed with Goligher grade III and IV haemorrhoids, who had undergone Doppler-guided haemorrhoidal artery ligation (DG-HAL) and rectoanal repair (RAR) at 2 medical centres in Spain.
- primaryOutcome The main objective was to evaluate the number and 12-h clock locations of arterial ligatures necessary to achieve Doppler silence.
- result The average number of ligatures per patient was 7 (range 2-12). Ligature percentages greater than 60% occurred at clock positions 7, 11, 10, 12, 9, and 1. The average number of mucopexies per patient was 3 (range 1-4).
- n In total, 146 patients were included: 111 (76%) men, and 35 (24%) women.
Cir Esp (Engl Ed) · PMID 37949364 · Read it on PubMed ↗
Zhou et al. 2023
Traditional Chinese Medicine in the treatment of hemorrhoids-a review of preparations used and their mechanism of action
Reviews TCM mechanisms, no outcome data.Narrative reviewVery low qualityRelated question
size not given2023
not a trial result; review discusses mechanisms by which TCM may relieve symptoms
Who was studied
people with hemorrhoids
What they received
Traditional Chinese Medicine treatments
Compared with
no specific comparator, review of mechanisms and surgery mentioned generally
Main outcome
symptom relief and mechanism of action in treating hemorrhoids
Quality
This is a narrative review summarizing proposed mechanisms, not a controlled study testing treatment effectiveness.
Limitations
No original data, no controlled comparisons, no quantified outcomes; abstract itself notes few summary literature exist on mechanisms.
Taken word for word from the abstract
- population Hemorrhoids are a proctological disease primarily characterized by bleeding, prolapse, edema, and pain, severely affecting the quality of life.
- intervention Traditional Chinese Medicine (TCM) has a distinctive advantage in alleviating the clinical symptoms of hemorrhoid patients, reducing pain, and improving the quality of life.
- comparator Surgery is an effective treatment for hemorrhoids, but the cost is relatively high, and complications such as difficulty in defecation, persistent pain, and heavy bleeding may occur postoperatively.
- primaryOutcome this paper reviews the recent research on the mechanism of TCM in the treatment of hemorrhoids
- result hoping to provide a basis for the better application of TCM in clinical and experimental research
Front Pharmacol · PMID 37927595 · 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, few complications.RetrospectiveLow quality
size not givenfive years
Cumulative success rates at one, three, and five years were 96.5%, 85.3%, and 85.3%, with low pain scores, few complications, and high patient satisfaction
Who was studied
patients with grade III prolapsed hemorrhoids
What they received
ALTA sclerotherapy combined with rectal mucopexy (AM surgery)
Compared with
none - no comparison group, single-arm study
Main outcome
long-term success rate of the procedure, pain, complications, and satisfaction
Quality
This was a retrospective, single-institution study with no comparison group, so it can't show whether the treatment is better than other options.
Limitations
Retrospective design from a single institution with no control group for comparison.
Taken word for word from the abstract
- population Patients with grade III hemorrhoids who underwent AM surgery were enrolled in this retrospective analysis of prospectively collected data from a single institution.
- intervention ALTA therapy with rectal mucopexy (AM) is a new approach for treating hemorrhoidal prolapse.
- comparator Patients with grade III hemorrhoids who underwent AM surgery were enrolled in this retrospective analysis of prospectively collected data from a single institution.
- primaryOutcome Cumulative success rates, postoperative symptoms, including pain scores, analgesic requirements, and postoperative complications, and patient satisfaction were assessed.
- result Cumulative success rates at one, three, and five years were 96.5%, 85.3%, and 85.3%, respectively.
Tech Coloproctol · PMID 37848640 · Read it on PubMed ↗
Drezdzon et al. 2023
Anorectal Emergencies
General review, no specific findings reported.Narrative reviewVery low qualityRelated question
size not given2023
The abstract describes the article as a review of diagnosis and management approaches but does not report specific treatment outcomes or results
Who was studied
patients with anorectal emergencies
What they received
not reported
Quality
This is a narrative review describing general topics without presenting original data, comparisons, or outcome results.
Limitations
No specific data, methods, outcomes, or results are reported; this is a general overview article covering multiple conditions, not a focused study on prolapsed hemorrhoids.
Taken word for word from the abstract
- population Anorectal emergencies are rare presentations of common anorectal disorders
- intervention workup, diagnosis, and management of common anorectal emergencies including thrombosed hemorrhoids, incarcerated hemorrhoids, anal fissure, anorectal abscess, rectal prolapse, and pilonidal abscess
- result This article provides a review of pertinent anatomy; examination techniques; and workup, diagnosis, and management of common anorectal emergencies
Surg Clin North Am · PMID 37838461 · Read it on PubMed ↗
Durgun et al. 2023
Laser Hemorrhoidoplasty Versus Ligasure Hemorrhoidectomy: A Comparative Analysis
Less pain, but more recurrence.RetrospectiveLow quality
100 people2023
LHP had less pain and faster return to activity but higher recurrence than LigH
Who was studied
patients with grade III hemorrhoids (a type of prolapsed hemorrhoid)
What they received
laser hemorrhoidoplasty (LHP)
Compared with
LigaSure hemorrhoidectomy (LigH)
Main outcome
pain scores, recovery time, and recurrence after surgery
Quality
This was a retrospective (non-randomized) study comparing two surgery types, so differences could be due to patient selection rather than the treatments themselves.
Limitations
Retrospective analysis of patient records rather than a randomized trial.
Taken word for word from the abstract
- population patients who underwent LHP or LigH for grade III hemorrhoidal disease
- n A total of 100 patients were included in the study.
- intervention Laser hemorrhoidoplasty (LHP)
- comparator LigaSure™ (LigH; Medtronic, Dublin, Ireland) hemorrhoidectomy
- primaryOutcome Postoperative pain levels, time to return to work or daily activities, complication rates, and recurrence rates of the treated patients were recorded.
- result The visual analog scale (VAS) scores on postoperative days one and seven were lower in favor of the LHP (2.4 ± 0.7 and 1.2 ± 0.9 vs. 6.2 ± 1.5 and 3.8 ± 1.3, respectively; p< 0.001).
- result Recurrence was observed in 11 (22%) patients in the LHP group and in three (6%) patients in the LigH group (p<0.001).
Cureus · PMID 37692631 · 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
Less pain, fewer complications, less recurrenceRetrospectiveLow quality
115 people12 months
the combined surgery caused less pain, less bleeding, less swelling, less urinary retention, lower recurrence, and higher satisfaction than hemorrhoidectomy alone
Who was studied
adults with grade III/IV (prolapsed) hemorrhoids
What they received
surgery combining Milligan-Morgan hemorrhoidectomy with non-Doppler hemorrhoidal artery ligation
Compared with
Milligan-Morgan hemorrhoidectomy alone
Main outcome
pain, bleeding, swelling, urinary retention, recurrence, and patient satisfaction after surgery
Quality
this was a retrospective, non-randomized comparison from one hospital, so other factors besides the surgery could explain the differences
Limitations
retrospective design, single centre, not randomized
Taken word for word from the abstract
- n We conducted a retrospective analysis of 115 patients with grade III/IV hemorrhoids, 53 patients had received MMH + ND-HAL, and the remaining 62 patients received MMH.
- population 115 patients with grade III/IV hemorrhoids
- intervention 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)
- 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
Different surgeries best for different outcomesMeta-analysisModerate qualityRelated question
3,573 people2023
Different procedures were best for different outcomes: Ligasure had shortest operating time and least blood loss, TST had quickest return of bowel function, STARR had lowest recurrence, PPH had least anal narrowing, and Ferguson had least pain after 24 hours, while other procedures performed worse on these same measures
Who was studied
adults with hemorrhoids undergoing surgery
What they received
different surgical procedures for hemorrhoids (e.g. Ligasure, Milligan-Morgan, Ferguson, Harmonic scalpel, PPH, TST, STARR)
Compared with
the other surgical procedures compared with each other
Main outcome
operating time, blood loss, hospital stay, time to first bowel movement, recurrence, anal narrowing, and pain after surgery
Quality
It pools many randomized trials using network meta-analysis, which is a strong method, but comparing many different surgeries indirectly across trials makes the individual comparisons less certain.
Limitations
The abstract does not specify how many of the hemorrhoid patients had prolapse, so findings may not apply specifically to prolapsed hemorrhoids; indirect network comparisons carry more uncertainty than direct head-to-head trials.
Taken word for word from the abstract
- population patients with hemorrhoids treated by different surgical procedures
- n involved 3573 patients and 10 interventions
- 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 different surgical approaches in patients with hemorrhoids
- primaryOutcome L has the 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
Better cure, less recurrence than PPHRandomised trialModerate quality
306 people12 months
M-TST-CACP had higher cure rate, lower recurrence, lower incontinence scores, and lower anal stenosis rates than PPH
Who was studied
patients with circumferential mixed hemorrhoids
What they received
modified tissue-selecting therapy stapler combined with complete anal canal epithelial preservation operation (M-TST-CACP)
Compared with
procedure for prolapse and hemorrhoids (PPH)
Main outcome
cure rate, recurrence, anal incontinence, and anal stenosis
Quality
it was a randomized trial with a reasonable number of patients, but it was conducted at a single center and only the statistical analyst was blinded.
Limitations
single-center, statistical analyst-blinded only (not patients or surgeons)
Taken word for word from the abstract
- n A total of 306 patients were finally included for analysis.
- population 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)
- 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.
Langenbecks Arch Surg · PMID 37620667 · Read it on PubMed ↗
Bonomo et al. 2023
Hemorrhoidal Artery Ligation for the Treatment of Grade II-III Hemorrhoids: Is it Worth the Use of Doppler Guide in Long-Term Follow-Up?: A Single-Center Cohort Study
Doppler guidance gave no extra benefit.RetrospectiveLow quality
122 people46 months (6-86)
no significant difference in recurrence rate between DG-HAL and HAL, but DG-HAL took longer to perform
Who was studied
patients with grade II-III prolapsed hemorrhoids
What they received
Doppler-guided hemorrhoidal artery ligation (DG-HAL)
Compared with
hemorrhoidal artery ligation without Doppler guidance (HAL)
Main outcome
recurrence of hemorrhoids and patient satisfaction
Quality
This was a retrospective, non-randomized single-center comparison, so differences between groups could be due to other factors, not just the treatment.
Limitations
Retrospective design, single center, not randomized, unequal group sizes.
Taken word for word from the abstract
- population 122 patients affected by grade II-III hemorrhoidal prolapse underwent DG-HAL or HAL at Chivasso Hospital, Italy.
- intervention To compare two groups of patients (treated with DG-HAL or HAL) in terms of recurrence risk and patients' satisfaction grade.
- comparator To compare two groups of patients (treated with DG-HAL or HAL) in terms of recurrence risk and patients' satisfaction grade.
- n 122 patients affected by grade II-III hemorrhoidal prolapse underwent DG-HAL or HAL at Chivasso Hospital, Italy.
- primaryOutcome To compare two groups of patients (treated with DG-HAL or HAL) in terms of recurrence risk and patients' satisfaction grade.
- result we registered 18 (23.7%) recurrences in the DG-HAL group and 13 (28.3%) in the HAL one (P = 0.574)
- result In our study, the use of DG did not reduce recurrence risk. Operative time was significantly increased in the DG-HAL group.
- followUp During a median follow-up of 46 months (6-86)
Ann Surg Open · PMID 37601476 · Read it on PubMed ↗
Fišere et al. 2023
Evaluation of Clinical Manifestations of Hemorrhoidal Disease, Carried Out Surgeries and Prolapsed Anorectal Tissues: Associations with ABO Blood Groups of Patients
Blood type linked to tissue changes, not treatment efficacyCase seriesLow qualityRelated question
size not given2023
blood type O patients had more surgeries performed below the dentate line and different patterns of tissue damage, and males had more vascular rupture than females
Who was studied
adults with hemorrhoidal disease, mostly grade III and IV, undergoing surgery
What they received
surgical treatment of hemorrhoids (mostly the Longo technique)
Compared with
blood type O patients versus patients with other ABO blood types
Main outcome
associations between ABO blood group and hemorrhoid symptoms, surgery type, and tissue changes
Quality
This is a small, non-randomized observational study without a clear control group or reported number of patients, so it cannot show whether any treatment works.
Limitations
No exact sample size given, no comparison of treatment outcomes, and authors say future studies should include earlier-grade patients for a fuller picture.
Taken word for word from the abstract
- population The blood type 0, grade III and IV HD individuals constituted the largest group in a moderately-sized cohort of equally represented males and females studied and submitted to surgical treatment of hemorrhoids.
- intervention The Longo technique appeared mostly used
- comparator there were proportionally more surgeries performed below the dentate line for HD individuals with blood type 0 compared to other blood type patients (24% vs. 11%)
- primaryOutcome This study aimed to evaluate HD clinical manifestations, surgeries carried out, and the status of prolapsed anorectal tissues by exploring the associations with the patients' ABO blood groups.
- result Loosening and weakening of collagenous components of the rectal wall combined with vascular dilation and hemorrhage was found to differ in 0 blood type HD individuals compared to other types.
- result HD males were demonstrated to develop the ruptures of vascular beds significantly more often when compared to HD females (p = 0.0165).
- n a moderately-sized cohort of equally represented males and females
J Clin Med · PMID 37568521 · Read it on PubMed ↗
Wei et al. 2023
Prevention and Treatment of Anastomotic Strictures After Procedure for Prolapse and Hemorrhoids
Describes surgery complication, not effectiveness.Narrative reviewLow quality
size not given2023
Review describes causes, surgical warnings, and treatments for anastomotic stenosis, a common complication of PPH surgery, without reporting quantitative outcome data
Who was studied
patients with severe prolapsed hemorrhoids or rectal mucosal prolapse
What they received
stapled surgery to remove and reposition prolapsed hemorrhoid tissue (PPH)
Main outcome
narrowing of the surgical join (anastomotic stricture/stenosis) after PPH surgery
Quality
This is a narrative review summarizing clinical experience and prior literature rather than new controlled data, so it cannot show whether the treatment works.
Limitations
Abstract does not report study design details, sample size, or outcome data; it is a review based on 'experience of clinical applications' rather than a systematic analysis.
Taken word for word from the abstract
- population patients with severe prolapsed annular hemorrhoids or rectal mucosal prolapse
- intervention Procedure for Prolapse and Hemorrhoids (PPH), also known as circular stapled hemorrhoidectomy
- primaryOutcome Anastomotic stenosis is one of the most common complications of PPH
- result we analyzed the causes, intraoperative warnings, and postoperative therapy of anastomotic stenosis induced by PPH, with an eye toward scientific application in the anorectal field, based on the experience of clinical applications
Risk Manag Healthc Policy · PMID 37525828 · 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
Less bleeding after embolization treatment.RegistryLow qualityRelated question
80 people12 months
68.7% of patients had no rectal bleeding after 12 months, while 31.3% had bleeding come back, and no major complications were seen
Who was studied
adults with bleeding hemorrhoids graded mild to moderate (Goligher grade I-III)
What they received
catheter-directed hemorrhoidal embolization using microcoils (with microspheres if bleeding recurred)
Compared with
no comparison group; outcomes measured before and after treatment in the same patients
Main outcome
whether rectal bleeding stopped at 12 months
Quality
This was a single-arm registry with no comparison group, so improvement could be due to other factors rather than the procedure itself.
Limitations
No control group for comparison; some patients needed a second embolization or surgery; only minor complications were tracked in detail.
Taken word for word from the abstract
- n Eighty patients (62.5% males) with a mean age of 48 ± 9 years were recruited prospectively.
- population All patients had symptomatic bleeding hemorrhoids. All patients were classified according to Goligher classification: grade I (13.7%), grade II (71.1%), grade III (15%), and no grade IV were recruited in this study.
- intervention microcoils were used to embolize the superior rectal artery(SRA), and microspheres if recurrence of bleeding occurred
- primaryOutcome Fifty-five (68.7%) participants had the absence of rectal bleeding after 12 months of embolization.
- result Fifty-five (68.7%) participants had the absence of rectal bleeding after 12 months of embolization. VAS and QL improved 4 points and 1.5 respectively after embolization. A total of 25/80 (31.3%) had a recurrence in rectal bleeding.
- comparator Subjective post-treatment symptom and QL surveys showed significant differences from the baseline survey.
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 surgery recovery.Randomised trialModerate qualityRelated question
150 people1 year
no meaningful difference in pain, complications, or infection markers between antibiotic and no-antibiotic groups
Who was studied
patients with grade III to IV prolapsed hemorrhoids undergoing surgery
What they received
IV antibiotics given before or before and after hemorrhoid surgery
Compared with
no antibiotics given around hemorrhoid surgery
Main outcome
pain scores, healing complications, and infection markers after surgery
Quality
it was a randomized trial but relatively small and compared antibiotic use rather than hemorrhoid treatment itself.
Limitations
study focuses on antibiotic prophylaxis for surgery, not on comparing treatment methods for prolapsed hemorrhoids themselves
Taken word for word from the abstract
- n A total of 150 consecutive patients undergoing Milligan Morgan hemorrhoidectomy (MMH) in a tertiary hospital for grade III/IV hemorrhoids
- population Grade III to IV Prolapsing Hemorrhoids
- 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
- result Our results suggest that there is no efficacy on intravenous prophylactic antibiotics in Milligan Morgan hemorrhoidectomy.
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
Predicts recurrence risk after hemorrhoid surgery.RetrospectiveLow qualityRelated question
415 people2023
The model predicted recurrence with moderate-to-good accuracy (AUC 0.813 in training, 0.679 in validation; AUC 0.839 and 0.746 for 5-year recurrence)
Who was studied
Patients who had stapler surgery (PPH) for hemorrhoids between 2014 and 2017
What they received
Building a prediction model using patient factors (like BMI, anal pressure, hemorrhoid grade) to forecast recurrence after PPH surgery
Compared with
No treatment comparator; patients were split into a training group and a validation group to test the model
Main outcome
Risk of hemorrhoids coming back after PPH surgery
Quality
It's a retrospective single-center study building a prediction tool, not testing a treatment, and its accuracy dropped notably when checked in a separate group of patients.
Limitations
Retrospective data collection from a single hospital, and the model performed worse in the validation group than the training group
Taken word for word from the abstract
- n Finally, 415 patients were included, which were divided into training group (n = 290) and verification group (n = 125).
- population patients who underwent stapler hemorrhoidal mucosal circumcision in Shanxi Bethune Hospital from April 2014 to June 2017
- intervention 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.
- comparator which were divided into training group (n = 290) and verification group (n = 125)
- primaryOutcome 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.
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 pain, similar recurrence rates.Prospective cohortModerate quality
197 peopleMedian follow-up was 3.1 (1.0-5.5) years
recurrence rates were similar between the two procedures, but THD caused less pain and higher early satisfaction
Who was studied
adults with prolapsed internal hemorrhoids involving at least 3 columns
What they received
transanal hemorrhoidal dearterialization (THD) with mucopexy
Compared with
Ferguson hemorrhoidectomy
Main outcome
rate of hemorrhoids coming back (recurrence)
Quality
it's a fairly large multicenter study with long follow-up, but surgeons chose which operation to perform rather than patients being randomly assigned, so the groups may not be fully comparable.
Limitations
not randomized — each surgeon performed only the operation they were most experienced in, which could bias results
Taken word for word from the abstract
- n Twenty surgeons enrolled 197 patients.
- population Patients with prolapsed internal hemorrhoids in at least 3 columns were eligible.
- intervention transanal hemorrhoidal dearterialization (THD) with mucopexy
- comparator Ferguson hemorrhoidectomy
- primaryOutcome The primary endpoint was recurrence rates defined as prolapsing internal hemorrhoids.
- result Recurrence rates did not differ between the study arms (5.9% vs 2.4%, P =0.253).
- result THD patients had lower Visual pain scores at postoperative day (POD) 1 (6.2 vs 8.3, P =0.047)
- followUp Median follow-up was 3.1 (1.0-5.5) years.
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 anal strictures after surgery.Randomised trialLow quality
400 people1-3 years
no rectal stenosis in the group getting both thread-drawing and anal enlargement, versus 11%, 7%, and 14% stenosis in the other three groups
Who was studied
adults with severe mixed hemorrhoids needing surgery
What they received
thread-drawing during surgery plus anal enlargement after PPH (procedure for prolapse and hemorrhoids)
Compared with
PPH alone, or PPH with only thread-drawing, or PPH with only anal enlargement
Main outcome
rate of rectal narrowing (stenosis) after surgery
Quality
it was randomized but the abstract gives no detail on randomization method, blinding, or how patients were allocated, and it appears to be a single-center trial.
Limitations
no information given on randomization process, blinding, or loss to follow-up
Taken word for word from the abstract
- population 400 patients with severe mixed hemorrhoids hospitalized in the [anonymous hospital] from January 2018 to February 2022
- intervention Thread-drawing during operation and anal enlargement after PPH
- comparator Group A: Thread-drawing during PPH surgery, group B: Anal enlargement after PPH, and group C: PPH alone
- primaryOutcome to investigate preventive measures of rectal stricture after procedure for prolapse and hemorrhoids (PPH)
- 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
- followUp followed up for 1-3 years
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 relief, more pain with combined methodRandomised trialModerate qualityRelated question
70 people12 months
no significant difference in success rate between the two methods, but the combined method caused more pain afterward
Who was studied
patients with symptomatic grade I to III hemorrhoids
What they received
endoscopic rubber band ligation of hemorrhoids alone
Compared with
combined ligation of hemorrhoids and nearby normal tissue
Main outcome
overall treatment success rate (complete or partial symptom resolution)
Quality
it was a randomized trial but small, open-label (not blinded), and some patients were lost to follow-up.
Limitations
open-label design, moderate sample size, and some patients did not complete the 12-month follow-up
Taken word for word from the abstract
- population Seventy patients with symptomatic grade I to III hemorrhoids were randomly assigned
- 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).
- n Seventy patients with symptomatic grade I to III hemorrhoids were randomly assigned to the hemorrhoid and combined ligation groups (35 in each group).
- followUp Patients were followed up at 3, 6, and 12 months
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 success, but more pain with banding.Meta-analysisLow quality
size not given2023
no difference in efficacy, prolapse, or recurrence, but rubber band ligation caused more pain and less bleeding than coagulation
Who was studied
people with hemorrhoids
What they received
rubber band ligation
Compared with
coagulation treatment
Main outcome
treatment success, prolapse recurrence, bleeding, pain, and urine retention after treatment
Quality
Only nine trials of moderate quality were pooled, so the comparison carries limited certainty.
Limitations
All trials were of moderate methodological quality.
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
- 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
No specific findings reported.Narrative reviewVery low qualityRelated question
size not given2023
review summarizes developments but does not report a specific outcome result
Who was studied
people with hemorrhoid disease
What they received
various treatments and new drug molecules for hemorrhoids
Main outcome
safety and effectiveness of hemorrhoid treatments
Quality
This is a general narrative review without original data, trial numbers, or outcome statistics.
Limitations
No original study data, no patient numbers, no specific results reported; broad literature summary only.
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.
- intervention To highlight the recent developments in terms of safety, clinical efficacy, and marketed formulation for the effective management of hemorrhoids.
- primaryOutcome To highlight the recent developments in terms of safety, clinical efficacy, and marketed formulation for the effective management of hemorrhoids.
- result This review article mainly focuses on the newer molecules to overcome hemorrhoids and also emphasizes various studies carried out in the past.
Infect Disord Drug Targets · PMID 37106517 · Read it on PubMed ↗
Long et al. 2023
Analgesic effect of subcutaneous injection of different concentrations of methylene blue after hemorrhoidectomy: A retrospective study
Less pain, but higher dose less safeRetrospectiveLow qualityRelated question
180 people14 days for pain, 1 and 3 months for incontinence scores
both methylene blue concentrations reduced pain and pain medicine use compared with no injection, with no difference between the two concentrations, but the higher concentration caused more temporary incontinence symptoms at one month
Who was studied
patients with grade III or IV hemorrhoids having hemorrhoid removal surgery
What they received
injection of methylene blue (0.1% or 0.2%) under the skin after hemorrhoid surgery
Compared with
no methylene blue injection after hemorrhoid surgery
Main outcome
pain scores and amount of pain medicine needed over 14 days after surgery
Quality
this was a retrospective study with patients sorted into non-randomized groups, which makes it easier for other differences to explain the results.
Limitations
retrospective design, not randomized, groups assigned by surgeon choice rather than random allocation
Taken word for word from the abstract
- population A total of 180 consecutive patients with grade III or IV hemorrhoids from March 2020 to December 2021 were reviewed.
- intervention Group A received subcutaneous injection of 0.1% methylene blue after hemorrhoidectomy, group B received subcutaneous injection of 0.2% methylene blue
- comparator Group C did not received subcutaneous injection of methylene blue.
- primaryOutcome The primary outcome measures were the visual analog scale (VAS) pain score on postoperative days 1, 2, 3, 7, 14, and total analgesic consumption within 14 days.
- result The VAS pain score and total analgesics consumption within 14 days in group A and group B were significantly lower than those in group C, but the differences between group A and group B were not statistically significant.
- result The Wexner scores of group B were significantly higher than those of group A and group C one month after the operation
- n A total of 180 consecutive patients with grade III or IV hemorrhoids from March 2020 to December 2021 were reviewed.
Front Surg · PMID 37077863 · Read it on PubMed ↗
Kumar et al. 2023
A Prospective Study Comparing Stapler and Open Surgical Technique of Hemorrhoidectomy
Stapler surgery: less pain, faster recovery.Prospective cohortLow quality
60 peoplethree months
stapler hemorrhoidectomy had shorter operating time and hospital stay, less postoperative pain, and no recurrence at three months compared to open hemorrhoidectomy which had 10% recurrence
Who was studied
patients with grade III and IV hemorrhoids
What they received
stapled hemorrhoidectomy surgery
Compared with
open hemorrhoidectomy surgery
Main outcome
postoperative pain, operating time, hospital stay, complications, and recurrence
Quality
This was a small non-randomized prospective study of only 60 patients from a single center, so the results may not be reliable for all patients.
Limitations
Not described as randomized; small sample size of 60 patients from a single institution.
Taken word for word from the abstract
- population The present prospective study was conducted among 60 patients in the General Surgery department at Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar over the duration of two years presenting with grade III and IV degree hemorrhoids.
- intervention stapled hemorrhoidectomy
- comparator open hemorrhoidectomy
- primaryOutcome The study was done to assess postoperative pain, time duration of the procedure, complications in the postoperative period, return to normal work, and recurrence between the stapler and open hemorrhoidectomy for grade III and IV hemorrhoids.
- result The operating time and hospital stay were much less in the stapler hemorrhoidectomy group as compared to the open procedure group.
- result There was recurrence seen in 10% of cases at three months in the open hemorrhoidectomy group as compared to the stapler hemorrhoidectomy group where no recurrence was found at three months follow-up.
- n The present prospective study was conducted among 60 patients
Cureus · PMID 37077600 · 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
Less post-surgery pain with acupuncture.Randomised trialLow qualityRelated question
124 people72 h
lower pain and swelling scores, fewer painkillers needed, and less urinary retention with electroacupuncture
Who was studied
patients with mixed hemorrhoids having PPH surgery (stapled hemorrhoidopexy)
What they received
electroacupuncture at the Baliao point added to PPH surgery
Compared with
PPH surgery alone
Main outcome
pain and anal swelling after surgery
Quality
it is a randomized trial but only looks at short-term pain-related outcomes after one surgical technique, with no mention of blinding.
Limitations
abstract does not mention blinding, and outcomes are limited to short-term pain, swelling, and urinary symptoms rather than hemorrhoid cure or recurrence
Taken word for word from the abstract
- population patients with mixed hemorrhoids
- 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.
- n A total of 124 eligible patients undergoing PPH surgery were included in this study and randomly divided into a control group (n = 67) and an EA group (n = 57)
- followUp at 8, 24, 48, and 72 h after operation
Int J Colorectal Dis · PMID 37074488 · Read it on PubMed ↗
Turco et al. 2023
Extensive subcutaneous emphysema and intra-abdominal sepsis following haemorrhoid operation: a rare complication of a novel procedure
Serious bowel injury after this procedure.Case seriesVery low quality
1 people2023
developed rectal perforation, severe infection and sepsis requiring emergency surgery and colostomy
Who was studied
71-year-old woman with grade III/IV haemorrhoids
What they received
Doppler-guided haemorrhoid artery ligation and recto anal repair (HAL-RAR) surgery
Quality
single patient case report, so it cannot show how often this happens or how the treatment generally performs
Limitations
only one patient described, no comparison group, cannot estimate how common this complication is
Taken word for word from the abstract
- population A 71-year-old female presented with sepsis, abdominal distension and extensive subcutaneous emphysema
- intervention Doppler-guided haemorrhoidal artery ligation and recto anal repair (HAL-RAR) procedure is a relatively new, minimally invasive procedure for the treatment of Grades III and IV haemorrhoids.
- result found to have intra- and extraperitoneal rectal perforation requiring repair, laparoscopy and sigmoid colostomy
- n A 71-year-old female presented with sepsis
J Surg Case Rep · PMID 37064065 · Read it on PubMed ↗
Xiong et al. 2023
Comparison of the long-term efficacy and safety of multiple endoscopic rubber band ligations in a single session for varying grades of internal hemorrhoids
More bands helped shrink worse hemorrhoids.Prospective cohortLow quality
120 people14.3 ± 7.9 (1.3-30.9) months
78.8% had no symptoms at 6 weeks; grade II did better than grade III (87.8% vs 69.2%); recurrence was lower with more bands for grade III hemorrhoids
Who was studied
patients with internal hemorrhoids (grades I-III)
What they received
endoscopic rubber band ligation with multiple bands per session
Compared with
fewer bands vs more bands, and grade II vs grade III hemorrhoids
Main outcome
no hemorrhoid symptoms 6 weeks after treatment
Quality
This was not a randomized trial, so differences between band numbers or grades could be due to other factors, not just the treatment itself.
Limitations
No control group or randomization described; recurrence varied by severity grade and band number without controlling for other factors.
Taken word for word from the abstract
- n One hundred twenty-three eligible patients met the inclusion criteria, and 3 patients were excluded.
- population Patients with IH were treated with ERBL.
- intervention Patients with IH were treated with ERBL.
- intervention The average bands were 3.9 ± 1.1, and grade II hemorrhoids required significantly fewer bands than grade III hemorrhoids (3.45 ± 0.85 vs 4.35 ± 1.06, P = 0.000).
- comparator grade II hemorrhoids required significantly fewer bands than grade III hemorrhoids (3.45 ± 0.85 vs 4.35 ± 1.06, P = 0.000)
- primaryOutcome The primary endpoint was no hemorrhoid symptoms 6 weeks after ERBL.
- result 78.8% of patients achieved the primary endpoint. The efficacy of grade II hemorrhoids was higher than that of grade III hemorrhoids (87.8% vs 69.2%).
- result For grade III hemorrhoids, the recurrence rate was lower with more than 4 bands of ligation than with less than 4 bands (26.5% vs 53.3%).
- followUp The median follow-up time was 14.3 ± 7.9 (1.3-30.9) months.
Ir J Med Sci · PMID 37059872 · Read it on PubMed ↗
Zhou et al. 2023
Multiple thread ligations versus stapled hemorrhoidopexy on operative outcomes of grade III hemorrhoids: A retrospective cohort study
Similar recurrence; faster surgery, less bleeding with MTL.RetrospectiveLow quality
230 people6 months
similar recurrence rates between the two surgeries, but MTL was faster and had less bleeding risk
Who was studied
patients with grade III hemorrhoids (prolapsed hemorrhoids)
What they received
multiple thread ligations (MTL) surgery
Compared with
stapled hemorrhoidopexy (SH) surgery
Main outcome
prolapse coming back within 6 months
Quality
this was a retrospective, non-randomized comparison of two surgeries, so differences could be due to other factors rather than the treatment itself.
Limitations
retrospective cohort design with propensity score matching rather than randomization; only univariate analysis used for the bleeding difference
Taken word for word from the abstract
- n A total of 115 patients in MTL group and 115 patients in SH group were finally included by propensity score matching with a ratio of 1:1.
- population grade III hemorrhoids
- intervention multiple thread ligations (MTL)
- comparator stapled hemorrhoidopexy (SH)
- primaryOutcome The primary outcome was the recurrence of prolapse within 6 months.
- result Multiple thread ligations and SH resulted in comparable recurrence within 6 months of follow-up, with five and seven cases of recurrence, respectively, (P = 0.352).
- result Univariate analysis showed that the MTL technique had a lower risk of postoperative bleeding than that with the SH technique (P < 0.05).
- followUp recurrence of prolapse within 6 months
Front Med (Lausanne) · PMID 37056735 · Read it on PubMed ↗
Gambardella et al. 2023
Mid-term efficacy and postoperative wound management of laser hemorrhoidoplasty (LHP) vs conventional excisional hemorrhoidectomy in grade III hemorrhoidal disease: the twisting trend
Less pain, but higher recurrence.RetrospectiveLow quality
174 people25 ± 8 months
LHP caused less pain and easier wound care but had a higher rate of symptom recurrence (21.6% vs 8.1%) compared to MM
Who was studied
Patients with grade III symptomatic hemorrhoid disease
What they received
Laser hemorrhoidoplasty (LHP) using a 1470-nm diode laser
Compared with
Conventional Milligan-Morgan excisional hemorrhoidectomy (MM)
Main outcome
Postoperative pain, wound care, and recurrence of hemorrhoid symptoms
Quality
This was a retrospective, non-randomized comparison, which makes it easier for bias to affect the results.
Limitations
Retrospective design without randomization; authors call for larger comparative studies
Taken word for word from the abstract
- population grade III symptomatic HD patients
- intervention laser hemorrhoidoplasty treatment using a 1470-nm diode laser
- comparator conventional Milligan Morgan as control group
- primaryOutcome Postoperative pain, wound care management, symptoms' resolution, patients' quality of life, and length of return to daily activity
- result Laser hemorrhoidoplasty patients experienced lower postoperative pain score (p < 0.0001) and smoother wound management.
- result the recurrence of symptoms occurred in 8.1% after Milligan-Morgan and 21.6% after laser hemorrhoidoplasty (p < 0.05)
- n 93 patients received conventional Milligan Morgan as control group and 81 patients received laser hemorrhoidoplasty treatment
- followUp After 25 ± 8 months follow-up
Langenbecks Arch Surg · PMID 37020091 · Read it on PubMed ↗
Laurain et al. 2023
French multicentre prospective evaluation of radiofrequency ablation in the management of haemorrhoidal disease
Less prolapse, bleeding, better quality of lifeCase seriesLow qualityRelated question
129 people1 year's follow-up
quality-of-life score dropped sharply and symptoms such as bleeding and prolapse were much less common at 3 months
Who was studied
adults with grade II-III hemorrhoids (prolapsing and bleeding types)
What they received
radiofrequency ablation (Rafaelo device) of hemorrhoids
Compared with
none; outcomes compared to patients' own baseline before treatment
Main outcome
quality-of-life score specific to hemorrhoid disease (HEMO-FISS-QoL) at 3 months
Quality
This was a single-group study without a comparison group, so it can't rule out that patients would have improved anyway.
Limitations
No control group; some patients needed repeat surgery or had complications; follow-up for symptom comparisons mainly limited to 3 months despite 1-year study aim.
Taken word for word from the abstract
- population outpatients with grade II-III haemorrhoids
- intervention RFA (Rafaelo©)
- comparator Median HEMO-FISS-QoL score dropped significantly from 17.4/100 to 0/100 (p < 0.0001) at 3 months.
- primaryOutcome Primary endpoint was the evolution of a quality-of-life score adapted to the haemorrhoid pathology (HEMO-FISS-QoL) 3 months after surgery.
- result the rate of patients reporting bleeding (21% vs. 84%, p < 0.001), prolapse (34% vs. 91.3%, p < 0.001) and anal discomfort (0/10 vs. 5/10, p < 0.0001) decreased significantly
- n A total of 129 patients (69% men, median age 49 years) were operated on in 16 French centres.
- followUp with 1 year's follow-up
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
Complication usually resolved without major surgery.Case seriesLow qualityRelated question
14 people2023
most hematomas resolved with conservative care and self-drainage; the few progressive ones were treated with embolization, and no patient needed major surgery
Who was studied
patients who developed perirectal hematoma after stapled surgery for hemorrhoidal prolapse or obstructed defecation
What they received
conservative treatment (antibiotics, monitoring) or angiographic embolization for the hematoma
Compared with
no comparator; described treatment algorithm for different severity hematomas
Main outcome
whether the hematoma resolved without needing major abdominal surgery
Quality
this is a small, retrospective case series of a rare complication, not a controlled comparison of treatments for prolapse itself.
Limitations
retrospective design, very small number of cases (14 out of 3058), no control group, and it studies a surgical complication rather than hemorrhoid prolapse treatment directly.
Taken word for word from the abstract
- n 3058 patients underwent stapling procedures for hemorrhoidal disease or obstructed defecation syndrome with internal prolapse
- n 14 (0.46%) large PH cases were reported
- population Perirectal hematoma (PH) is one of the most feared complications of stapling procedures
- intervention 12 of these hematomas were stable and treated conservatively (antibiotics and CT/laboratory test monitoring)
- intervention 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
- comparator The aim of this study was to analyze a homogenous case series of PH and to define a treatment algorithm for huge postoperative PHs
- primaryOutcome This approach helped ensure that no patients with PH were referred for major abdominal surgery
- result Most PH cases are stable and treatable with a conservative approach, evolving with self-drainage. Progressive hematomas are rare and should undergo angiography with embolization to minimize the possibility of major surgery and severe complications.
Updates Surg · PMID 36899291 · Read it on PubMed ↗
Ram et al. 2023
Laser hemorrhoidoplasty for II-IV grade hemorrhoids: should we treat them the same?
Effective but riskier for grade IV.RetrospectiveLow quality
162 people2023
most patients had symptom relief, but grade IV hemorrhoids had much higher rates of bleeding, readmission, and reoperation
Who was studied
patients with grade II to IV hemorrhoids
What they received
laser hemorrhoidoplasty surgery
Compared with
comparison between hemorrhoid grades (II, III, IV) rather than a separate control treatment
Main outcome
symptom relief and post-operative complications after surgery
Quality
this was a retrospective analysis without a comparison group receiving different treatment, so it cannot prove the surgery caused the outcomes.
Limitations
Retrospective analysis of a prospective database; no control group treated with another method.
Taken word for word from the abstract
- n One hundred and sixty two patients that underwent laser hemorrhoidoplasty (LHP) were included.
- population patients undergoing LHP surgery based on hemorrhoid grade
- intervention Laser Hemorrhoidoplasty (LHP) is a novel therapeutic option for hemorrhoids.
- comparator Post-operative complication rate was significantly higher in patients with grade 4 hemorrhoids compared to grades 3 or 2
- primaryOutcome Complete remission of symptoms following surgery was reported by 134 patients (82.7%), while 21 patients (13%) reported partial symptomatic relief.
- result LHP is an effective treatment for hemorrhoids grades II-IV, but carries significant risk for bleeding and re-intervention in patients with grade IV hemorrhoids.
Updates Surg · PMID 36881287 · Read it on PubMed ↗
Yu et al. 2023
Modified ultrasound scalpel haemorrhoidectomy versus conventional haemorrhoidectomy for mixed haemorrhoids: a study protocol for a single-blind randomised controlled trial
No results yet reported.Registered trial, no results postedVery low qualityRelated question
78 people6 months
Study protocol only; no outcome results reported yet
Who was studied
adults with mixed hemorrhoids requiring surgery
What they received
modified ultrasonic scalpel hemorrhoidectomy
Compared with
Milligan-Morgan (conventional) hemorrhoidectomy
Main outcome
healing time, return to normal activity, complications, anal function, quality of life, and patient satisfaction
Quality
This is a trial protocol describing planned methods, so no outcome data are yet available to judge effectiveness.
Limitations
Only patients will be blinded (not researchers), and the planned sample size is small.
Taken word for word from the abstract
- n with 39 patients in each group
- population treatment of mixed haemorrhoids
- intervention The experimental group will be treated with modified ultrasonic scalpel haemorrhoidectomy
- comparator the control group will be treated with the Milligan-Morgan operation
- primaryOutcome including the incision healing time and the time for patients to return to normal activities, postoperative complications, evaluations of anal function 3 months and 6 months after surgery, an evaluation of quality of life 6 months after surgery, and an evaluation of the patient satisfaction rate 6 months after surgery
- result The purpose of this trial will be to evaluate the clinical efficacy and safety of the modified ultrasonic scalpel haemorrhoidectomy procedure
- followUp an evaluation of quality of life 6 months after surgery
Trials · PMID 36829253 · Read it on PubMed ↗
Al-Sawat et al. 2023
The Effect of High Altitude on Short-Term Outcomes of Post-hemorrhoidectomy
Altitude affected recovery, not treatment choice.RetrospectiveLow qualityRelated question
135 peopleDay 7
low-altitude patients returned to normal activity sooner and had less pain on day 7, while high-altitude patients had more urinary retention
Who was studied
patients who had hemorrhoid removal surgery in Saudi Arabia, living at either high or low altitude
What they received
living in a high-altitude region (Taif) after hemorrhoidectomy
Compared with
living in a sea-level/low-altitude region (Jeddah) after hemorrhoidectomy
Main outcome
recovery time, pain, and complications after hemorrhoid surgery
Quality
this is a retrospective study comparing locations, not treatments, so it cannot directly show how to treat a prolapsed hemorrhoid.
Limitations
retrospective design using patient files, comparing geographic regions rather than treatment methods
Taken word for word from the abstract
- n A total of 135 patients were included in this study.
- population This retrospective study was conducted among patients who underwent hemorrhoidectomy between January 2019 and January 2022 in Taif and Jeddah, Saudi Arabia.
- intervention high-altitude region (Taif)
- comparator sea-level (low-altitude level) region (Jeddah)
- primaryOutcome This study aims to compare postoperative complications of hemorrhoidectomy among patients who live in a high-altitude region (Taif) and a sea-level (low-altitude level) region (Jeddah).
- result The majority of low-altitude area patients require less than a week to return to normal activities (54.1%), whereas the majority of high-altitude area patients (59%) require more than a week (P = 0.047).
- result we found that urinary retention was most common in the high-altitude regions (37.7%).
Cureus · PMID 36819323 · 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 2026-10-13
The exact search — paste this into PubMed to repeat it: ("Hemorrhoids"[Mesh] OR hemorrhoid*[tiab] OR haemorrhoid*[tiab]) AND (prolaps*[tiab] OR "Rectal Prolapse"[Mesh] OR "grade III"[tiab] OR "grade IV"[tiab]) AND (treatment[tiab] OR therapy[tiab] OR management[tiab] OR "Hemorrhoidectomy"[Mesh] OR hemorrhoidectomy[tiab] OR ligation[tiab] OR "rubber band"[tiab] OR stapled[tiab] OR reduction[tiab]); PubMed expanded that to: ("Hemorrhoids"[MeSH Terms] OR "hemorrhoid*"[Title/Abstract] OR "haemorrhoid*"[Title/Abstract]) AND ("prolaps*"[Title/Abstract] OR "Rectal Prolapse"[MeSH Terms] OR "grade III"[Title/Abstract] OR "grade IV"[Title/Abstract]) AND ("treatment"[Title/Abstract] OR "therapy"[Title/Abstract] OR "management"[Title/Abstract] OR "Hemorrhoidectomy"[MeSH Terms] OR "Hemorrhoidectomy"[Title/Abstract] OR "ligation"[Title/Abstract] OR "rubber band"[Title/Abstract] OR "stapled"[Title/Abstract] OR "reduction"[Title/Abstract])
What came back: 1242 records found · 196 read · 177 answered the question
Included: Human, animal or laboratory studies reporting an outcome relevant to the question
Excluded: Records about a different condition or intervention
Records reporting no outcome
Retracted publications, which are listed but excluded from every count
Limits: Details were read from abstracts, not full papers, so anything reported only in a paper's methods section is not captured here.
Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured.
Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.

1242records came back from the search
196were read
177actually answered the question

Why people try thisThe reasoning behind the question — not a claim that it works.

A visible, painful lump makes people want an immediate fix.
Fear of surgery and its recovery time pushes people toward banding, creams, or laser treatments first.
Marketing of 'minimally invasive' or laser procedures makes them sound like an easy cure.
Embarrassment about the problem leads people to try home remedies before seeing a doctor.

Common questionsShort answers, drawn from the same studies.

What is a prolapsed hemorrhoid?: It's an internal hemorrhoid — a cushion of blood vessels inside the anal canal — that has slipped down and bulges out through the anus. Doctors grade it by how it behaves: grade III needs to be pushed back in by hand, and grade IV stays out all the time and can't be pushed back in.
How do you get rid of prolapsed hemorrhoids?: Studied options include rubber band ligation, injection treatments, laser or radiofrequency procedures, stapled hemorrhoidopexy, and excisional hemorrhoidectomy (surgical removal). In the trials reviewed here, excisional surgery gave the lowest chance of the prolapse returning, while banding and newer minimally invasive techniques caused less pain but recurred more often.
Prolapsed hemorrhoids vs external hemorrhoids — what's the difference?: A prolapsed hemorrhoid starts inside the anal canal and pushes out through the anus; an external hemorrhoid forms under the skin right at the anal opening and doesn't come from inside. The studies summarized here focus on internal hemorrhoids that have prolapsed (grade III-IV), not on external hemorrhoids alone.
Should I avoid stapled hemorrhoid surgery (stapled hemorrhoidopexy)?: Not necessarily, but go in informed: a large pooled analysis of randomized trials found stapled hemorrhoidopexy comes back more often long-term than standard excisional surgery, and rare serious complications have been reported. Ask your surgeon how recurrence and complication rates compare for the specific technique they're offering you.
Can I push a prolapsed hemorrhoid back in myself?: A single case report describes a prolapsed hemorrhoid being pushed back manually, but this isn't a studied, reliable treatment for grade III-IV disease and doesn't prevent it from prolapsing again. See a doctor for an evaluation rather than relying on manual reduction alone.
Since stapled surgery can raise the risk of prolapse coming back, what should I do instead?: A large analysis of 17 trials (2,072 patients) found that stapled hemorrhoidopexy had a higher rate of long-term recurrence than conventional excisional hemorrhoidectomy, especially prolapse coming back again, with no difference in reoperation, pain, or quality of life between the two. If avoiding recurrence is your priority, conventional excisional hemorrhoidectomy is the better-supported surgical option for grade III-IV prolapse — talk with your surgeon about this trade-off against stapled surgery's usually easier recovery.

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.