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

Many surgical procedures have been developed to treat hemorrhoidal disease. Although conventional excisional techniques are effective, they are also associated with significant postoperative pain and longer recovery times. Consequently, newer techniques have been introduced to address these issues, including laser hemorrhoidoplasty (LHP) and LigaSure hemorrhoidectomy (LigH). This systematic review and meta-analysis aims to compare these two approaches in terms of perioperative outcomes and recurrence. A comprehensive search was conducted across PubMed, Scopus, Web of Science, Cochrane Library, ClinicalTrials.gov, and Google Scholar, up to December 2025. We included all eligible studies involving adults with grade II-IV hemorrhoids. Primary outcomes included postoperative pain, time to return to routine activities, and recurrence. Secondary outcomes were operative time, length of hospital stay, and complications. The risk of bias was assessed using the RoB2 and ROBINS-I V2 tools. Meta-analyses were performed with a random-effects model. The certainty of evidence was evaluated using the GRADE approach. Data from 461 patients (213 LHP, 248 LigH) across five studies were analyzed. Patients in the LHP group reported significantly lower pain scores on postoperative day 1 (MD: - 1.61 points; p = 0.025), earlier return to routine activities (MD: -5.75 days; p = 0.0002), shorter operative time (MD: -6.5min; p = 0.002), and shorter hospital stay (MD: -0.3 days; p < 0.0001) compared to the LigH group. Conversely, LigH demonstrated a significantly lower risk of recurrence (RD: 0.12; 95% CI: [0.05, 0.19]). No significant differences were observed regarding postoperative bleeding, wound infection, urinary retention, or thrombosis. LHP yields better perioperative outcomes, including less pain and faster recovery, making it a favorable option for patient comfort. However, LigH has lower recurrence rates. The certainty of evidence is very low. Further high-quality randomized trials are needed to confirm these results.

This study aimed at analysing the outcomes of laser hemorrhoidoplasty (LHP) in a 2-year period.LHP was carried out in 77 patients (83% of them had grade III or grade IV) treated over a two-year period. Inclusion criteria were an age above 18 years old, symptomatic haemorrhoids of grade 2 to 4 with minimal to moderate prolapse. Post operative pain, recurrence of the disease, persistence of symptoms, complications, length of stay and patients' satisfaction were all documented. The distribution of patients along the follow-up period was: 77 patients (100%) seen in 3 months, 73 patients (94.8%) seen in 1 year, 51 patients (66.2%) seen in 3 months, 26 patients (33.8%) seen in 2 years.The procedure was well-tolerated and associated with commendable short- to medium-term outcomes. 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. Postoperative pain was minimal, with a low mean pain score and limited use of opioids. Hospital stay was one day for most patients, and most patients returned to normal activities within the first postoperative week. Overall, 81% of patients were highly satisfied, and 90% reported satisfactory outcomes. Postoperative complications occurred in only one patient, who developed a submucosal abscess requiring surgical intervention.LHP demonstrated favourable short- to medium-term outcomes, with low postoperative pain, minimal opioid use, and high patient satisfaction. LHP may be a promising minimally invasive option for advanced hemorrhoidal disease.

Cap-assisted endoscopic sclerotherapy (CAES) via a long needle optimizes the visualization of operation field and enables precise injection of sclerosant, yet evidence regarding its application in high-grade internal hemorrhoids (HDs) remains limited. This study aims to evaluate the efficacy and safety of CAES therapy for bleeding-predominant grade III symptomatic internal HDs, and explore potential risk factors associated with postoperative bleeding persistence and recurrence. 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. Treatment efficacy was assessed at 3months 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. Bleeding recurrence was monitored during follow-ups. Logistic regression analysis was employed to explore potential risk factors associated with bleeding outcomes. (1) The overall efficacy rate was 85.4%. The effective rates for bleeding and prolapse symptoms were 96.3% and 58.2%, respectively. (2) During a follow-up of 24months, the bleeding recurrence rate was 25.3% (20/79). (3) Exploratory logistic regression analysis suggested that a high pre-CAES bleeding intensity score (odds ratio [OR] = 2.887, p = 0.030) was significantly associated with non-excellent outcome (i.e., persistent bleeding); meanwhile, a high pre-CAES bleeding intensity score (OR = 3.981, p = 0.012) and a high post-CAES bleeding frequency score (OR = 3.803, p = 0.006) were significantly associated with post-CAES bleeding recurrence. (4) No severe complications were reported. CAES with long-needle injection of polidocanol may serve as an effective and safe therapeutic option for managing bleeding symptom in grade III internal HDs. The higher bleeding-associated scores, which encompass both bleeding frequency and intensity, may represent potential risk factors for persistent or recurrent bleeding after the CAES procedure.

Open hemorrhoidectomy remains the gold standard for the surgical treatment of hemorrhoidal disease but is associated with substantial postoperative pain and complications. In contrast, Laser Hemorrhoidoplasty (LHP) has emerged as a minimally invasive alternative. This study aimed to evaluate the clinical outcomes, complication and recurrence rates of LHP in a single-center cohort. This retrospective study included 132 patients (72 % male, mean age 52.8 years) with grade II-IV hemorrhoidal disease who underwent Laser Hemorrhoidoplasty in our center between January 2021 and June 2025. Postoperative pain, complications, patient satisfaction, and recurrence rates were analyzed. Univariable and multivariable logistic regression analyses were performed to identify associations with recurrence and complications. Postoperative pain scores were low, with a median Visual Analogue Scale (VAS) score of zero at discharge, after one week and after one month. Most patients (94.7 %) were discharged on the day of surgery, and 95.5 % reported satisfaction with the postoperative outcome. Postoperative complications occurred in twelve patients (9.1 %), including three readmissions (2.3 %) and one reintervention (0.8 %). Overall recurrence occurred in thirteen patients (9.8 %), while five patients (3.8 %) required surgical treatment. Higher hemorrhoidal grade was significantly associated with recurrence, whereas no association was observed with postoperative complications. In multivariable analysis, grade IV hemorrhoids were independently associated with increased odds of recurrence after adjustment for age and previous treatment. Within this cohort, LHP may represent a safe and minimally invasive treatment option for hemorrhoidal disease associated with generally low postoperative pain, favorable patient satisfaction and relatively short hospital stay. Complication and readmission rates were low. However, grade IV disease was independently associated with increased recurrence after adjustment for age and previous treatment, indicating that caution is warranted in this subgroup. Further prospective studies with larger sample sizes, comparison group and longer follow-up are needed to better define the role of LHP in advanced hemorrhoidal disease.

Polidocanol foam (PF) sclerotherapy has regained interest as a minimally invasive treatment for hemorrhoidal disease (HD). However, the early hemodynamic effects of sclerotherapy and their relationship with clinical outcomes remain poorly defined. This study aimed to evaluate early local hemodynamic changes following endoscopic PF sclerotherapy using transperineal ultrasound (TPUS) and to explore their association with patient-reported outcome measures (PROMs). This prospective observational study included patients with Goligher grade I-IV HD treated with endoscopic PF sclerotherapy. TPUS Doppler assessment of peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI) was performed at baseline, 7days, and 30days post-treatment. Symptoms were evaluated using the PROM-HISS score. Hemodynamic and clinical outcomes were compared over time and stratified by HD severity (Goligher I-II vs III-IV). Thirty-seven patients completed follow-up. No significant differences in preoperative PSV were observed between lower- (Goligher I/II) and higher-grade HD (Goligher III/IV). After treatment, patients with lower-grade HD showed a significant reduction in PSV and RI at both 7 and 30days (p < 0.01), indicating effective modulation of arterial inflow. In contrast, no significant changes in PSV or RI were observed in higher-grade HD, while EDV increased at 30days (p = 0.012). PROM-HISS scores significantly improved in all patients at 7days; however, symptom scores increased between 7 and 30days in higher-grade HD. PF sclerotherapy induces early short-term hemodynamic changes detectable by TPUS in lower-grade HD, paralleling consistent short-term symptom improvement. In advanced HD, clinical benefit appears transient and not supported by objective vascular remodeling. TPUS emerges as a valuable non-invasive tool for functional assessment, follow-up, and treatment stratification after sclerotherapy.

What factors prolong symptoms in patients with hemorrhoidal disease who require surgery?

Prior investigations have indicated an association between sedentary and physically active behaviors, tobacco and alcohol intake behaviors, and hemorrhoidal disease (HD). Yet, the causal relationship between these factors and HD remains unclear and is a topic of debate. The data from the genome-wide association study were selected as the exposures (sedentary behavior, physical activity behavior, and tobacco and alcohol intake behavior) and the outcome (HD). We employed a range of Mendelian randomization (MR) analysis methods for causal estimation. The primary analysis method was the inverse variance weighted random effect model (IVW[RE]), with the MR-Egger, weighted median estimator, MR-pleiotropy residual sum and outlier (MR-PRESSO), MR-Radial, and MR-LAP methods serving as auxiliary and supplementary. Additionally, secondary MR analyses were conducted by identifying and removing outlier single nucleotide polymorphisms through MR-Radial. A series of sensitivity analyses were performed to ascertain the reliability and robustness of the results. Among the MR analysis results, the IVW(RE) results for Leisure screen time’s analysis with HD showed an odds ratio (OR) of 1.052 (95% confidence interval [CI]: 1.001–1.106, P: .047). After the removal of outliers, the IVW(RE) OR was 1.055 (95% CI: 1.015–1.096, P: .006). For the smoking initiation analysis with HD, the P difference in the MR-LAP results was 0.031. The MR-LAP corrected IVW results were deemed to be more plausible, with an OR of 1.058 (95% CI: 1.020–1.096, P: .002). After the removal of outliers, the IVW(RE) yielded an OR of 1.066 (95% CI: 1.007–1.129, P: .029). In the initial analysis of moderate-to-vigorous intensity physical activity during leisure time with HD, weighted median estimator yielded a negative correlation (OR: 0.856, 95% CI: 0.750–0.978, P: .022). Following the removal of outliers, the IVW(RE) results indicated a negative correlation (OR: 0.900, 95% CI: 0.814–0.995, P: .039). For smoking cessation analysis with HD, P difference was found to be statistically significant (.034) in the MR-LAP results. The corrected IVW results yielded an OR of 0.951 (95% CI: 0.907–0.997, P: .035). The secondary analysis yielded an OR of 0.901 (95% CI: 0.812–1.000, P: .05). However, no notable correlation was identified between alcohol consumption and HD in the conducted analyses. The results indicate that sedentary and smoking behaviors are risk factors, whereas physical active and smoking cessation are possible protective factors. The study provides evidence for further research into the etiology of HD and enables the development of prevention strategies.

This study investigates METTL3's function and mechanisms in hemorrhoidal disease-related inflammation. A rat model of hemorrhoidal disease was induced in vivo using croton oil. Human monocytic leukemia cells THP-1 were induced into macrophages using phorbol myristate acetate, and then lipopolysaccharide (LPS) was used to induce an inflammatory phenotype in the macrophages. The pathological changes in the rectal and anal tissues of rats were evaluated using the rectoanal coefficient and HE staining. Key gene and protein expression levels were detected using RT-qPCR, Western blotting, immunofluorescence, and immunohistochemistry. METTL3 expression was significantly upregulated in hemorrhoidal tissues and LPS-induced macrophages, and its knockdown alleviated rectal-anal lesions in hemorrhoidal rats. Silencing METTL3 suppressed the expression of M1 polarization markers (iNOS, CD80, CD86) while increasing IL-10 and reducing TNF-α, IL-1β, and IL-6 levels in hemorrhoidal tissues and LPS-stimulated macrophages. Furthermore, LPS treatment enhanced Smad2/3 and IL-6R expression in macrophages, and positive correlations were observed between the expression of Smad2, Smad3, and METTL3, as well as between METTL3 and IL-6R. Mechanistically, nuclear-translocated Smad2/3 bound to METTL3 to promote its expression. The resulting elevated METTL3 then promoted IL-6R expression via m6A modification, driving macrophage activation and ultimately exacerbating the inflammatory response in hemorrhoidal disease. This work demonstrates that the Smad2/3-induced METTL3 drives hemorrhoidal inflammation via m6A modification of IL-6R, presenting a novel intervention target.

Transanal hemorrhoidal dearterialization (THD) with Anolift mucopexy is a validated non-excisional procedure for hemorrhoidal disease. Although surgeon experience is acknowledged as a determinant of THD outcomes, no formal learning curve analysis exists. This study aimed to characterize the learning curve of a single surgeon adopting THD-Anolift. Retrospective analysis of 60 consecutive THD-Anolift cases (May 2023-February 2026). Nine patients with incomplete outcome data were excluded, leaving 51 for analysis. Median follow-up was 12months (range 3-33). Cumulative sum (CUSUM) charts were constructed for a composite failure endpoint (recurrence and/or any complication) and for operative time. The proficiency point was identified at the CUSUM inflection. Sensitivity analyses included CUSUM on recurrence alone, CUSUM restricted to recurrence and Clavien-Dindo ≥ II complications, best-case/worst-case imputation for excluded patients, and risk-adjusted CUSUM controlling for hemorrhoid grade and previous procedures. Median age was 53years; 72.5% were male; 80.4% had grade III hemorrhoids. The overall composite failure rate was 37.3% (19/51) and the recurrence rate 15.7% (8/51). Mean operative time was 23.5 ± 7.4min. The composite outcome CUSUM identified a proficiency point at case 23: 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). Operative time decreased from 27.1 ± 7.4 to 20.4 ± 6.0min (p < 0.001). On sensitivity analysis, both the recurrence-only CUSUM and the risk-adjusted CUSUM confirmed an identical proficiency point at case 23, and worst-case/best-case imputation for excluded patients moved the inflection only to cases 25 and 22 respectively, indicating that the finding was robust to endpoint definition and case-mix variation, as well as to plausible patterns of missing data. CUSUM analysis identified an inflection at approximately 23 cases, with a statistically significant reduction in operative time and a clinically relevant but underpowered reduction in composite failure that did not reach the conventional threshold for statistical significance. Rather than a fixed competency threshold, these findings provide an initial benchmark to help structure supervised adoption-suggesting that the 10 mentored cases conventionally proposed in industry-sponsored teaching may be insufficient- and to inform future multicenter validation.

We present a clinical case of a 77-year-old male with an aortic aneurysm extending from aorta ascendens to the beginning of the descending aorta. Signi&amp;#64257; cant patient comorbidities included prostate carcinoma, ischemic heart disease with single-vessel coronary artery disease (status post PCI with DES &amp;times;1 of the LCX in 2019), chronic heart failure NYHA class III, peripheral arterial disease stage IIA, anemic syndrome, left-sided nephrolithiasis, hemorrhoidal disease, colonic diverticulosis, and oesophageal haemangiomas. After multidisciplinary discussion, the patient underwent minimally invasive aortic arch debranching and wrapping of the ascending aorta without the need for extracorporeal circulation (ECC), followed by endovascular implantation of an aortic arch stent-graft and PTA of the right common and external iliac arteries with implantation of a 7/150 mm balloon. The postoperative period was uneventful. The patient was discharged in good general condition with recommendations for medical therapy and cardiology follow-up.

ABSTRACT"Haemorrhoids" are the vascular cushions located under the distal rectal mucosa and provide around one-fifth of the resting pressure following the closure of the anal canal. It is referred to as "hemorrhoidal disease" when they grow sufficiently large to cause symptoms and/or move towards the distal portion of the anal canal. Prolapse, pain, anal itching, and bleeding are the primary symptoms. The male-to-female ratio is similar, although the true incidence is unclear. Its frequency increases between the ages of 45 and 65. Strangulation of internal hemorrhoids and thrombosis of external hemorrhoids cause "hemorrhoidal crisis", which is painful and has high morbidity. In these situations, immediate surgical treatment is advised within the first 3 days after symptom onset, in contrast to the cautious approach followed in most cent- res. Surgical intervention removes the negative economic and psychological consequences of long-term recovery attained by a conservative strategy. Furthermore, it reduces the probability of surgical treatment in the advanced stages of the disease.We present our case, who underwent surgery on the eighth day following a hemorr- hoidal crisis, with the consideration that it would contribute to the selection of treatment.The postoperative pain complaint resolved on the first day, and the bleeding in the form of leakage resolved on the third day. In acute hemorrhoidal crises like ours, where surgical intervention is usually the primary requirement, delayed surgery was eventually undertaken and yielded a favorable outcome.

Hemorrhoidal disease is one of the most ubiquitous benign anorectal conditions. While early disease is largely able to be controlled and treated in the office, Grade IV hemorrhoidal disease (i.e., permanently prolapsed and irreducible hemorrhoidal cushions) requires radical surgery. The gold standard for advanced disease is excisional hemorrhoidectomy. These extremely aggressive excisional procedures are very painful and can sacrifice much of the normal anoderm. The resultant healing by secondary intention often causes an iatrogenic anatomical anal stenosis. As a result, the field of contemporary reconstructive proctology has moved towards flap-based anoplasty. Pliable and well-vascularized perianal skin is brought into the anal canal by a set of techniques such as V-Y advancement, Diamond, and House flaps to restore the reconstructive principle of like with like. These techniques are used prophylactically during primary excisional hemorrhoidectomy and reactively to reconstruct the anal canal. The pathophysiology of Grade IV hemorrhoidal disease and postoperative anal stenosis, as well as geometric issues of modern flap anoplasty, are discussed in this review. The clinical outcome is compared with the more effective one by keeping the functional continence intact and the aesthetic satisfaction.

Haemorrhoidal disease affects 25-40% of adults worldwide and constitutes a primary reason for outpatient colorectal consultations. Surgical management is essential for grade III-IV or treatment-refractory cases. Numerous procedures have emerged, including Milligan-Morgan open haemorrhoidectomy, Ferguson closed haemorrhoidectomy, stapled haemorrhoidopexy, Doppler-guided haemorrhoidal artery ligation, transanal haemorrhoidal dearterialisation and laser haemorrhoidoplasty. However, randomised controlled trials and conventional meta-analyses report conflicting results on efficacy, postoperative pain, recurrence rates and complications such as bleeding, stenosis and incontinence. Although network meta-analyses exist, an updated synthesis is needed because outcomes and follow-up vary across trials. This protocol aims to determine the most effective and safest haemorrhoid interventions (office-based and operative) through systematic review and network meta-analysis, providing evidence-based guidance for clinical practice and guideline development. The Cochrane Library, Web of Science, MEDLINE, Embase, China National Knowledge Infrastructure, VIP, SinoMed and Wanfang databases will be searched from inception to January 2025, limited to English or Chinese publications. Randomised controlled trials evaluating haemorrhoid interventions/procedures for haemorrhoidal disease will be included, with outcomes encompassing cure rate, recurrence, complications, postoperative pain, wound-healing time, anal function and operative duration. Risk of bias will be assessed using RoB 2. Pairwise meta-analyses will be conducted in RevMan; network meta-analysis will employ Bayesian frameworks in GeMTC or R, incorporating consistency evaluation, node-splitting and surface under the cumulative ranking curve for treatment ranking. Subgroup analyses (haemorrhoid grade, follow-up duration), sensitivity analyses and publication bias assessments will be performed. Evidence certainty will be graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and the Confidence in Network Meta-Analysis (CINeMA) framework. As only published data will be used, ethical approval is not required. Results will be disseminated via peer-reviewed publication and conference presentations. CRD420251053697.

Association between varicocele and hemorrhoidal disease in men presenting with groin pain: a retrospective comparative study

IntroductionHemorrhoidal disease is one of the most common anorectal disorders encountered in surgical practice and significantly affects patients’ daily activities and well-being. Conservative management remains the first-line treatment for early hemorrhoids (Grade I and II), focusing primarily on symptom relief. However, the impact of conservative therapy on health-related quality of life has not been extensively evaluated. The present study aimed to assess symptomatic improvement and quality-of-life outcomes following conservative management in patients with early hemorrhoidal disease.MethodsA retrospective observational study was conducted in the Department of General Surgery at ESIC Medical College and Hospital, Varanasi, India. Medical records of patients diagnosed with Grade I or Grade II internal hemorrhoids and managed conservatively were reviewed. Patients with a minimum follow-up duration of six weeks were included in the study. Symptom severity was assessed using the Hemorrhoid Severity Score (HSS). Health-related quality of life was evaluated using the Short Form-12 (SF-12) questionnaire, generating the Physical Component Score (PCS) and Mental Component Score (MCS). Baseline and follow-up scores were compared using paired statistical analysis. Subgroup analysis was performed to evaluate differences in improvement between Grade I and Grade II hemorrhoids.ResultsA total of 50 patients were included in the final analysis. The mean age of the study population was 45.04 ± 12.48 years, with equal gender distribution comprising 25 (50%) males and 25 (50%) females. Grade II hemorrhoids were present in 29 (58%) patients, while 21 (42%) had Grade I disease.Following conservative management, a significant reduction in symptom severity was observed. The mean Hemorrhoid Severity Score decreased from 10.71 ± 2.01 at baseline to 5.57 ± 2.39 at follow-up (p < 0.001), indicating substantial improvement. Similarly, the mean Physical Component Score improved from 39.31 ± 2.78 to 49.18 ± 3.26 (p < 0.001), reflecting better physical functioning, while the mean Mental Component Score improved from 40.99 ± 2.79 to 49.51 ± 3.72 (p < 0.001), indicating enhanced psychological well-being.Large effect sizes were observed for improvements in symptom severity and quality-of-life measures. Subgroup analysis demonstrated comparable improvement between Grade I and Grade II hemorrhoids. Additionally, no significant correlation was identified between the magnitude of symptom improvement and changes in quality-of-life scores.ConclusionConservative management of Grade I and II hemorrhoids leads to significant reduction in symptom severity and substantial improvement in both physical and mental aspects of quality of life. These findings reinforce the role of conservative therapy as an effective first-line treatment strategy in early hemorrhoidal disease.

Background: Hemorrhoidal disease is a highly prevalent anorectal condition impacting quality of life and functional capacity. Modern understanding highlights a complex interplay of mechanical, vascular, and inflammatory pathologies. Optimal management demands an etiology- and stage-specific approach. Aim: This narrative review aims to integrate current evidence on the etiology, pathophysiology, and classification of hemorrhoidal disease to evaluate therapeutic strategies. It focuses on correlating treatment efficacy, recurrence rates, and functional outcomes with specific disease stages, including their impact on patient quality of life and engagement in active lifestyles. Material and methods: A comprehensive literature search was conducted using PubMed, PubMed Central (PMC), MEDLINE, Embase, and the Cochrane Library for studies published between 2015 and 2025. Selected articles focused on hemorrhoid etiology, staging, and both physical and psychological treatment outcomes. Results: Hemorrhoidal disease progresses from vascular congestion (Grade I-II) to significant connective tissue failure (Grade III-IV). Conservative and office-based interventions effectively manage early vascular-dominant disease with minimal downtime. Minimally invasive surgical techniques balance efficacy with reduced morbidity for mixed vascular-structural pathologies (Grade III). Excisional hemorrhoidectomy remains the definitive treatment for severe structural collapse (Grade IV), offering the lowest recurrence. Treatment success, measured by physical relief and high patient-reported quality of life, strongly correlates with precise stage- and etiology-matched therapy, facilitating return to active lifestyles. Conclusions: A tailored, etiology- and stage-adapted approach to hemorrhoidal disease management is crucial for optimizing clinical outcomes, preventing recurrence, and enhancing patient functional status and psychological well-being.

Hemorrhoidal disease is a common anorectal condition, and surgical hemorrhoidectomy remains the definitive treatment for advanced cases. In recent years, various energy-based surgical devices have been introduced into hemorrhoidectomy practice; however, their impact on surgical outcomes remains unclear. We aim to evaluate the role of energy devices in contemporary hemorrhoid surgery by comparing outcomes between energy device-assisted and conventional hemorrhoidectomy. We conducted a retrospective study using electronic medical records to identify patients who underwent hemorrhoidectomy at our institution between January 1 and December 31, 2022. Patients were matched 1:1 between the energy device and non-energy device groups using propensity score matching. The primary outcome was the incidence of postoperative complications. Secondary outcomes included the duration of postoperative analgesic use and the total dose of opioid analgesics administered. After matching, no significant baseline differences were observed between the two groups. The energy device group had significantly higher rates of infection (13.8% vs. 5.3%, p = 0.002), postoperative bleeding (5.3% vs. 1.8%, p = 0.042), and emergency department visits (23.1% vs. 12.4%, p = 0.003) compared to the non-energy device group. There were no significant differences in overall complication rates or postoperative pain scores between the groups. Although overall complication rates did not differ significantly between groups, energy device-assisted hemorrhoidectomy was associated with higher rates of postoperative bleeding and infection, likely reflecting lateral thermal injury and the intrinsic properties of energy-based instruments. Further research is warranted to investigate additional contributing factors.

Background Hemorrhoidal disease affects around 4% of the global population. It presents a clinically important disease leading to significant work load and associated with significant complications if left untreated including bleeding leading to anemia, hygiene issues, progression to prolapse and impaired quality of life. Over the past decade, surgical management has expanded from conventional excisional hemorrhoidectomy to a range of minimally invasive and energy-based techniques. These procedures differ in terms of postoperative pain, recovery, recurrence, complications, and patient satisfaction. The primary aim of this review was to evaluate and compare the short- and long-term outcomes of various surgical treatments for hemorrhoidal disease. It also sought to identify each technique’s strengths and limitations to support individualized, evidence-based treatment planning. Methods A systematic review was conducted in accordance with PRISMA guidelines. Literature published between 2010 and 2025 was sourced from PubMed, Embase, Scopus, Google Scholar, and the Cochrane Library. A comprehensive MeSH-based search strategy was applied, and two reviewers independently performed screening, extraction, and quality assessment .Included studies comprised meta-analyses, randomized controlled trials, cohort studies, and clinical guidelines. Study selection and data extraction were performed independently by two reviewers, with discrepancies resolved by consensus. Results Postoperative outcomes varied according to the extent of tissue disruption. Pain and bleeding were highest after open excisional surgery and progressively lower with energy-based and minimally invasive techniques, with laser procedures showing the best early comfort profile. Complications were most frequent with open excision, unique but occasionally severe with stapled surgery, and lowest with minimally invasive approaches. Recurrence was lowest after excisional techniques, moderate with stapled methods, and higher with laser and arterial-ligation procedures in advanced disease. Recovery was fastest with minimally invasive techniques and slowest after conventional excision. Conclusion No single operative technique is universally optimal. Treatment should be tailored based on hemorrhoid grade, patient comorbidities, preferences, and surgical expertise to achieve the best outcomes.

Stapled hemorrhoidopexy (SH) has been proposed as a less invasive alternative to open hemorrhoidectomy (OH) for advanced hemorrhoidal disease. This study compared perioperative and short-term postoperative outcomes between SH and OH in a Bangladeshi population. A prospective comparative study was conducted among 130 patients (65 per group) with Grade III and IV hemorrhoids. Baseline characteristics, perioperative blood loss, postoperative pain (VAS), complications, hospital stay, return to work and treatment cost were analyzed using appropriate statistical tests. Baseline age, gender and hemorrhoid grade distributions were comparable between groups (p>0.05). 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). Return to work was faster in SH (mean 7.72 vs. 14.29 days, p<0.001). Reactionary hemorrhage occurred only in OH (6.2%, p=0.042). Perioperative blood loss differences were not statistically significant (p=0.149). SH incurred significantly higher costs (mean Tk. 18,876.92 vs. Tk. 6,690.77, p<0.001). SH offers significant short-term clinical benefits over OH, including reduced pain, faster recovery and fewer complications. However, higher costs may limit its feasibility in resource-constrained healthcare systems. Cost-effectiveness evaluation is essential before widespread adoption.