Comparison of efficacy and safety of different treatment modalities for hemorrhoids: A network meta-analysis

Table 1 Characteristics of included studies

Reference	Grade of hemorrhoids	Treatment	Sample size	Recurrence	Effectiveness	Satisfaction	Further treatment	Pain	Bleeding	Urinary retention	Septic complications	Anorectal stenosis	Incontinence	Constipation
McKenzie et al[13], 2010	II	RBL vs SH	60	Reported	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported
Sakr[14], 2010	III/IV	MM vs LigaH	84	Reported	Not reported	Not reported	Not reported	Not reported	Reported	Reported	Reported	Reported	Reported	Reported
Nyström et al[15], 2010	III/IV	MM vs SH	180	Not reported	Reported	Not reported	Not reported	Reported	Reported	Not reported	Not reported	Not reported	Not reported	Not reported
Abo-hashem et al[16], 2010	III/IV	HarS vs BPC	64	Not reported	Not reported	Not reported	Not reported	Not reported	Reported	Reported	Reported	Not reported	Reported	Not reported
Filingeri et al[17], 2010	IV	FH vs RFC	28	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported	Reported	Not reported	Reported	Reported	Not reported
Sakr et al[18], 2010	III/IV	SH vs LigaH	68	Reported	Not reported	Not reported	Reported	Not reported	Reported	Reported	Reported	Reported	Reported	Reported
Giordano et al[19], 2011	II/III	SH vs HAL	52	Reported	Not reported	Reported	Reported	Reported	Reported	Reported	Not reported	Reported	Reported	Not reported
Zaher et al[20], 2011	II/III/IV	SH vs RBL	26	Reported	Not reported	Not reported	Not reported	Reported	Reported	Reported	Reported	Not reported	Reported	Not reported
Franceschilli et al[21], 2011	III/IV	MM vs LigaH	210	Reported	Not reported	Not reported	Reported	Reported	Reported	Reported	Reported	Reported	Reported	Reported
Giamundo et al[22], 2011	II/III	HAL vs RBL	60	Not reported	Reported	Reported	Not reported	Not reported	Reported	Reported	Not reported	Not reported	Reported	Not reported
Infantino et al[23], 2012	III	SH vs HAL	169	Reported	Not reported	Not reported	Reported	Reported	Reported	Reported	Reported	Not reported	Reported	Reported
Gupta et al[24], 2011	III	SLM vs HAL	48	Reported	Not reported	Not reported	Not reported	Not reported	Reported	Reported	Reported	Not reported	Not reported	Not reported
Arslani et al[25], 2012	III	SH vs LigaH	98	Reported	Not reported	Not reported	Not reported	Not reported	Reported	Reported	Not reported	Reported	Reported	Not reported
Filingeri et al[26], 2012	II	RBL vs CHR	90	Not reported	Reported	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported
Ammaturo et al[27], 2012	III	MM vs SH	79	Reported	Not reported	Not reported	Reported	Not reported	Reported	Reported	Reported	Not reported	Reported	Not reported
Zampieri et al[28], 2012	III/IV	HAL vs LigaH	114	Not reported	Not reported	Not reported	Not reported	Not reported	Reported	Not reported	Not reported	Not reported	Reported	Not reported
Elmér et al[29], 2013	II/III	MM vs HAL	40	Not reported	Not reported	Not reported	Reported	Not reported	Reported	Reported	Not reported	Reported	Reported	Not reported
Kim et al[30], 2013	III	MM vs SH	122	Reported	Not reported	Not reported	Reported	Not reported	Reported	Reported	Not reported	Not reported	Reported	Not reported
Bulus et al[31], 2014	III/IV	FH vs HarS	151	Reported	Not reported	Not reported	Not reported	Not reported	Reported	Reported	Reported	Reported	Reported	Not reported
Verre et al[32], 2013	III/IV	HAL vs SH	122	Not reported	Not reported	Not reported	Not reported	Not reported	Reported	Not reported	Not reported	Not reported	Not reported	Not reported
Ahmad et al[33], 2013	I/II	HAL vs IRC	245	Not reported	Reported	Not reported	Reported	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported
Gagloo et al[34], 2013	II/III	MM vs RBL	100	Not reported	Not reported	Reported	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported
De Nardi et al[35], 2014	III	MM vs HAL	50	Reported	Not reported	Reported	Reported	Not reported	Reported	Not reported	Not reported	Reported	Reported	Not reported
Talha et al[36], 2017	III/IV	MM vs HarS vs LigaH	180	Reported	Not reported	Not reported	Not reported	Not reported	Reported	Reported	Not reported	Reported	Not reported	Not reported
Denoya et al[37], 2014	III/IV	FH vs HAL	27	Reported	Reported	Not reported	Reported	Reported	Reported	Not reported	Not reported	Reported	Reported	Not reported
Elshazly et al[38], 2015	II/III	MM vs SLM	200	Reported	Not reported	Not reported	Not reported	Reported	Reported	Reported	Not reported	Not reported	Reported	Reported
Bilgin et al[39], 2015	III/IV	SH vs HarS	99	Reported	Not reported	Not reported	Not reported	Not reported	Reported	Not reported	Reported	Reported	Reported	Not reported
Wang et al[40], 2015	III/IV	MM vs TST	480	Not reported	Reported	Reported	Not reported	Reported	Not reported	Reported	Not reported	Not reported	Reported	Reported
Lu et al[41], 2015	III/IV	MM vs SH	108	Reported	Not reported	Not reported	Not reported	Not reported	Not reported	Reported	Not reported	Reported	Reported	Reported
Ripetti et al[42], 2015	III/IV	MM vs SCH vs SH	180	Reported	Not reported	Not reported	Not reported	Reported	Reported	Reported	Not reported	Reported	Reported	Not reported
Aigner et al[43], 2016	III	HAL vs SLM	40	Reported	Reported	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported	Not reported
Zhai et al[44], 2016	III	HAL vs SLM	100	Reported	Reported	Reported	Reported	Not reported	Reported	Reported	Not reported	Reported	Reported	Not reported
Brown et al[45], 2016	II/III	HAL vs RBL	372	Reported	Reported	Not reported	Reported	Reported	Reported	Reported	Reported	Not reported	Not reported	Not reported
Leardi et al[46], 2016	II/III	SH vs HAL	100	Reported	Not reported	Reported	Reported	Reported	Reported	Not reported	Not reported	Not reported	Reported	Not reported
Watson et al[47], 2016	II/III/IV	MM vs SH	774	Reported	Not reported	Not reported	Reported	Reported	Reported	Reported	Reported	Reported	Not reported	Reported
Lehur et al[48], 2016	II/III	SH vs HAL	393	Reported	Not reported	Reported	Reported	Reported	Reported	Reported	Reported	Reported	Reported	Reported
Naderan et al[49], 2017	II/III	MM vs LASER	60	Reported	Reported	Not reported	Reported	Not reported	Reported	Reported	Reported	Not reported	Not reported	Not reported
Nikooiyan et al[50], 2016	I/II/III/IV	FH vs DCV	120	Reported	Reported	Not reported	Reported	Reported	Reported	Reported	Reported	Not reported	Reported	Reported
Tsunoda et al[51], 2017	III	HAL vs HarS	44	Not reported	Not reported	Not reported	Reported	Reported	Reported	Reported	Not reported	Reported	Not reported	Not reported
Leung et al[52], 2017	II/III	HAL vs TST	80	Reported	Not reported	Not reported	Reported	Not reported	Not reported	Reported	Not reported	Reported	Not reported	Not reported
Nikshoar et al[53], 2018	III	FH vs IRC	40	Reported	Not reported	Not reported	Not reported	Not reported	Reported	Not reported	Not reported	Not reported	Not reported	Not reported
Giarratano et al[54], 2018	III/IV	SH vs HAL	100	Reported	Not reported	Reported	Reported	Not reported	Reported	Not reported	Not reported	Not reported	Not reported	Not reported
Venara et al[55], 2018	II/III	SH vs HAL	377	Reported	Not reported	Not reported	Reported	Reported	Reported	Reported	Reported	Reported	Reported	Reported
Lisi et al[56], 2019	III/IV	LigaH vs RFC	50	Reported	Not reported	Not reported	Not reported	Not reported	Reported	Reported	Not reported	Reported	Reported	Not reported
Carvajal López et al[57], 2019	III/IV	MM vs HAL	40	Reported	Reported	Not reported	Reported	Reported	Reported	Reported	Not reported	Not reported	Not reported	Not reported
Trenti et al[58], 2019	III/IV	LigaH vs HAL	80	Not reported	Not reported	Reported	Not reported	Not reported	Reported	Reported	Reported	Not reported	Not reported	Not reported
Genova et al[59], 2019	III/IV	MM vs HAL	89	Reported	Not reported	Not reported	Reported	Not reported	Reported	Not reported	Reported	Reported	Not reported	Not reported
Poskus et al[60], 2020	II/III	MM vs SLM vs LASER	121	Reported	Reported	Not reported	Reported	Not reported	Not reported	Not reported	Reported	Reported	Not reported	Not reported
Rørvik et al[61], 2020	II/III/IV	MM vs HAL	98	Reported	Not reported	Reported	Reported	Reported	Reported	Reported	Reported	Reported	Reported	Not reported
Abiodun et al[62], 2020	II/III	IJS vs RBL	60	Reported	Reported	Reported	Reported	Reported	Reported	Not reported	Reported	Not reported	Not reported	Not reported
Jin et al[63], 2021	III	RBL vs MM	120	Reported	Not reported	Not reported	Reported	Not reported	Reported	Reported	Not reported	Not reported	Not reported	Not reported
Zhai et al[64], 2022	II/III/IV	SLM vs MM	123	Reported	Not reported	Reported	Reported	Not reported	Reported	Not reported	Not reported	Not reported	Reported	Not reported
Lee et al[65], 2021	III/IV	HAL vs LigaH	80	Not reported	Reported	Reported	Reported	Reported	Reported	Reported	Not reported	Not reported	Not reported	Not reported
Huang et al[66], 2021	III/IV	MM vs TST	169	Reported	Not reported	Reported	Not reported	Not reported	Reported	Reported	Not reported	Reported	Not reported	Not reported
Song et al[67], 2022	III/IV	MPSH vs MM	186	Reported	Not reported	Not reported	Not reported	Not reported	Reported	Not reported	Not reported	Reported	Not reported	Not reported
Salgueiro et al[68], 2022	I/II/III	IJS vs RBL	120	Reported	Reported	Not reported	Reported	Not reported	Not reported	Not reported	Reported	Not reported	Not reported	Not reported
Trenti et al[69], 2023	III/IV	HAL vs LigaH	75	Not reported	Not reported	Reported	Reported	Not reported	Not reported	Not reported	Not reported	Reported	Reported	Not reported
Yang et al[70], 2022	II/III/IV	SH vs MLPPH	130	Not reported	Reported	Not reported	Not reported	Not reported	Not reported	Reported	Not reported	Not reported	Not reported	Not reported
Mert[71], 2023	III/IV	LASER vs FH	100	Not reported	Reported	Not reported	Reported	Not reported	Reported	Reported	Reported	Not reported	Reported	Not reported
Huang et al[72], 2023	III/IV	TST vs SH	306	Reported	Reported	Not reported	Not reported	Not reported	Reported	Reported	Not reported	Reported	Not reported	Not reported
Cemil et al[73], 2024	II/III	LASER vs MM	85	Not reported	Not reported	Not reported	Not reported	Not reported	Reported	Not reported	Not reported	Not reported	Reported	Not reported
Nada et al[74], 2024	III/IV	HarS vs SH	70	Reported	Not reported	Reported	Not reported	Not reported	Reported	Not reported	Reported	Reported	Reported	Not reported
Jin et al[75], 2024	II	LASER vs RBL	70	Reported	Not reported	Not reported	Reported	Not reported	Reported	Reported	Reported	Not reported	Reported	Not reported
Mustapha et al[76], 2025	II/III/IV	LigaH vs MM	52	Not reported	Reported	Reported	Reported	Not reported	Not reported	Reported	Not reported	Not reported	Reported	Not reported
Huang et al[77], 2025	III/IV	TST vs SH vs EPH	141	Not reported	Reported	Not reported	Not reported	Reported	Not reported	Reported	Not reported	Reported	Not reported	Not reported
Fernandez-Hurtado et al[78], 2025	III	HAL vs MM	50	Reported	Reported	Not reported	Reported	Not reported	Not reported	Reported	Not reported	Reported	Reported	Not reported

BPC: Bipolar coagulation; CHR: Combined hemorrhoidal radiocoagulation; DCV: Direct current electrotherapy; EPH: Eastern rubber band ligation and coincident of dislocation for prolapse and hemorrhoid; FH: Ferguson hemorrhoidectomy; HAL: Hemorrhoidal artery ligation; HarS: Harmonic scalpel hemorrhoidectomy; IJS: Injection sclerotherapy; IRC: Infrared coagulation; LASER: Laser hemorrhoidectomy; LigaH: LigaSure™ hemorrhoidectomy; MLPPH: Modified ligation procedure for prolapsed hemorrhoids; MM: Milligan–Morgan hemorrhoidectomy; MPSH: Modified Park’s submucosal hemorrhoidectomy; RBL: Rubber band ligation; RFC: Radiofrequency coagulation; SCH: Semi-closed hemorrhoidectomy; SH: Stapled hemorrhoidopexy; SLM: Suture ligation with mucopexy; TST: Tissue-selecting technique.