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Chen B, Xiong XR, Zhang ZG, Chen QQ. Comparison of efficacy and safety of different treatment modalities for hemorrhoids: A network meta-analysis. World J Gastroenterol 2027; 33(2): 125931 [DOI: 10.3748/wjg.125931]
World J Gastroenterol. Jan 14, 2027; 33(2): 125931 Published online Jan 14, 2027. doi: 10.3748/wjg.125931
Comparison of efficacy and safety of different treatment modalities for hemorrhoids: A network meta-analysis
Bin Chen, Xin-Ru Xiong, Zhen-Guo Zhang, Qing-Qing Chen
Bin Chen, Xin-Ru Xiong, Zhen-Guo Zhang, Qing-Qing Chen, Department of Proctology, Ningbo Hospital of Integrated Traditional Chinese and Western Medicine, Ningbo 315100, Zhejiang Province, China
Author contributions: Chen B, Zhang ZG, and Xiong XR designed the research study; Chen B, Zhang ZG, and Chen QQ performed the data analysis and interpretation; Xiong XR and Chen QQ checked and confirmed the authenticity of the raw data; and Chen B, Xiong XR, Zhang ZG, and Chen QQ collected and assembled the data, wrote the manuscript, and read and approved the final version of the manuscript.
AI contribution statement: No AI tools were used to polish the language, assist with formatting, generate research data, interpret results, or formulate conclusions.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Bin Chen, PhD, Department of Proctology, Ningbo Hospital of Integrated Traditional Chinese and Western Medicine, No. 998 Qianhebei Road, Ningbo 315100, Zhejiang Province, China. chenbin031212@yeah.net
Received: July 21, 2026 Revised: August 10, 2026 Accepted: October 8, 2026 Published online: January 14, 2027 Processing time: 109 Days and 3.3 Hours
Abstract
BACKGROUND
Hemorrhoidal disease is a prevalent anorectal condition for which a variety of interventional treatments are available; however, their comparative efficacy and complication profiles remain incompletely defined.
AIM
To compare the clinical effectiveness and safety of hemorrhoidal treatments via a network meta-analysis.
METHODS
We systematically searched major electronic databases for randomized controlled trials published up to June 2026. A Bayesian network meta-analysis was performed to compare the 20 interventions in terms of recurrence, efficacy, patient satisfaction, subsequent treatment rate, and adverse events, with subgroup analyses stratified by Goligher grade.
RESULTS
Sixty-six studies encompassing 8549 patients and 20 therapeutic modalities were included. LigaSure™ hemorrhoidectomy demonstrated a significantly lower recurrence risk than Milligan–Morgan hemorrhoidectomy [odds ratio (OR) = 0.18, 95% credible interval (95%CI): 0.03–0.94] and ranked first in effectiveness [surface under the cumulative ranking curve (SUCRA) = 98.2%], with the lowest further treatment rate (SUCRA = 4.3%), although it ranked higher for pain (82.5%) and urinary retention (75.4%). The tissue-selecting technique showed a nearly significant reduction in recurrence (OR = 0.210, 95%CI: 0.037–1.000) and improvements in safety outcomes, particularly anorectal stenosis (SUCRA = 20.0%) and constipation (11.7%). Direct current electrotherapy also showed a favorable SUCRA ranking for recurrence, but this result was derived from a very limited number of studies with small sample sizes. Rubber band ligation was associated with a markedly higher recurrence risk (OR = 6.7; SUCRA = 90.5%), as was injection sclerotherapy (SUCRA = 76.4%); both interventions had low effectiveness rankings. Subgroup analyses suggested that procedure performance might vary by Goligher grade, with LigaSure™ hemorrhoidectomy and the tissue-selecting technique showing potential advantages in severe (grade ≥ III) disease, although these findings should be interpreted with caution because of limited data.
CONCLUSION
LigaSure™ hemorrhoidectomy and the tissue-selecting technique are preferred for surgical candidates with severe disease; rubber band ligation and sclerotherapy are better suited for mild disease or for patients who are not surgical candidates. Treatment selection may be individualized according to disease severity, although the current evidence for grade-based recommendations remains exploratory.
Core Tip: This network meta-analysis of 66 randomized controlled trials involving 8549 patients compares 20 therapeutic modalities for hemorrhoidal disease. LigaSure™ hemorrhoidectomy and the tissue-selecting technique demonstrate the most favorable balance between recurrence control and safety, particularly in severe (grade ≥ III) disease. Rubber band ligation and injection sclerotherapy, though safer, carry substantially higher recurrence risks and are best suited for mild disease or patients who are not surgical candidates. Treatment decisions should be individualized, with grade-based recommendations considered exploratory.
