Hemorrhoids: From basic pathophysiology to clinical management

Table 2 Selected meta-analyses showing various treatment options for hemorrhoidal disease (in order of publication year)

Authors	Characteristics of comparative studies	Number of trials (total cases)	Results
Johanson et al[23]	IC, IS and RBL	5 (863)	RBL had greater long-term efficacy, but led to a higher incidence of post-treatment pain. IC was associated with both fewer and less severe complications
MacRae et al[24]	IC, IS, RBL, manual anal dilation and hemorrhoidectomy	18 (1952)1	Hemorrhoidectomy was more effective than manual anal dilation and RBL, but more pain and complications. RBL had greater efficacy than IS for treating grade I-III hemorrhoids, with no difference in the complication rate. Patients treated with IC or IS were more likely to require further therapy
Shanmugam et al[25]	RBL vs hemorrhoidectomy	3 (202)	Hemorrhoidectomy was superior to RBL for the long-term treatment of grade III, not grade II, hemorrhoids. Although hemorrhoidectomy had more pain, higher complications and more time off work, patient satisfaction and acceptance of the two treatment modalities seems to be similar
Alonso-Coello et al[26]	Fiber vs no therapy	7 (378)	Fiber reduced the risk of bleeding and persisting by 50% and 47%, respectively, but it had no significant effect on pain and prolapse
Alonso-Coello et al[27]	Oral flavonoids vs placebo or no therapy	14 (1514)	Flavonoids reduced the risk of bleeding, pain, persisting symptoms and recurrence by 67%, 65%, 58% and 47%, respectively
Ho et al[28]	Closed vs open hemorrhoidectomy	6 (686)	Closed hemorrhoidectomy had faster wound healing but longer operating time. There was no difference in treatment efficacy, pain, complication and hospital stay between the two operations
Nienhuijs et al[29]	Conventional vs ligasure hemorrhoidectomy	12 (1142)	Ligasure hemorrhoidectomy resulted in significantly shorter operative time, less early postoperative pain, earlier recovery, without any difference in recurrent bleeding or incontinence
Burch et al[30]	Hemorrhoidectomy vs SH	27 (2279)	SH had less postoperative pain, shorter operative time, shorter hospital stay, and shorter convalescence, but a higher rate of prolapse and reintervention for prolapse
Giordano et al[31]	Hemorrhoidectomy vs SH (minimum follow-up of 1 yr)	15 (1201)	SH had a significantly higher incidence of recurrences and additional operations
Gan et al[32]	Various TCMH vs another TCMH or Western medicines	9 (1822)	TCMHs significantly improved overall symptoms and bleeding as well as decreased the inflammation of perianal mucosa

¹With available detailed data on the patients enrolled. IC: Infrared coagulation; IS: Injection sclerotherapy; RBL: Rubber band ligation; SH: Stapled hemorrhoidopexy; TCMH: Traditional Chinese medicinal herbs.