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 |
1
With 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.