Long-Term Recurrence After Transanal Hemorrhoidal Dearterialization Versus Excisional and Stapled Surgery for Hemorrhoidal Disease: A Systematic Review and Meta-Analysis of Studies with ≥24 Months of Follow-Up.
5 affiliations
- 1Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
- 2Department of General Surgery, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
- 3College of Medicine, Ibn Sina National College for Medical Studies, Jeddah 22421, Saudi Arabia.
- 4College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah 21423, Saudi Arabia.
- 5Faculty of Medical Sciences, University of Groningen, 9713 GZ Groningen, The Netherlands.
Abstract
Background/Objectives: Hemorrhoidal dearterialization offers less postoperative pain and faster recovery than excisional hemorrhoidectomy, but prior meta-analyses pooled recurrence at predominantly 6-12-month follow-up; long-term durability has never been quantified. We compared recurrence at ≥24 months after dearterialization versus excisional hemorrhoidectomy and stapled hemorrhoidopexy or anopexy. Methods: Five databases were searched up to 19 August 2026 (PROSPERO CRD420261362253). Randomized trials and comparative cohorts of dearterialization reporting recurrence with ≥24 months of follow-up in both arms were eligible. Screening, extraction, and risk-of-bias assessment were performed in duplicate; random-effects risk ratios (RR) were pooled separately by study design and comparator class, with Hartung-Knapp and continuity-correction sensitivity analyses. Results: Thirteen studies were included (6 randomized trials, 7 cohorts; 3283 patients). Versus excisional hemorrhoidectomy, recurrence was higher after dearterialization in the 4 randomized trials (241 patients, 12 events; RR 3.67, 95% CI 1.04-12.97) and in the 5 cohorts (RR 1.71, 95% CI 1.31-2.21); the combined estimate, weighted toward the cohorts, was RR 1.76 (95% CI 1.36-2.27; crude recurrence 12.1% vs. 6.5%). Versus stapled techniques (4 studies, 521 patients), the difference was not significant (RR 2.07, 95% CI 0.89-4.81). Recurrences after dearterialization clustered in grade IV disease (21.5% vs. 4.2% for grade III). Dearterialization had fewer overall complications (RR 0.76, 95% CI 0.60-0.95) and fewer late complications (RR 0.19, 95% CI 0.04-0.85; 9 events). Conclusions: At two or more years, dearterialization is associated with higher recurrence than excisional hemorrhoidectomy; the randomized evidence is imprecise, and the combined estimate is supportive rather than definitive. Recurrence after dearterialization clustered in grade IV disease, and late morbidity may be lower; both findings are descriptive. Long-term evidence versus stapled techniques remains limited. These findings may help inform patient counseling on the trade-off between durability and largely irreversible harms.
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BibTeX
@article{abulfaraj2026longterm,
title = {{Long-Term Recurrence After Transanal Hemorrhoidal Dearterialization Versus Excisional and Stapled Surgery for Hemorrhoidal Disease: A Systematic Review and Meta-Analysis of Studies with ≥24 Months of Follow-Up.}},
author = {Moaz W Abulfaraj and Ghader Jamjoom and Sultan Almuallem and Ghada H Postaji and Taibeh S Alamoudi and Doaa A Halawani and Juri M Alhazmi and Mrwan M Almutairi and Murad Aljiffry},
journal = {Journal of clinical medicine},
year = {2026},
month = sep,
doi = {10.3390/jcm15197606},
url = {https://europepmc.org/article/MED/42882067},
note = {CC BY},
}
RIS
TY - JOUR
TI - Long-Term Recurrence After Transanal Hemorrhoidal Dearterialization Versus Excisional and Stapled Surgery for Hemorrhoidal Disease: A Systematic Review and Meta-Analysis of Studies with ≥24 Months of Follow-Up.
AU - Moaz W Abulfaraj
AU - Ghader Jamjoom
AU - Sultan Almuallem
AU - Ghada H Postaji
AU - Taibeh S Alamoudi
AU - Doaa A Halawani
AU - Juri M Alhazmi
AU - Mrwan M Almutairi
AU - Murad Aljiffry
PY - 2026
DA - 2026/09/30
JO - Journal of clinical medicine
DO - 10.3390/jcm15197606
UR - https://europepmc.org/article/MED/42882067
AB - Background/Objectives: Hemorrhoidal dearterialization offers less postoperative pain and faster recovery than excisional hemorrhoidectomy, but prior meta-analyses pooled recurrence at predominantly 6-12-month follow-up; long-term durability has never been quantified. We compared recurrence at ≥24 months after dearterialization versus excisional hemorrhoidectomy and stapled hemorrhoidopexy or anopexy. Methods: Five databases were searched up to 19 August 2026 (PROSPERO CRD420261362253). Randomized trials and comparative cohorts of dearterialization reporting recurrence with ≥24 months of follow-up in both arms were eligible. Screening, extraction, and risk-of-bias assessment were performed in duplicate; random-effects risk ratios (RR) were pooled separately by study design and comparator class, with Hartung-Knapp and continuity-correction sensitivity analyses. Results: Thirteen studies were included (6 randomized trials, 7 cohorts; 3283 patients). Versus excisional hemorrhoidectomy, recurrence was higher after dearterialization in the 4 randomized trials (241 patients, 12 events; RR 3.67, 95% CI 1.04-12.97) and in the 5 cohorts (RR 1.71, 95% CI 1.31-2.21); the combined estimate, weighted toward the cohorts, was RR 1.76 (95% CI 1.36-2.27; crude recurrence 12.1% vs. 6.5%). Versus stapled techniques (4 studies, 521 patients), the difference was not significant (RR 2.07, 95% CI 0.89-4.81). Recurrences after dearterialization clustered in grade IV disease (21.5% vs. 4.2% for grade III). Dearterialization had fewer overall complications (RR 0.76, 95% CI 0.60-0.95) and fewer late complications (RR 0.19, 95% CI 0.04-0.85; 9 events). Conclusions: At two or more years, dearterialization is associated with higher recurrence than excisional hemorrhoidectomy; the randomized evidence is imprecise, and the combined estimate is supportive rather than definitive. Recurrence after dearterialization clustered in grade IV disease, and late morbidity may be lower; both findings are descriptive. Long-term evidence versus stapled techniques remains limited. These findings may help inform patient counseling on the trade-off between durability and largely irreversible harms.
SN - 2077-0383
ER -