# Long-term outcomes of stapled haemorrhoidopexy versus conventional haemorrhoidectomy: An updated systematic review, meta-analysis and trial-sequential analysis of randomized controlled trials

## TL;DR

Stapled haemorrhoidopexy has higher long-term recurrence rates than conventional haemorrhoidectomy, though short-term recovery is better.

## Contribution

This study provides updated evidence comparing long-term outcomes of stapled haemorrhoidopexy and conventional haemorrhoidectomy using systematic review and trial-sequential analysis.

## Key findings

- Stapled haemorrhoidopexy has a higher risk of overall recurrence compared to conventional haemorrhoidectomy.
- Prolapse-related recurrence is significantly more frequent after stapled haemorrhoidopexy.
- Long-term pain, functional outcomes, and quality of life are comparable between the two procedures.

## Abstract

Stapled haemorrhoidopexy (SH) offers well-established short-term advantages over conventional haemorrhoidectomy (CH), but its long-term effectiveness remains controversial. This systematic review and meta-analysis aimed to compare long-term outcomes of SH versus CH in adult patients with grade II–IV haemorrhoids, incorporating Trial Sequential Analysis (TSA).

MEDLINE, EMBASE and CENTRAL were searched from January 2001 to October 2025 for randomized controlled trials (RCTs) comparing SH and CH with a minimum follow-up of 12 months. Two reviewers independently performed study selection, data extraction and risk-of-bias assessment (RoB-2). Primary outcomes included recurrence, reintervention, anal function, and quality of life (QoL). Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effects models. TSA was applied to overall recurrence.

Seventeen RCTs including 1,041 SH and 1,031 CH patients were analysed. SH was associated with a higher risk of overall recurrence compared with CH (RR = 1.56,95%CI = 1.00–2.44;I2 = 48%). TSA showed that the accrued information size (1,913 patients) did not reach the required information size (2,608 patients), indicating that current evidence remains underpowered. Prolapse-related recurrence was significantly more frequent after SH (RR = 3.28,95%CI = 1.49–7.25;I2 = 12%), whereas bleeding-related recurrence did not differ between groups (RR = 1.20,95%CI = 0.63–2.26;I2 = 23%). No significant differences were found for reintervention, persistent anal pain, functional impairment or QoL.

SH is associated with a higher risk of long-term recurrence, particularly prolapse-related recurrence, compared with CH, while long-term pain, functional outcomes and QoL appear broadly comparable. These findings suggest that, although SH may remain an option for selected patients, CH provides more durable anatomical correction, and procedural choice should balance early recovery against long-term durability.

The online version contains supplementary material available at 10.1007/s00384-026-05080-3.