Comparison of efficacy and safety between surgical and conservative treatments for hemorrhoids: a meta-analysis

Abstract

Objectives: Hemorrhoids, a common anorectal condition, can be managed through surgical or conservative treatments. The aim of this meta-analysis is to compare the efficacy and safety of surgical and conservative treatments for hemorrhoids.

Methods: A systematic search was conducted from of PubMed, Embase, the Cochrane Library, and Web of Science from their inception to September 25, 2024. Eligible studies compared surgical treatments with non-invasive conservative treatments in hemorrhoids. Statistical analyses included pooled odds ratios (ORs) and mean differences (MDs)/standard mean differences (SMDs) with 95% confidence intervals (CIs).

Results: Seven studies, including 760 patients, were analyzed. Surgery achieved higher rates of complete symptom resolution than conservative therapy (OR = 2.96, 95% CI: 1.66-5.28, p < 0.001). Overall pain scores favored surgery (SMD = -0.93, 95% CI: 1.73 to -0.13, p = 0.02). Subgroup analysis showed clear superiority within four days (SMD = -1.26, 95% CI -1.84 to -0.68) but parity beyond ten days (SMD = 0.00, 95% CI -0.44 to 0.44; p = 0.99). Comparable patterns were observed in pregnant women with thrombosed external hemorrhoids. Rates of postoperative bleeding (OR: 1.09; 95% CI: 0.42 to 2.82, p = 0.86; I2 = 41%, p = 0.15) and urinary retention (OR: 1.75; 95% CI: 0.30 to 10.31, p = 0.54; I2 = 45%, p = 0.18) did not differ significantly between groups. Surgical-specific adverse events were infrequent (incontinence 3%, persistent pain 5%, watery discharge 6%). Surgery shortened recovery in pregnant thrombosed cases by approximately seven days (MD: -6.80; 95% CI: -7.64 to -5.96, p < 0.001; I2 = 55%, p = 0.14) and reduced overall recurrence (95% CI: 0.10 to 0.37, p < 0.001; I2 = 0%, p = 0.97).

Conclusion: Surgical treatments provide superior symptom relief, faster recovery, and lower recurrence but with some specific post-treatment complications, while conservative treatments are safer and less invasive but with provides slower symptom relief and higher recurrence rates. Individualized treatment should consider symptom severity, patient preferences, and risk tolerance.

Keywords: Conservative treatment; Hemorrhoids; Meta-Analysis; Surgical treatment.

Fig. 1

PRISMA flowchat for the selected studies

Fig. 2

Risk of bias assessment. A Risk of bias graph; B risk of bias summary

Fig. 3

Comparative efficacy of surgical and conservative treatments in achieving asymptomatic status and pain reduction (A) number of patients asymptomatic; (B) pain scores

Fig. 4

Comparison of post-treatment bleeding and recurrence rate between surgical and conservative treatments (A) Bleeding; (B) Recurrence rates