Hemorrhoidal Artery Ligation (HAL) vs. Rubber Band Ligation (RBL) for Second- and Third-Degree Hemorrhoids: A Systematic Review and Meta-Analysis.

This systematic review investigates the outcomes of rubber band ligation (RBL) vs. hemorrhoidal artery ligation (HAL) for second and third-degree hemorrhoids. This review was designed, performed, and reported as per the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Literature databases, including PubMed, Cochrane, Science Direct, and Google Scholar, were searched for studies comparing rubber band ligation vs. hemorrhoidal artery ligation for second- and third-degree hemorrhoids. The primary outcome was the recurrence of hemorrhoids, while post-operative bleeding, post-operative pain, surgical site infection, and success rate were the secondary outcomes. The literature search and inclusion criteria identified five studies (n=953) comparing HAL (n=548) vs. RBL (n=405). The recurrence rate was higher in the RBL group (28.4%) compared to the HAL group (19.3%) (odds ratio {OR}: 0.57, p=0.001). The two groups showed comparable results regarding post-operative pain (OR: 0.77, p=0.77), post-operative bleeding (OR: 1.48, p=0.44), and surgical site infection (risk difference: 0.00, p=0.67). Moreover, the short-term success rate was 85% in HAL compared to 86% in RBL (p=0.71). Rubber band ligation and hemorrhoidal artery ligation showed comparable short-term outcomes regarding symptom treatment, post-operative bleeding, and pain. However, HAL was superior in terms of recurrence rate.