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.

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.