To evaluate the effectiveness and safety of procedure for prolapse and hemorrhoids (PPH) and Doppler-guided hemorrhoidal artery ligation (DGHAL) in the treatment of hemorrhoids by systematically analyzing the data of operation time, hospital stay, pain score, postoperative recurrence rate and related complication rates.

The full-text database of CNKI, Wanfang database, CBMdisc, Pubmed, Cochrane Library and Embase were retrieved from the date of their establishment to December 2020. All clinical studies of PPH and DGHAL in the treatment of hemorrhoids were collected. Two reviewers independently screened the literature and extracted the data, and analyzed the heterogeneity of the included studies.

A total of 1 316 patients were included in 14 studies, including 646 in PPH group and 670 in DGHAL group. Meta analysis showed that there were no significant differences between the two groups in terms of operative time (WMD=1.58, 95% CI: -2.40-5.55; P=0.44), bleeding (OR=1.75, 95% CI: 0.96-3.19; P=0.07) and urinary retention (OR=1.47, 95% CI: 0.91-2.38; P=0.11). There were significant differences in the length of hospital stay (WMD=1.39, 95% CI: 0.59-2.20; P=0.000 7), and 24-hour pain score (WMD=2.34, 95% CI: 1.10-3.58, P=0.000 2). The recurrence rate of DGHAL group was significantly higher (OR=0.62, 95% CI:0.43-0.88, P=0.007). The incidence of anal stenosis in PPH group was 13.68% (26/190), which was higher than that in DGHAL group (5.79%, 11/190) (OR=2.79, 95% CI: 1.31-5.98, P=0.008).

DGHAL therapy is associated with significantly less rectal stenosis rate, postoperative recovery and pain. However, PPH is better than DGHAL in the long-term efficacy.