To compare the milligant-morgant hemorrhoidectomy (MMH), procedure for prolapse and hemorrhoids (PPH), tissue selecting therapy (TST) and Doppler-guided hemorrhoidal artery ligation (DG-HAL) in the treatment of hemorrhoids, and to provide evidence-based reference in clinic.

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. Randomized controlled trials (RCTs) about MMH, PPH, TST and DG-HAL in the treatmnet of hemorrhoids were collected. Meta-analysis was conducted by using GeMTC 0.14.3 statistical software.

A total of 45 RCTs were included, involving 5 847 patients. Compared with MMH, DG-HAL (MD=-4.16, 95% CI: -6.49, -1.82; P<0.05) and PPH (MD=2.28, 95% CI: 0.64, 3.89; P<0.05) could significantly reduce the degree of postoperative pain, the incidence of urinary retention after TST was significantly lower (OR=2.08, 95% CI: 1.23, 4.09; P<0.05). Compared with MMH (OR=0.01, 95% CI: 0, 0.15; P<0.05) and PPH (OR=0.08, 95% CI: 0, 0.78; P<0.05), the incidence of anal stenosis after DG-HAL was lower. PPH (OR=6.56, 95% CI: 1.20, 57.74; P<0.05) and TST (OR=58.25, 95% CI: 4.37, 2 605.94; P<0.05) had lower anal stenosis rates than MMH, TST was better than PPH (OR=8.50, 95% CI: 1.23, 150.91; P<0.05), with statistical significance. The order of probability were as follows: DA-HAL>TST>PPH>MMH in pain scores 24 hours after operation, MMH>PPH>TST>DA-HAL in postoperative bleeding, MMH>PPH>DA-HAL>TST in urinary retention, MMH>PPH>TST>DA-HAL in anal stenosis, DA-HAL>PPH>MMH>TST in recurrence rate.

The four surgical methods show their own advantages in the treatment of hemorrhoids. DG-HAL and TST have low incidence of postoperative complications such as pain, bleeding, urinary retention, anal stenosis and obvious advantages in postoperative comfort and safety. However, in terms of recurrence rate, TST is the best and DG-HAL is the worst.