Abstract / Summary
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.