Laser hemorrhoidoplasty versus LigaSure hemorrhoidectomy for grade II-IV hemorrhoidal disease: a systematic review and meta-analysis

BACKGROUND: Many surgical procedures have been developed to treat hemorrhoidal disease. Although conventional excisional techniques are effective, they are also associated with significant postoperative pain and longer recovery times. Consequently, newer techniques have been introduced to address these issues, including laser hemorrhoidoplasty (LHP) and LigaSure hemorrhoidectomy (LigH). This systematic review and meta-analysis aims to compare these two approaches in terms of perioperative outcomes and recurrence. METHODS: A comprehensive search was conducted across PubMed, Scopus, Web of Science, Cochrane Library, ClinicalTrials.gov, and Google Scholar, up to December 2025. We included all eligible studies involving adults with grade II-IV hemorrhoids. Primary outcomes included postoperative pain, time to return to routine activities, and recurrence. Secondary outcomes were operative time, length of hospital stay, and complications. The risk of bias was assessed using the RoB2 and ROBINS-I V2 tools. Meta-analyses were performed with a random-effects model. The certainty of evidence was evaluated using the GRADE approach. RESULTS: Data from 461 patients (213 LHP, 248 LigH) across five studies were analyzed. Patients in the LHP group reported significantly lower pain scores on postoperative day 1 (MD: - 1.61 points; p = 0.025), earlier return to routine activities (MD: -5.75 days; p = 0.0002), shorter operative time (MD: -6.5 min; p = 0.002), and shorter hospital stay (MD: -0.3 days; p < 0.0001) compared to the LigH group. Conversely, LigH demonstrated a significantly lower risk of recurrence (RD: 0.12; 95% CI: [0.05, 0.19]). No significant differences were observed regarding postoperative bleeding, wound infection, urinary retention, or thrombosis. CONCLUSION: LHP yields better perioperative outcomes, including less pain and faster recovery, making it a favorable option for patient comfort. However, LigH has lower recurrence rates. The certainty of evidence is very low. Further high-quality randomized trials are needed to confirm these results.