{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T21:58:14Z","timestamp":1793656694353,"version":"4.5.1"},"reference-count":29,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>Haemorrhoidal arterial ligation (HAL) with or without mucopexy (recto\u2010anal repair, RAR) is a minimally invasive technique for the treatment of haemorrhoidal disease. It is still debated if it should be performed with Doppler guidance (DG\u2010HAL) or without. The primary aim of this study was to find evidence that the use of Doppler guidance reduces the risk of recurrence. The secondary aim was to evaluate the benefit of Doppler guidance on postoperative complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A comprehensive literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses (PRISMA) guidelines (2020). The population, intervention, comparison, outcomes and study design (PICOS) framework was used for eligibility criteria. Data were extracted independently by two reviewers for initial screening and for eligibility to be included in the meta\u2010analysis of randomized controlled trials. Random effects meta\u2010analysis, leave\u2010one\u2010out meta\u2010analysis and meta\u2010regression were performed to assess the main outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seven randomized controlled trials, published between 2008 and 2023, were selected. They included 514 patients (mean age 49.13\u2009years, 46% men) with different haemorrhoidal degrees. The HAL technique was performed in 255 patients and DG\u2010HAL in 259 patients. The meta\u2010analysis revealed that the DG\u2010HAL procedure was associated with a significant risk of recurrence (<jats:italic>P<\/jats:italic>\u2009=\u20090.007) and similar postoperative pain (<jats:italic>P<\/jats:italic>\u2009=\u20090.623) compared to the HAL procedure. In a subgroup analysis of patients treated with a combined RAR procedure, no differences were found between the DG\u2010HAL\u2010RAR and HAL\u2010RAR regarding the risk of recurrence (<jats:italic>P<\/jats:italic>\u2009=\u20090.36) and postoperative pain (<jats:italic>P<\/jats:italic>\u2009=\u20090.31).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In conclusion, this meta\u2010analysis did not find superiority of DG\u2010HAL over HAL with or without RAR in reducing postoperative complications and recurrence.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.70163","type":"journal-article","created":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T05:27:30Z","timestamp":1752730050000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Haemorrhoidal artery ligation: Is Doppler guidance useful? A systematic review and meta\u2010analysis of randomized controlled trials"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0891-4689","authenticated-orcid":false,"given":"Roberta","family":"Tutino","sequence":"first","affiliation":[{"name":"Department of General and Emergency Surgery AOU Citt\u00e0 Della Salute e Della Scienza di Torino  Torino Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6361-1111","authenticated-orcid":false,"given":"Arcangelo","family":"Picciariello","sequence":"additional","affiliation":[{"name":"Department of Experimental Medicine University of Salento  Lecce Italy"},{"name":"National Institute of Gastroenterology S. De Bellis, IRCSS Research Hospital  Castellana Grotte Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Santarelli","sequence":"additional","affiliation":[{"name":"Department of General and Emergency Surgery AOU Citt\u00e0 Della Salute e Della Scienza di Torino  Torino Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"De Simone","sequence":"additional","affiliation":[{"name":"Colorectal Surgery Unit, Faculty of Medicine and Surgery IRCSS San Raffaele Scientific Institute, Vita\u2010Salute University  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierluigi","family":"Lobascio","sequence":"additional","affiliation":[{"name":"Department of Surgery University Hospital of Bari  Bari Italy"},{"name":"Department of Medicine of Precision and Regenerative and Jonic Area (DiMePRe\u2010J) University Hospital of Bari  Bari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianfranco","family":"Cocorullo","sequence":"additional","affiliation":[{"name":"Department of Surgical, Oncological and Stomatological Disciplines University of Palermo  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Massani","sequence":"additional","affiliation":[{"name":"Division of General Surgery 1 Treviso Regional Hospital, AULSS 2 Marca Trevigiana  Treviso Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giusi","family":"Graziano","sequence":"additional","affiliation":[{"name":"CORESEARCH, Center for Outcomes Research and Clinical Epidemiology  Pescara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulio Aniello","family":"Santoro","sequence":"additional","affiliation":[{"name":"Third Referral Pelvic Floor Centre Treviso Regional Hospital, AULSS 2 Marca Trevigiana  Treviso 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