{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T04:59:53Z","timestamp":1790830793848,"version":"4.1.0"},"reference-count":64,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Conventional excisional haemorrhoidectomy remains the gold standard treatment for grade IV haemorrhoids, although energy\u2010based devices may reduce postoperative pain. We performed a systematic review and meta\u2010analysis of randomised controlled trials comparing LigaSure with conventional haemorrhoidectomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A systematic search of PubMed, Scopus, Web of Science and the Cochrane Central Register was performed up to July 2025. Randomised controlled trials comparing LigaSure with conventional techniques were included. Pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random\u2010effects models. Heterogeneity was assessed with the I\n                      <jats:sup>2<\/jats:sup>\n                      statistic, and trial sequential analysis (TSA) was applied to assess conclusiveness.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Forty\u2010three unique RCTs comprising 3,277 participants were analysed. LigaSure was associated with lower postoperative pain scores on days 1 and 2 and during the first and second postoperative weeks, reduced analgesic requirements and intraoperative blood loss, shorter operating time and time to return to daily activities, and lower risks of postoperative wound discharge, postoperative bleeding and acute urinary retention. No statistically significant differences were observed in immediate postoperative pain, pain on postoperative day 3 or week 4, recurrence, length of hospital stay, constipation, pruritus, surgical site infection, incomplete healing, anal fissure, anal stenosis, or faecal incontinence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>LigaSure was associated with improvements in selected early perioperative outcomes, particularly postoperative pain and return to daily activities. However, uncertainty remains for several outcomes, and evidence regarding recurrence and other long\u2010term anorectal outcomes remains limited.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/codi.70641","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T04:20:35Z","timestamp":1790828435000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["<scp>LigaSure<\/scp>\n                    versus conventional excisional haemorrhoidectomy: A systematic review and meta\u2010analysis with trial sequential analysis of randomised controlled trials"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6086-4240","authenticated-orcid":false,"given":"Gabriel Leal","family":"Barone","sequence":"first","affiliation":[{"name":"University of S\u00e3o Caetano do Sul  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2960-3810","authenticated-orcid":false,"given":"Bernardo Fontel","family":"Pompeu","sequence":"additional","affiliation":[{"name":"University of S\u00e3o Caetano do Sul  S\u00e3o Paulo Brazil"},{"name":"Department of Colorectal Surgery Heliopolis Hospital  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7687-3073","authenticated-orcid":false,"given":"Lucas Monteiro","family":"Delgado","sequence":"additional","affiliation":[{"name":"Federal University of Minas Gerais  Belo Horizonte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2881-1305","authenticated-orcid":false,"given":"Giulia Luiza","family":"Garcia","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Heliopolis Hospital  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8139-3963","authenticated-orcid":false,"given":"Patr\u00edcia","family":"Viana","sequence":"additional","affiliation":[{"name":"University of the Extreme South of Santa Catarina  Crici\u00fama Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1303-298X","authenticated-orcid":false,"given":"Claudia","family":"Theis","sequence":"additional","affiliation":[{"name":"Department of Surgery University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2986-8164","authenticated-orcid":false,"given":"Sergio Mazzola Poli","family":"de Figueiredo","sequence":"additional","affiliation":[{"name":"Department of Surgery University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7225-7145","authenticated-orcid":false,"given":"Fernanda Bellotti","family":"Formiga","sequence":"additional","affiliation":[{"name":"University of S\u00e3o Caetano do Sul  S\u00e3o Paulo Brazil"},{"name":"Department of Colorectal Surgery Hospital of Santa Casa de Misericordia  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.70749\/ijbr.v3i5.819"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.37506\/v20\/il\/2020\/mlu\/194486"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.53350\/pjmhs20221611235"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10350\u2010007\u20109171\u20106"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.12669\/pjms.323.9976"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.45015"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151\u2010008\u20100426\u20106"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.142.12.1209"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10350\u2010008\u20109214\u20107"},{"issue":"93","key":"e_1_2_11_11_1","first-page":"66","article-title":"Randomised clinical trial comparing ligasure hemorrhoidectomy with conventional hemorrhoidectomy","volume":"22","author":"Bouini N","year":"2012","journal-title":"J Mazandaran Univ Med Sci"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384\u2010009\u20100715\u20101"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10350\u2010004\u20106501\u20109"},{"issue":"10","key":"e_1_2_11_14_1","first-page":"58","article-title":"Comparative study to outcome of conventional versus Ligasure Hemorrhoidectomy","volume":"15","author":"El Hefny AM","year":"2019","journal-title":"J Am Sci"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.4103\/1110\u20102098.155930"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151\u2010009\u20100520\u20104"},{"issue":"8","key":"e_1_2_11_17_1","first-page":"495","article-title":"A prospective study comparing ligasure and open hemorrhoidectomy","volume":"69","author":"Fazeli MS","year":"2011","journal-title":"Tehran Univ Med J"},{"issue":"1","key":"e_1_2_11_18_1","article-title":"LigaSure\u2010assisted versus diathermy day case haemorroidectomy: a randomized controlled trial","volume":"14","author":"Fok KL","year":"2008","journal-title":"Ambul Surg [Internet]"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384\u2010011\u20101216\u20106"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10350\u2010004\u20106754\u20103"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.5402\/2011\/467258"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.5455\/ijsm.hemorrhoids\u2010ligasure"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1159\/000381754"},{"issue":"1","key":"e_1_2_11_24_1","first-page":"26","article-title":"Conventional Ferguson's versus ligasure hemorrhoidectomy: our long\u2010term results in patients with symptomatic hemorrhoids","volume":"18","author":"Gunes ME","year":"2013","journal-title":"Surg Chron"},{"key":"e_1_2_11_25_1","unstructured":"HamdyASA.Conventional hemorrhoidectomy versus Ligasure hemorrhoidectomy: a comparative study.2018.https:\/\/doi.org\/10.12816\/0046611"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.0007\u20101323.2002.02056.x"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12262\u2010010\u20100192\u20103"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s101510200038"},{"key":"e_1_2_11_29_1","unstructured":"MohamedHAS.Comparative study between conventional and Ligasure hemorrhoidectomy.2020."},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.5904"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.21608\/aimj.2022.108381.1694"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.53350\/pjmhs22164437"},{"issue":"4","key":"e_1_2_11_33_1","first-page":"453","article-title":"Closed vs ligasure hemorrhoidectomy: a prospective, randomized clinical trial","volume":"89","author":"Pattana\u2010Arun J","year":"2006","journal-title":"J Med Assoc Thail"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.5812\/ircmj.10180"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463\u20101318.2005.00817.x"},{"key":"e_1_2_11_36_1","unstructured":"RaslanMM.Comparison of outcome of LigaSure hemorrhoidectomy with conventional Milligan\u2010Morgan hemorrhoidectomy.2019."},{"key":"e_1_2_11_37_1","first-page":"377","article-title":"Comparison of open Hemorrhoidectomy versus Ligasure Hemorrhoidectomy","volume":"27","author":"Rehman A","year":"2021","journal-title":"Ann King Edward Med Univ Lahore Pak"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151\u2010009\u20100549\u20104"},{"key":"e_1_2_11_39_1","unstructured":"ShafiA.Comparison of perioperative outcomes: conventional Milligan Morgan hemorrhoidectomy versus Ligasure assisted hemorrhoidectomy.2023."},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/ans.12838"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151\u2010008\u20100405\u2010y"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.5174\/tutfd.2010.03074.2"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1080\/110241502321116497"},{"key":"e_1_2_11_44_1","doi-asserted-by":"crossref","unstructured":"TurkiAM.Early and late surgical outcomes after LigaSure and conventional diathermy hemorrhoidectomy: a comparative randomized study.2018.","DOI":"10.21608\/asjs.2018.178384"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.18535\/jmscr\/v6i9.132"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.14260\/jemds\/2018\/915"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010005\u20100297\u20101"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_11_49_1","unstructured":"BaroneG.LigaSure hemorrhoidectomy versus conventional techniques (Milligan\u2010Morgan and Ferguson): a systematic review and meta\u2010analysis of randomized controlled trials. PROSPERO.2025; CRD420251184254."},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_2_11_51_1","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1002\/9781119536604.ch13","volume-title":"Cochrane handbook for systematic reviews of interventions [Internet]","author":"Page MJ","year":"2019"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.315.7109.629"},{"key":"e_1_2_11_53_1","doi-asserted-by":"publisher","DOI":"10.1177\/0962280216669183"},{"key":"e_1_2_11_54_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102288\u201014\u2010135"},{"key":"e_1_2_11_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/0197\u20102456(86)90046\u20102"},{"key":"e_1_2_11_56_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1221"},{"key":"e_1_2_11_57_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.14705"},{"key":"e_1_2_11_58_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.66430"},{"key":"e_1_2_11_59_1","doi-asserted-by":"publisher","DOI":"10.1136\/ijgc\u20102018\u2010000131"},{"key":"e_1_2_11_60_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00595\u2010009\u20104234\u2010z"},{"key":"e_1_2_11_61_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v18.i17.2009"},{"key":"e_1_2_11_62_1","doi-asserted-by":"publisher","DOI":"10.17795\/jjhr\u201034119"},{"key":"e_1_2_11_63_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.70321"},{"key":"e_1_2_11_64_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12893\u2010025\u201002819\u20107"},{"key":"e_1_2_11_65_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000000792"}],"container-title":["Colorectal Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/codi.70641","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/codi.70641","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/codi.70641","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T04:20:42Z","timestamp":1790828442000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/codi.70641"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":64,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/codi.70641"],"URL":"https:\/\/doi.org\/10.1111\/codi.70641","archive":["Portico"],"relation":{},"ISSN":["1462-8910","1463-1318"],"issn-type":[{"value":"1462-8910","type":"print"},{"value":"1463-1318","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]},"assertion":[{"value":"2026-03-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70641"}}