{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T04:49:27Z","timestamp":1791607767228,"version":"4.3.4"},"reference-count":37,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004054","name":"King Abdulaziz University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004054","id-type":"DOI","asserted-by":"publisher"}]},{"id":[{"id":"https:\/\/ror.org\/02ma4wv74","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Hemorrhoidal dearterialization offers less postoperative pain and faster recovery than excisional hemorrhoidectomy, but prior meta-analyses pooled recurrence at predominantly 6\u201312-month follow-up; long-term durability has never been quantified. We compared recurrence at \u226524 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 \u226524 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\u2013Knapp 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\u201312.97) and in the 5 cohorts (RR 1.71, 95% CI 1.31\u20132.21); the combined estimate, weighted toward the cohorts, was RR 1.76 (95% CI 1.36\u20132.27; 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\u20134.81). 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\u20130.95) and fewer late complications (RR 0.19, 95% CI 0.04\u20130.85; 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.<\/jats:p>","DOI":"10.3390\/jcm15197606","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T15:20:59Z","timestamp":1790781659000},"page":"7606","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-Term Recurrence After Transanal Hemorrhoidal Dearterialization Versus Excisional and Stapled Surgery for Hemorrhoidal Disease: A Systematic Review and Meta-Analysis of Studies with \u226524 Months of Follow-Up"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6893-537X","authenticated-orcid":false,"given":"Moaz W.","family":"Abulfaraj","sequence":"first","affiliation":[{"name":"Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghader","family":"Jamjoom","sequence":"additional","affiliation":[{"name":"Department of General Surgery, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1574-7871","authenticated-orcid":false,"given":"Sultan","family":"Almuallem","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghada H.","family":"Postaji","sequence":"additional","affiliation":[{"name":"College of Medicine, Ibn Sina National College for Medical Studies, Jeddah 22421, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taibeh S.","family":"Alamoudi","sequence":"additional","affiliation":[{"name":"College of Medicine, Ibn Sina National College for Medical Studies, Jeddah 22421, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doaa A.","family":"Halawani","sequence":"additional","affiliation":[{"name":"College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah 21423, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juri M.","family":"Alhazmi","sequence":"additional","affiliation":[{"name":"College of Medicine, Ibn Sina National College for Medical Studies, Jeddah 22421, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mrwan M.","family":"Almutairi","sequence":"additional","affiliation":[{"name":"Faculty of Medical Sciences, University of Groningen, 9713 GZ Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murad","family":"Aljiffry","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2009","DOI":"10.3748\/wjg.v18.i17.2009","article-title":"Hemorrhoids: From basic pathophysiology to clinical management","volume":"18","author":"Lohsiriwat","year":"2012","journal-title":"World J. Gastroenterol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1097\/DCR.0000000000001030","article-title":"The ASCRS clinical practice guidelines for the management of hemorrhoids","volume":"61","author":"Davis","year":"2018","journal-title":"Dis. Colon Rectum"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1080\/110241502321116505","article-title":"Long-term results of haemorrhoidectomy","volume":"168","author":"Johannsson","year":"2002","journal-title":"Eur. J. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1007\/s10151-020-02149-1","article-title":"Consensus statement of the Italian Society of Colorectal Surgery (SICCR): Management and treatment of hemorrhoidal disease","volume":"24","author":"Gallo","year":"2020","journal-title":"Tech. Coloproctol."},{"key":"ref_5","first-page":"610","article-title":"A novel therapy for internal hemorrhoids: Ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter","volume":"90","author":"Morinaga","year":"1995","journal-title":"Am. J. Gastroenterol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"O10","DOI":"10.1111\/codi.12779","article-title":"Doppler-guided transanal haemorrhoidal dearterialization for haemorrhoids: Results from a multicentre trial","volume":"17","author":"Ratto","year":"2015","journal-title":"Colorectal Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1002\/bjs.9913","article-title":"Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids","volume":"102","author":"Simillis","year":"2015","journal-title":"Br. J. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00384-018-3187-3","article-title":"Transanal hemorrhoidal dearterialization (THD) versus stapled hemorrhoidopexy (SH) in treatment of internal hemorrhoids: A systematic review and meta-analysis of randomized clinical trials","volume":"34","author":"Emile","year":"2019","journal-title":"Int. J. Colorectal Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1007\/s10151-016-1551-2","article-title":"Transanal hemorrhoidal dearterialization with mucopexy versus open hemorrhoidectomy: A meta-analysis of randomized control trials","volume":"20","author":"Xu","year":"2016","journal-title":"Tech. Coloproctol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1159\/000540256","article-title":"Conventional excisional haemorrhoidectomy versus transanal haemorrhoidal dearterialization for haemorrhoids: A systematic review and meta-analysis","volume":"41","author":"Jee","year":"2024","journal-title":"Dig. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1007\/s10151-023-02855-6","article-title":"Comparison of the efficacy and safety of different surgical procedures for patients with hemorrhoids: A network meta-analysis","volume":"27","author":"Yuan","year":"2023","journal-title":"Tech. Coloproctol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"287","DOI":"10.3393\/ac.2023.00871.0124","article-title":"The Italian Unitary Society of Colon-Proctology (Societ\u00e0 Italiana Unitaria di Colonproctologia) guidelines for the management of acute and chronic hemorrhoidal disease","volume":"40","author":"Brillantino","year":"2024","journal-title":"Ann. Coloproctol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1007\/s13304-025-02460-2","article-title":"Global knowledge mapping and technological evolution in hemorrhoid therapy: A multi-tool bibliometric analysis","volume":"78","author":"Chen","year":"2026","journal-title":"Updat. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e818","DOI":"10.1097\/DCR.0000000000002272","article-title":"Transanal hemorrhoidal dearterialization with mucopexy versus vessel-sealing device hemorrhoidectomy for grade III to IV hemorrhoids: Long-term outcomes from the THDLIGA randomized controlled trial","volume":"66","author":"Trenti","year":"2023","journal-title":"Dis. Colon Rectum"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e1254","DOI":"10.1097\/DCR.0000000000002885","article-title":"Excisional hemorrhoidectomy versus dearterialization with mucopexy for the treatment of grade III hemorrhoidal disease: The EMODART3 multicenter study","volume":"66","author":"Giuliani","year":"2023","journal-title":"Dis. Colon Rectum"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1097\/SLA.0000000000005961","article-title":"Transanal hemorrhoidal dearterialization with mucopexy versus Ferguson hemorrhoidectomy: A multicenter prospective study","volume":"278","author":"Gachabayov","year":"2023","journal-title":"Ann. Surg."},{"key":"ref_17","first-page":"znaf282","article-title":"Open excisional haemorrhoidectomy versus transanal haemorrhoidal dearterialization for grade III haemorrhoids: Open-label randomized clinical trial","volume":"113","author":"Sarubbo","year":"2026","journal-title":"Br. J. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1097\/DCR.0000000000000085","article-title":"A prospective, randomized trial comparing the short- and long-term results of Doppler-guided transanal hemorrhoid dearterialization with mucopexy versus excision hemorrhoidectomy for grade III hemorrhoids","volume":"57","author":"Capretti","year":"2014","journal-title":"Dis. Colon Rectum"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1007\/s10151-014-1219-8","article-title":"Hemorrhoidal dearterialization with mucopexy versus hemorrhoidectomy: 3-year follow-up assessment of a randomized controlled trial","volume":"18","author":"Denoya","year":"2014","journal-title":"Tech. Coloproctol."},{"key":"ref_21","first-page":"145","article-title":"Transanal hemorrhoidal dearterialization versus Milligan\u2013Morgan hemorrhoidectomy in grade III\/IV hemorrhoids","volume":"90","author":"Genova","year":"2019","journal-title":"Ann. Ital. Chir."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1177\/1553350618761757","article-title":"Transanal hemorrhoidal dearterialization versus stapled hemorrhoidopexy: Long-term follow-up of a randomized trial","volume":"25","author":"Giarratano","year":"2018","journal-title":"Surg. Innov."},{"key":"ref_23","first-page":"365","article-title":"Stapled anopexy versus transanal haemorrhoidal dearterialisation for haemorrhoids: A randomized study","volume":"71","author":"Venturi","year":"2016","journal-title":"Minerva Chir."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Popov, V., Yonkov, A., Arabadzhieva, E., Zhivkov, E., Bonev, S., Bulanov, D., Tasev, V., Korukov, G., Simonova, L., and Kandilarov, N. (2019). Doppler-guided transanal hemorrhoidal dearterilization versus conventional hemorrhoidectomy for treatment of hemorrhoids\u2014Early and long-term postoperative results. BMC Surg., 19.","DOI":"10.1186\/s12893-019-0469-9"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Symeonidis, D., Spyridakis, M., Zacharoulis, D., Tzovaras, G., Samara, A.A., Valaroutsos, A., Diamantis, A., and Tepetes, K. (2022). Milligan\u2013Morgan hemorrhoidectomy vs. hemorrhoid artery ligation and recto-anal repair: A comparative study. BMC Surg., 22.","DOI":"10.1186\/s12893-022-01861-z"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1886","DOI":"10.1007\/s11605-016-3220-1","article-title":"Doppler-guided transanal hemorrhoidal dearterialization versus stapled hemorrhoidopexy: Long-term follow-up","volume":"20","author":"Leardi","year":"2016","journal-title":"J. Gastrointest. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1007\/s13304-025-02202-4","article-title":"The comparison of Doppler-guided haemorrhoidal artery ligation and the tissue selecting technique for patients with grade III\/IV haemorrhoids: A retrospective cohort study","volume":"77","author":"Liu","year":"2025","journal-title":"Updat. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"118","DOI":"10.3393\/ac.2017.09.04","article-title":"Transanal hemorrhoidal dearterialization with Doppler arterial identification versus classic hemorrhoidectomy: A retrospective analysis of 270 patients","volume":"35","author":"Consalvo","year":"2019","journal-title":"Ann. Coloproctol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1007\/s00384-024-04603-0","article-title":"Long-term results and quality of life after stapled hemorrhoidopexy vs Doppler-guided HAL-RAR: A propensity score matching analysis","volume":"39","author":"Lauricella","year":"2024","journal-title":"Int. J. Colorectal Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1007\/s10151-017-1726-5","article-title":"Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: A single-center study on 1000 consecutive cases and a review of the literature","volume":"21","author":"Ratto","year":"2017","journal-title":"Tech. Coloproctol."},{"key":"ref_31","first-page":"e1421","article-title":"Effect of Doppler-guided hemorrhoidal artery ligation technique and mucopexy on posttreatment symptoms in hemorrhoidal disease","volume":"36","author":"Benli","year":"2026","journal-title":"Surg. Laparosc. Endosc. Percutan. Tech."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1007\/s10151-026-03291-y","article-title":"Milligan-Morgan hemorrhoidectomy, mucopexy, and hybrid combination for grade III hemorrhoids: A large retrospective cohort study","volume":"30","author":"Gallo","year":"2026","journal-title":"Tech. Coloproctol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2484","DOI":"10.1097\/DCR.0000000000004372","article-title":"Five-year follow-up of the double-blinded randomized controlled trial comparing laser hemorrhoidoplasty with sutured mucopexy and excisional hemorrhoidectomy","volume":"69","author":"Makunaite","year":"2026","journal-title":"Dis. Colon Rectum"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e70163","DOI":"10.1111\/codi.70163","article-title":"Haemorrhoidal artery ligation: Is Doppler guidance useful? A systematic review and meta-analysis of randomized controlled trials","volume":"27","author":"Tutino","year":"2025","journal-title":"Colorectal Dis."},{"key":"ref_35","first-page":"109","article-title":"Long-term impact of haemorrhoidal artery ligation on anal function and continence","volume":"119","author":"Anwar","year":"2026","journal-title":"Ir. Med. J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1097\/DCR.0000000000001234","article-title":"Hemorrhoidal Disease Symptom Score and Short Health ScaleHD: New tools to evaluate symptoms and health-related quality of life in hemorrhoidal disease","volume":"62","author":"Styr","year":"2019","journal-title":"Dis. Colon Rectum"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e113469","DOI":"10.1136\/bmjopen-2025-113469","article-title":"Comparing the effectiveness and safety of different surgical procedures for haemorrhoids: A protocol for systematic evaluation and network meta-analysis of randomised controlled trials","volume":"16","author":"Li","year":"2026","journal-title":"BMJ Open"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7606\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T04:11:49Z","timestamp":1791605509000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7606"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":37,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["jcm15197606"],"URL":"https:\/\/doi.org\/10.3390\/jcm15197606","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]}}}