Evidence map›Paper›PMID 40665575›Full record

SynthesisColorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland2025

Haemorrhoidal artery ligation: Is Doppler guidance useful? A systematic review and meta-analysis of randomized controlled trials.

Roberta Tutino, Arcangelo Picciariello, Mauro Santarelli, Veronica De Simone, Pierluigi Lobascio, Gianfranco Cocorullo, Marco Massani, Giusi Graziano, Giulio Aniello Santoro, Gaetano Gallo

Abstract readMeta-AnalysisSystematic Review
In one paragraph

Synthesis in Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Haemorrhoidal artery ligation: Is Doppler guidance useful? A systematic review and meta-analysis of randomized controlled trials.Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland · 2025
    Pooled it
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Roberta TutinoDepartment of General and Emergency Surgery, AOU Città Della Salute e Della Scienza di Torino, Torino, Italy.ORCID https://orcid.org/0000-0002-0891-4689
Arcangelo PicciarielloDepartment of Experimental Medicine, University of Salento, Lecce, Italy.ORCID https://orcid.org/0000-0002-6361-1111
Mauro SantarelliDepartment of General and Emergency Surgery, AOU Città Della Salute e Della Scienza di Torino, Torino, Italy.
Veronica De SimoneColorectal Surgery Unit, Faculty of Medicine and Surgery, IRCSS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
Pierluigi LobascioDepartment of Surgery, University Hospital of Bari, Bari, Italy.
Gianfranco CocorulloDepartment of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy.
Marco MassaniDivision of General Surgery 1, Treviso Regional Hospital, AULSS 2 Marca Trevigiana, Treviso, Italy.
Giusi GrazianoCORESEARCH, Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy.
Giulio Aniello SantoroThird Referral Pelvic Floor Centre, Treviso Regional Hospital, AULSS 2 Marca Trevigiana, Treviso, Italy.
Gaetano GalloColorectal Surgery Unit, Faculty of Medicine and Surgery, IRCSS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimHaemorrhoidal arterial ligation (HAL) with or without mucopexy (recto-anal 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-HAL) 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.

methodsA comprehensive literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (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-analysis of randomized controlled trials. Random effects meta-analysis, leave-one-out meta-analysis and meta-regression were performed to assess the main outcomes.

resultsSeven randomized controlled trials, published between 2008 and 2023, were selected. They included 514 patients (mean age 49.13 years, 46% men) with different haemorrhoidal degrees. The HAL technique was performed in 255 patients and DG-HAL in 259 patients. The meta-analysis revealed that the DG-HAL procedure was associated with a significant risk of recurrence (P = 0.007) and similar postoperative pain (P = 0.623) compared to the HAL procedure. In a subgroup analysis of patients treated with a combined RAR procedure, no differences were found between the DG-HAL-RAR and HAL-RAR regarding the risk of recurrence (P = 0.36) and postoperative pain (P = 0.31).

conclusionIn conclusion, this meta-analysis did not find superiority of DG-HAL over HAL with or without RAR in reducing postoperative complications and recurrence.

Indexed as

HemorrhoidsUltrasonography, DopplerUltrasonography, InterventionalAdultArteriesFemaleHumansLigationMaleMiddle AgedPostoperative ComplicationsRandomized Controlled Trials as TopicRecurrenceTreatment OutcomeDopplerhaemorrhoidhaemorrhoidal artery ligationhaemorrhoidal vascularizationmucopexy

Identifiers

PMID40665575
PMCPMC12264406

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.