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Background <p>Internal hemorrhoids are commonly managed using office-based procedures, with rubber band ligation (RBL) and infrared coagulation (IRC) among the most widely used minimally invasive treatments. In clinical practice, their comparative effectiveness is increasingly influenced by differences in post-procedural pain, tolerability, and recovery time.</p> Objective <p>This study aimed to systematically evaluate randomized controlled trial evidence comparing the clinical effectiveness, post-procedural pain, and recovery outcomes of RBL versus IRC for internal hemorrhoids.</p> Methods <p>A&#xa0;systematic review and meta-analysis of randomized controlled trials was conducted using PubMed, Scopus, Web of Science, and Google Scholar. Outcomes included post-procedural pain (analgesic use and visual analog scale [VAS]), bleeding, recurrence, and patient-reported outcomes (including treatment success and return to normal activity). Pooled estimates were calculated using a&#xa0;random-effects model and reported as risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI).</p> Results <p>Four randomized controlled trials (<i>n</i> = 375) were included. Meta-analysis of two studies (<i>n</i> = 142) showed higher analgesic use with rubber band ligation compared to infrared coagulation, although the estimate was imprecise and not statistically significant (RR 4.40, 95% CI 0.57–33.94; I<sup>2</sup> = 73%). In one study reporting VAS scores, pain was lower immediately after RBL but higher at follow-up (MD 2.20, 95% CI 0.96–3.44). No significant differences were observed in bleeding (RR 1.23, 95% CI 0.36–4.24; I<sup>2</sup> = 71%) or recurrence (RR 0.78, 95% CI 0.40–1.52; I<sup>2</sup> = 0%). Treatment success was comparable between interventions, while return to normal activity was shorter with infrared coagulation.</p> Conclusion <p>Rubber band ligation and infrared coagulation demonstrate comparable effectiveness for bleeding control and recurrence in internal hemorrhoids. Although RBL may be associated with greater post-procedural pain and slower recovery, the evidence remains limited and imprecise. When reduced pain and faster return to daily activity are prioritized, IRC may be preferred. Treatment decisions should remain individualized, based on clinical presentation, and patient preference, and broader health policy considerations.</p>

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Office-based management of internal hemorrhoids: a systematic review and meta-analysis of randomized trials on pain, recurrence and recovery

  • 期刊论文

  • 发表日期：

    2026年5月29日

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  • Jeevarathinam Thirumalai,
  • Indra Sivakumar,
  • Saravanan Sekaran,
  • Soundariya Shankar

摘要

Background

Internal hemorrhoids are commonly managed using office-based procedures, with rubber band ligation (RBL) and infrared coagulation (IRC) among the most widely used minimally invasive treatments. In clinical practice, their comparative effectiveness is increasingly influenced by differences in post-procedural pain, tolerability, and recovery time.

Objective

This study aimed to systematically evaluate randomized controlled trial evidence comparing the clinical effectiveness, post-procedural pain, and recovery outcomes of RBL versus IRC for internal hemorrhoids.

Methods

A systematic review and meta-analysis of randomized controlled trials was conducted using PubMed, Scopus, Web of Science, and Google Scholar. Outcomes included post-procedural pain (analgesic use and visual analog scale [VAS]), bleeding, recurrence, and patient-reported outcomes (including treatment success and return to normal activity). Pooled estimates were calculated using a random-effects model and reported as risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI).

Results

Four randomized controlled trials (n = 375) were included. Meta-analysis of two studies (n = 142) showed higher analgesic use with rubber band ligation compared to infrared coagulation, although the estimate was imprecise and not statistically significant (RR 4.40, 95% CI 0.57–33.94; I2 = 73%). In one study reporting VAS scores, pain was lower immediately after RBL but higher at follow-up (MD 2.20, 95% CI 0.96–3.44). No significant differences were observed in bleeding (RR 1.23, 95% CI 0.36–4.24; I2 = 71%) or recurrence (RR 0.78, 95% CI 0.40–1.52; I2 = 0%). Treatment success was comparable between interventions, while return to normal activity was shorter with infrared coagulation.

Conclusion

Rubber band ligation and infrared coagulation demonstrate comparable effectiveness for bleeding control and recurrence in internal hemorrhoids. Although RBL may be associated with greater post-procedural pain and slower recovery, the evidence remains limited and imprecise. When reduced pain and faster return to daily activity are prioritized, IRC may be preferred. Treatment decisions should remain individualized, based on clinical presentation, and patient preference, and broader health policy considerations.