To evaluate the effectiveness and safety of Doppler-guided hemorrhoidal artery ligation (DG-HAL) and rubber band ligation (RBL) in the treatment ofⅡ-Ⅲ degree mixed hemorrhoids.

We searched the Cochrane Library, PubMed, and EMBASE by computer and other sources to retrieve relevant controlled trials (including randomized controlled trials) that compared DG-HAL and RBL for the treatment of II-III degree mixed hemorrhoids. Data extraction and quality evaluation were performed by two independent reviewers according to the protocol. The χ² test was used for assessing the heterogeneity among the included studies. When there was no statistical homogeneity among the studies (P>0.1, I²<50%), the fixed-effect model was used for analysis. If there was statistical heterogeneity among the studies (P<0.1, I²>50%), the heterogeneity sources were analyzed, and subgroup analysis was performed according to the reasons that may lead to heterogeneity. When there was a sufficient similarity between the studies in the subgroup and between the subgroups (subgroup P>0.1, I²<50%), the fixed-effect model was used for meta-analysis; if there was statistical heterogeneity between subgroups but the clinical heterogeneity or difference was not statistically significant, the random-effects model was used for analysis; if the heterogeneity between subgroups was too large, a descriptive analysis was performed.

Three controlled trials were finally included, involving 674 patients with 425 cases undergoing DG-HAL (DG-HAL group) and 249 cases undergoing RBL (RBL group). Meta-analysis showed that the 6-week recurrence rate in the RBL group was significantly higher than that of the DG-HAL group (OR=0.23, 95%CI: 0.11-0.45, P<0.05), but the 1-year recurrence rate had no significance difference (OR=0.97, 95%CI: 0.24-3.92, P>0.05). Regarding the degree of postoperative wound cleansing, the DG-HAL group was significantly better than the RBL group (OR=0.17, 95%CI: 0.09-0.33, P<0.001). The postoperative complications and adverse reactions including bleeding, pain, urinary retention, mucus discharge, vasovagal upset postoperative had no significant differences between the two groups (bleeding: P=0.05; others: P>0.05).

Compared with RBL, DG-HAL therapy is safe and effective in treatment of Ⅱ-Ⅲ degree mixed hemorrhoids; however, its long-term safety requires further verification by more RCTs with large sample size and of high-quality.