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CC BY 4.0 · Journal of Coloproctology 2025; 45(03): s00451810623
DOI: 10.1055/s-0045-1810623
Review Article

Doppler-Guided Versus Digitally Guided Transanal Hemorrhoidal Dearterialization: A Systematic Review and Meta-Analysis

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Funding The author(s) received no financial support for the research.
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Abstract

Introduction

Transanal hemorrhoidal dearterialization (THD) has emerged as a minimally invasive alternative to conventional hemorrhoidectomy, often performed with Doppler guidance (DGHAL) to facilitate arterial ligation. However, some studies suggest that digitally guided THD (HAL) may offer comparable outcomes with reduced costs. This systematic review and meta-analysis aim to compare the efficacy and safety of DGHAL versus HAL in patients with hemorrhoidal disease.

Methods

Following PRISMA 2020 guidelines, a systematic review was registered in PROSPERO (CRD42024625878). Searches in PubMed, EMBASE, and Cochrane Library identified randomized controlled trials (RCTs) comparing DGHAL and HAL. Primary outcomes included prolapse recurrence, postoperative bleeding, pain, and operative time. Statistical analyses were performed using RevMan 5.4, with odds ratios (OR) and mean differences (MD) at 95% confidence intervals (CI). Risk of bias was assessed using Cochrane RoB 2.

Results

Ten RCTs with 961 patients were included. No significant differences were found between DGHAL and HAL in late bleeding (OR 1.38, 95% CI 0.68–2.79, P = 0.62), prolapse recurrence at one year (OR 1.60, 95% CI 0.62–4.13, P > 0.05), intermediate pain (MD 0.78, 95% CI -0.51–2.07, P = 0.24), or operative time (MD 3.87 min, 95% CI -18.94–26.67, P > 0.05).

Conclusion

Digitally guided THD appears to be a cost-effective alternative to Doppler-guided THD, with comparable outcomes in terms of bleeding, prolapse recurrence, postoperative pain, and operative time. These findings suggest that the additional cost of Doppler guidance may not be justified in routine clinical practice. Further studies focusing on specific patient subgroups may help refine indications for each technique.

Keywords

hemorrhoidal disease - transanal hemorrhoidal dearterialization - doppler-guided hemorrhoidal artery ligation - hemorrhoid surgery - meta-analysis

Authors' Contribution

MCM: conceptualization, data curation, formal analysis, methodology, project administration, software, supervision, writing-original draft, writing-review and editing; PALS: conceptualization, writing-original draft, writing-review and editing; GEA: conceptualization, data curation, formal analysis, methodology, project administration, software, supervision, writing-original draft, writing-review and editing; FSM: software, supervision, writing-original draft, writing-review and editing.


Data Availability Statement

The data that support the findings of this study are available from the authors upon reasonable request.


ORCID IDs

Marília Cardoso Massoni – https://orcid.org/0009-0008-3713-5757

Felipe Santos Marimpietri – https://orcid.org/0009-0009-3827-342X

Paulo André Lago Silva – https://orcid.org/0000-0002-0028-1303

Glicia Estevam de Abreu – https://orcid.org/0000-0003-3170-2294




Publication History

Received: 07 March 2025

Accepted: 21 July 2025

Article published online:
07 October 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
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Bibliographical Record
Marília Cardoso Massoni, Felipe Santos Marimpietri, Paulo André Lago Silva, Glicia Estevam de Abreu. Doppler-Guided Versus Digitally Guided Transanal Hemorrhoidal Dearterialization: A Systematic Review and Meta-Analysis. Journal of Coloproctology 2025; 45: s00451810623.
DOI: 10.1055/s-0045-1810623
 

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