LigaSure
versus conventional excisional haemorrhoidectomy: A systematic review and meta‐analysis with trial sequential analysis of randomised controlled trials
Gabriel Leal Barone, Bernardo Fontel Pompeu, Lucas Monteiro Delgado, Giulia Luiza Garcia, Patrícia Viana, Claudia Theis, Sergio Mazzola Poli de Figueiredo, Fernanda Bellotti Formiga Abstract
Background
Conventional excisional haemorrhoidectomy remains the gold standard treatment for grade IV haemorrhoids, although energy‐based devices may reduce postoperative pain. We performed a systematic review and meta‐analysis of randomised controlled trials comparing LigaSure with conventional haemorrhoidectomy.
Methods
A systematic search of PubMed, Scopus, Web of Science and the Cochrane Central Register was performed up to July 2025. Randomised controlled trials comparing LigaSure with conventional techniques were included. Pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random‐effects models. Heterogeneity was assessed with the I 2 statistic, and trial sequential analysis (TSA) was applied to assess conclusiveness.
Results
Forty‐three unique RCTs comprising 3,277 participants were analysed. LigaSure was associated with lower postoperative pain scores on days 1 and 2 and during the first and second postoperative weeks, reduced analgesic requirements and intraoperative blood loss, shorter operating time and time to return to daily activities, and lower risks of postoperative wound discharge, postoperative bleeding and acute urinary retention. No statistically significant differences were observed in immediate postoperative pain, pain on postoperative day 3 or week 4, recurrence, length of hospital stay, constipation, pruritus, surgical site infection, incomplete healing, anal fissure, anal stenosis, or faecal incontinence.
Conclusion
LigaSure was associated with improvements in selected early perioperative outcomes, particularly postoperative pain and return to daily activities. However, uncertainty remains for several outcomes, and evidence regarding recurrence and other long‐term anorectal outcomes remains limited.