Laser hemorrhoidoplasty vs. stapled hemorrhoidopexy: a meta-analysis of clinical outcomes with considerations in surgical anatomy

Purpose Hemorrhoidal disease is a common colorectal condition affecting millions. Recently, minimally invasive approaches have gained popularity for their faster recovery. However, current literature lacks a comprehensive comparison between these two methods. This systematic review and meta-analysis compares the efficacy and outcomes of stapled hemorrhoidopexy (SH) and laser hemorrhoidoplasty (LH). Materials and methods A systematic search of PubMed, Embase, Web of Science, and Scopus identified studies comparing SH and LH. Patient cohorts were analyzed for recovery, perioperative outcomes, and complications. Meta-analysis was performed using R to calculate pooled Odds Ratios (OR) and Weighted Mean Differences (WMD). Results LH demonstrated a significantly shorter mean operative time compared to SH (25.9 vs. 33.0 min; MD = 7.14). The stapled approach was associated with significantly higher rates of postoperative urinary retention (7.7% vs. 3.0%; OR = 1.92), stenosis (4.5% vs. 0%; OR = 9.74), and longer hospital stays (MD = 16.32). No significant differences were observed regarding estimated blood loss (MD = 2.49), return to normal activity, readmission, postoperative bleeding, or overall VAS pain scores at any time point (12 h, 24 h, 1 week, 2 weeks, and 3 months). Subgroup analyses indicated LH yielded significantly lower pain at 3 months in severe cases. Conclusion LH and SH showed no statistically significant differences across several reported short-term outcomes, including postoperative pain, bleeding, and time to return to normal activities. While LH was associated with shorter operative times, reduced hospital stays, and lower rates of urinary retention and stenosis in the available studies, these findings must be interpreted with caution. Crucially, the true comparative therapeutic efficacy of these techniques remains uncertain. Because relevant variables like symptom resolution, patient-reported outcomes, disease-specific functional outcomes were insufficiently assessed, while recurrence data are limited by heterogeneous and inadequately reported follow-up, this analysis permits conclusions regarding short-term perioperative recovery, but not robust conclusions regarding comparative long-term success and efficacy.