Design: Systematic review and meta-analysis of 43 randomised trials with trial sequential analysis
Population: 3,277 patients undergoing excisional haemorrhoidectomy
Primary outcome: Postoperative pain and perioperative outcomes
Effect: Lower pain on days 1-2 and weeks 1-2; less bleeding and urinary retention; no difference in recurrence or incontinence

A systematic review and meta-analysis in Colorectal Disease (1 October 2026), with trial sequential analysis, pooled 43 randomised trials and 3,277 patients comparing haemorrhoidectomy with a bipolar vessel-sealing device (LigaSure) against conventional excisional haemorrhoidectomy.

Vessel sealing was associated with lower pain scores on days 1 and 2 and through the first two weeks, lower analgesic use, less blood loss, shorter operations and a quicker return to normal activity. Postoperative bleeding, wound discharge and acute urinary retention were also less common. There was no difference in pain at day 3 or week 4, length of stay, recurrence, stenosis, fissure, infection or incontinence.

The benefit is real but short-lived, and the evidence on recurrence and long-term continence is thin. For a patient, the trade is a less painful first fortnight against the cost of a disposable device, which in many Indian hospitals is passed on directly.

Offer vessel-sealing haemorrhoidectomy where the device is available, mainly to reduce early pain.
Tell patients the pain advantage fades after about two weeks and recurrence appears the same.
Discuss device cost openly where the patient pays for disposables.
Keep good conventional excision as an acceptable standard when the device is not available.

Why it matters

It lets you frame the device as a comfort choice with a price, not as a better operation.

The statistics, in plain English

Trial sequential analysis checks whether enough patients have been studied to call a result conclusive, guarding against early false positives from many small trials. Pooling 43 trials brings precision, but these were mostly small, single-centre studies that varied in technique and pain scoring, so the size of the pain benefit is less certain than its direction.