Introduction
Materials and methods
Search strategy
Inclusion and exclusion criteria
Outcomes of interest
S/N | Reference | Study period | Country of study | Number of centres | Study type | Duration of follow-up (months) | Laser wavelength (nm) | Laser device | Primary outcome | Secondary outcomes | Intervention | ||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
LHP | EH | Total | |||||||||||
1 | Nazari MS et al. [41] | 2010–2011 | Iran | - | RCT | 6 | 980 | - | Mean pain on postoperative day 1 | • Intraoperative and postoperative bleeding • Urinary retention • Wound infection • Length of hospitalisation • Administered morphine dose | 29 | 30 | 59 |
2 | Naderan M et al. [59] | 2011–2012 | Iran | 1 | RCT | 12 | 980 | Biolitec AG CeramOptec | Mean pain on postoperative day 1 | • Intraoperative and postoperative bleeding • Urinary retention • Wound infection • Administered morphine dose • Operating time • Recurrence | 30 | 30 | 60 |
3 | Alsisy AA et al. [58] | 2016–2017 | Egypt | 1 | RCT | 3 | 980 | A.R.C Laser Gmbh | Mean pain on postoperative day 1 | • Intraoperative and postoperative bleeding • Urinary retention •Wound infection • Administered morphine dose • Operating time • Recurrence | 30 | 30 | 60 |
4 | Eskandaros MS et al. [52] | 2017–2019 | Egypt | 1 | RCT | 12 | 1470 | Cerlas Diode Laser (Biolitec) | Mean pain on postoperative day 1, weeks 1, 2, and 3, and months 1 and 2 | • Operating time • Length of hospitalisation • Return to daily activities • Urinary retention • Postoperative bleeding • Anal stenosis • Recurrence | 40 | 40 | 80 |
5 | Shabahang H et al. [44] | 2011–2013 | Iran | 2 | RCT | 6 | 1470 | Cerlas Diode Laser (Biolitec) | Mean pain on postoperative day 1 | • Postoperative bleeding • Urinary retention • Painful defecation • Wound infection • Anal stenosis, fistula, and thrombosis • Fecal incontinence • Length of hospitalisation • Quality of life of patients 6 months after operation based on SF-36 questionnaire | 40 | 40 | 80 |
6 | Poskus T et al. [43] | 2016–2018 | Lithuania | 1 | RCT | 12 | 1470 | Cerlas Diode Laser (Biolitec) | Recurrence of rectal bleeding and prolapse at 1 year after operation | • Time to return to work or normal activity • Mean pain on postoperative day 1 to 7 • Fecal incontinence • Quality of life of patients 6 months after operation based on SF-36 questionnaire • Recurrence | 40 | 40 | 80 |
7 | Plapler H et al. [60] | 2009 | Brazil | 1 | CCS | 1 | 810 | Synus Laser Inc | Mean pain on postoperative day 1, week 1, and month 1 | 15 | 10 | 25 | |
8 | Maloku H et al. [57] | 2012–2014 | Kosovo | 1 | CCS | 2 | 980 | Biolitec | Mean pain on postoperative day 1, weeks 1, 2, and 3, and months 1, 2, and 6 | • Operating time | 20 | 20 | 40 |
9 | Maloku H et al. [53] | 2014–2015 | Montenegro | 1 | CCS | 6 | 980 | Biolitec | Mean pain on postoperative day 1, weeks 1, 2, and 3, and months 1 and 2 | • Postoperative bleeding • Length of hospitalisation • Recovery time • Operating time | 100 | 100 | 200 |
10 | Mohammed AF et al. [54] | 2014–2018 | Iraq | 1 | CCS | 36 | 980 | - | Mean pain on postoperative day 1, weeks 1, 2, and 3, and months 1, 2, and 6 | • Postoperative bleeding • Wound infection • Anal stenosis • Recurrence | 500 | 500 | 1000 |
11 | Hassan AM et al. [56] | 2019–2020 | Egypt | 1 | CCS | 6 | 1470 | Biolitec | Mean pain on postoperative day 1, weeks 1, 2, and 3, and months 1, 2, and 6 | • Operating time • Length of hospitalisation • Postoperative bleeding, pain, abscess, oedema • Anal fistula and stricture • Faecal incontinence • Recurrence | 20 | 20 | 40 |
12 | Khan HM et al. [55] | 2019–2020 | India | 1 | CCS | 1 | 1470 | Lasotronix | Mean pain on postoperative day 1, weeks 1, 2, and 3, and month 1 | • Intraoperative and postoperative bleeding • Operating time • Administered morphine dose • Length of hospitalisation • Recovery time • Urinary retention • Anal stenosis, thrombosis and discharge | 50 | 50 | 100 |
914 | 910 | 1824 |
Data extraction and synthesis
Statistical analysis
Results
Eligible studies
Demographic characteristics
Reference | Study type | Interventional arm | Number of participants, n (%) | Mean age, years ± SD | Sex, n (%) | Haemorrhoid grade, n (%) | |
---|---|---|---|---|---|---|---|
M | F | ||||||
Nazari MS et al. [41] | RCT | LHP | 29 (49.15) | 43.3 ± 13.8 | 19 (65.5) | 10 (34.5) | All grade III or IV |
CoH | 30 (50.85) | 47.2 ± 14.0 | 12 (40.0) | 18 (60.0) | All grade III or IV | ||
Naderan M et al. [59] | RCT | LHP | 30 (50.0) | 43.7 ± 13.7 | 13 (43.3) | 17 (56.7) | II: 13 (43.3) III: 17 (56.7) |
CoH | 30 (50.0) | 44.3 ± 11.3 | 11 (36.7) | 19 (63.3) | II: 10 (33.3) III: 20 (66.7) | ||
Alsisy AA et al. [58] | RCT | LHP | 30 (50.0) | 34.73 ± 10.17 | 18 (60.0) | 12 (40) | II: 13 (43.3) III: 17 (56.7) |
CoH | 30 (50.0) | 33.67 ± 10.22 | 15 (50) | 15 (50) | II: 17 (56.7) III: 13 (43.3) | ||
Shabahang H et al. [44] | RCT | LHP | 40 (50.0) | 38.12 ± 8.29 | 18 (45.0) | 22 (55.0) | II: 29 (72.5) III: 11 (27.5) |
CoH | 40 (50.0) | 38.72 ± 9.52 | 18 (45.0) | 22 (55.0) | II: 25 (62.5) III: 15 (37.5) | ||
Eskandaros MS et al. [52] | RCT | LHP | 40 (50.0) | 40.8 ± 8.8 | 27 (67.5) | 13 (32.5) | III: 40 (100.0) |
CoH | 40 (50.0) | 41.0 ± 8.8 | 29 (72.5) | 11 (27.5) | III: 40 (100.0) | ||
Poskus T et al. [43] | RCT | LHP | 40 (50.0) | 47.0 ± 13.0 | 27 (67.5) | 13 (32.5) | II: 10 (25.0) III: 30 (75.0) |
CoH | 40 (50.0) | 45.0 ± 12.0 | 19 (47.5) | 21 (52.5) | II: 7 (17.5) III: 33 (82.5) | ||
Plapler H et al. [60] | CCS | LHP | 15 (60.0) | n.r | n.r | n.r | All grade II or III |
CoH | 10 (40.0) | n.r | n.r | n.r | All grade II or III | ||
Maloku H et al. [57] | CCS | LHP | 20 (50.0) | 47.0 ± 12.6 | 11 (55.0) | 9 (45.0) | III: 20 (100.0) |
CoH | 20 (50.0) | 49.0 ± 12.3 | 12 (60.0) | 8 (40.0) | IV: 20 (100.0) | ||
Maloku H et al. [53] | CCS | LHP | 100 (50.0) | 47.0 ± 12.6 | 57 (57.0) | 43 (43.0) | III: 100 (100.0) |
CoH | 100 (50.0) | 49.0 ± 12.3 | 64 (64.0) | 36 (36.0) | III: 100 (100.0) | ||
Mohammed AF et al. [54] | CCS | LHP | 500 (50.0) | n.r | 350 (70.0) | 150 (30.0) | All grade II or III |
CoH | 500 (50.0) | n.r | 368 (73.6) | 132 (26.4) | All grade II or III | ||
Hassan AM et al. [56] | CCS | LHP | 20 (50.0) | 47.0 ± 12.6 | 12 (60.0) | 8 (40.0) | III: 20 (100.0) |
CoH | 20 (50.0) | 49.0 ± 12.3 | 11 (55.0) | 9 (45.0) | III: 20 (100.0) | ||
Khan HM et al. [55] | CCS | LHP | 50 (50.0) | 42.7 ± 10.1 | 32 (64.0) | 18 (36.0) | III: 27 (54.0) IV: 23 (46.0) |
CoH | 50 (50.0) | 41.6 ± 10.3 | 29 (58.0) | 21 (42.0) | III: 30 (60.0) IV: 20 (40.0) |