Transanal Hemorrhoidal Dearterialization with Mucopexy Versus Excisional Hemorrhoidectomy for Prolapsed Internal Hemorrhoids: A Systematic Review

Background: Excisional hemorrhoidectomy remains the most established operation for advanced prolapsing internal hemorrhoids, but its durable anatomical correction is achieved at the expense of postoperative pain, delayed convalescence and wound-related morbidity. Transanal hemorrhoidal dearterialization (THD) with mucopexy is a non-excisional, sphincter-sparing operation designed to reduce arterial inflow and lift prolapsing cushions without creating an anodermal wound. Objective: To systematically review comparative evidence evaluating THD with mucopexy or anopexy versus excisional hemorrhoidectomy for prolapsed internal hemorrhoids. Methods: A PRISMA-based systematic review was prepared from randomized and prospective comparative studies identified in MEDLINE/PubMed, Embase, CENTRAL, Scopus and Web of Science. Eligible studies enrolled adults with grade II-IV internal hemorrhoids and compared THD, HAL or dearterialization with mucopexy/anopexy against closed Ferguson, open Milligan-Morgan or energy-device excisional hemorrhoidectomy. Outcomes were persistent or recurrent prolapse, postoperative pain, analgesic requirement, operative time, hospital stay, return to activity, complications, satisfaction and quality of life. Because comparator technique, grade distribution, follow-up and outcome definitions differed across studies, results were synthesized narratively without meta-analysis. Results: Eight comparative studies, reported in nine papers and enrolling more than 600 patients, were included. Across studies, recurrence or persistent prolapse was not clearly different between THD and excision, although recurrence tended to be numerically lower after excision in bulky grade IV disease. THD consistently reduced early pain, analgesic need, hospital stay and time to normal activity, and improved early satisfaction; operative time was generally longer. Conclusion: THD with mucopexy is a reasonable option for grade III and selected reducible grade IV hemorrhoids when rapid recovery is valued, whereas excisional hemorrhoidectomy remains preferable when maximum durability is the dominant objective. Larger long-term trials with standardized recurrence definitions are needed.