There were 18 RCTs (16 trials were included in the meta-analysis):
manual dilation of the anus versus haemorrhoidectomy (6 trials)
rubber band ligation versus haemorrhoidectomy (3 trials)
sclerotherapy versus infrared photocoagulation (2 trials)
sclerotherapy versus rubber band ligation (4 trials)
rubber band ligation versus infrared coagulation (3 trials)
Haemorrhoidectomy was found to be significantly more effective than manual dilation of the anus (p=0.0017) with less need for further therapy (p=0.034), no significant difference in complications (p=0.60), but significantly more pain (p<0.0001).
Haemorrhoidectomy patients had a better response to treatment than did patients treated with rubber band ligation (p=0.001), although complications were greater (p=0.02) as was pain (p<0.0001).
Rubber band ligation was better than sclerotherapy in response to treatment for all haemorrhoids (p=0.005), as well as for haemorrhoids stratified by grade (grades 1 to 2 ; p=0.007; grade 3 p=0.042), with no difference in the complication rate (p=0.35).
Patients treated with rubber band ligation were less likely to require further therapy than those treated with sclerotherapy (p=0.031) or infrared coagulation (p=0.0014), although pain was greater after rubber band ligation (p=0.03 for sclerotherapy, p<0.0001 for infrared coagulation).