To systematically evaluate the efficacy and safety for RPH (automatic ligation of hemorrhoids) combined with MMH (milligan-morgan hemorrhoidectomy) versus PPH (procedure for prolapse and hemorrhoids) in the treatment of severe mixed hemorrhoids.

A computer search of PubMed, Cochrane, Web of Science, CNKI, Wanfang and Weipu and other databases, collected and compared RPH combined with MMH and PPH in the treatment of mixed hemorrhoids in randomized controlled trials (RCT), RevMan5.3 software were used for Meta analysis.

A total of 11 randomized controlled clinical trials with a total of 2 762 patients were included. Meta-analysis results showed that between the RPH+MMH and PPH groups, the difference of the operation time [MD=-6.20, 95% (-12.81~0.40); P＞0.05]and postoperative infection [OR=2.18, 95%CI(0.77~6.18); P＞0.05] , wound healing time [MD=1.56, 95%(-6.84~9.96); P＞0.05]was not statistically significant. There were no significant differences(P＜0.05) in the total effective rate of surgery [OR=4.67, 95%CI(3.09~7.04)], the total score of postoperative anal function evaluation [MD=-3.47, 95%CI(-3.75~-3.21)], intraoperative blood loss [MD=-14.94, 95%CI(-25.07~-4.81)], hospitalization time [MD=-0.29, 95%CI (-0.44~-0.13)], postoperative wound edema [OR=0.21, 95%CI(0.08~0.55)], postoperative urinary retention [OR=0.50, 95%CI(0.39~0.64)], postoperative pain [OR=0.30, 95%CI(0.11~0.82)], postoperative bleeding [OR=0.19, 95%CI(0.09~0.40)], postoperative anal epidermis [OR=0.17, 95%CI(0.05~0.62)], postoperative anal bulging [OR=0.29, 95%CI(0.19~0.45)], postoperative anorectal stenosis [OR=0.20, 95%CI(0.09~0.45)].

Compared with PPH, RPH combined with MMH in the treatment of severe mixed hemorrhoids has the advantages of higher total effective rate, better postoperative recovery of anal function, less intraoperative blood loss, shorter hospital stay. At the same time, it can reduce postoperative wound edema, urinary retention, pain, bleeding, and residual anal epidermis, anus bulging, anorectal stenosis and other complications. However, due to the limitations of this study, the above conclusions still need to be verified by higher-quality clinical trials.