META-ANALYSIS OF KSHARA SUTRA, LASER HEMORRHOIDOPLASTY AND STAPLED HEMORRHOIDECTOMY FOR MANAGEMENT OF HAEMORRHOIDS (ARSHA)

Introdction: Hemorrhoidal disease, a common anorectal condition, can be managed through various treatment modalities, including Kshara Sutra, Laser Hemorrhoidoplasty, and Stapled Hemorrhoidectomy (SH). The aim of this review was to compare the efficacy of Kshara Sutra with Laser Hemorrhoidoplasty and SH in terms of postoperative outcomes, including pain, complications, recurrence rates, and recovery time. Methods: A comprehensive literature search was conducted across PubMed, Scopus, and the Cochrane Library for studies published from 2000 to 2023. Inclusion criteria focused on studies comparing Kshara Sutra with Laser Hemorrhoidoplasty or Stapled Hemorrhoidectomy for hemorrhoidal disease treatment. A total of 20 studies were included in the meta-analysis, with data extracted on baseline characteristics and postoperative outcomes. The quality of studies was assessed using the JADAD composite scale and CARE checklist. Results: The review identified 20 studies comparing Kshara Sutra, Laser Hemorrhoidoplasty, and SH. Key findings indicated that Kshara Sutra, particularly Apamarga Kshara Sutra, was a viable alternative to SH, demonstrating lower costs, fewer complications, and faster recovery times. Laser Hemorrhoidoplasty also showed promising results with quicker recovery and fewer complications compared to conventional hemorrhoidectomy. Postoperative outcomes, such as pain, recurrence rates, and recovery time, favored Kshara Sutra and Laser Hemorrhoidoplasty over traditional SH. The quality of studies varied, with most trials lacking randomization and blinding, which may have influenced the results. Conclusion: Kshara Sutra and Laser Hemorrhoidoplasty offer effective alternatives to Stapled Hemorrhoidectomy for the treatment of hemorrhoidal disease, with advantages in terms of cost, recovery time, and complication rates. However, further high-quality randomized controlled trials are needed to establish definitive conclusions regarding their comparative efficacy.