Background: This paper compares stapled haemorrhoidopexy with conventional haemorrhoidectomy for the treatment of haemorrhoids. Methods: An electronic literature search was undertaken to identify primary studies and systematic reviews. Results on efficacy and safety were analysed. A meta‐analysis was conducted to examine long‐term outcomes. Results: Twenty‐nine randomized clinical trials recruiting 2056 patients were identified. Meta‐analysis showed that stapled haemorrhoidopexy was less painful than conventional haemorrhoidectomy. Stapled haemorrhoidopexy required a shorter inpatient stay (weighted mean difference (WMD) − 0·95 (95 per cent confidence interval (c.i.) − 1·32 to − 0·59) days; P < 0·001) and operating time (WMD − 11·42 (95 per cent c.i. − 18·26 to − 4·59) min; P = 0·001). It was also associated with a faster return to normal activities (WMD − 11·75 (95 per cent c.i. − 21·42 to − 2·08) days; P = 0·017). No significant difference was noted between the two techniques in terms of the total incidence of complications. Stapled haemorrhoidopexy was associated with a higher rate of recurrent disease (relative risk 2·29 (95 per cent c.i. 1·57 to 3·33); P < 0·001). Conclusion: Stapled haemorrhoidopexy offers some short‐term benefits over conventional operation but the total complication rates are similar for both techniques. Stapled haemorrhoidopexy is associated with a higher rate of recurrent disease. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. More disease recurrence with stapling