title: The safety and efficacy of stapled hemorrhoidectomy in the treatment of hemorrhoids: a systematic review and meta-analysis of ten randomized control trials.
abstract: OBJECTIVE
  The objective of this study was to compare the safety and efficacy outcomes of stapled hemorrhoidectomy (PPH) with Milligan-Morgan hemorrhoidectomy (MMH) in the treatment of severe hemorrhoids.
  
  
  METHODS
  A meta-analysis pooled the effects of the safety and efficacy outcomes on PPH, and MMH in ten randomized control trials was presented using a fixed effects model or a random effects model (via RevMan Version 4.2).
  
  
  RESULTS
  There was reasonably clear evidence in favor of PPH for operating time, length of hospital stay, pain, anal discharge, and patient satisfaction. However, skin tags and prolapse occurred at higher rates in the PPH group. PPH was not more superior than MMH as to postoperative bleeding, urinary retention, difficulty in defecating, anal fissure and stenosis, sphincter damage, resumption of normal activities, incontinence, pruritus, anal resting and squeeze pressures, and analgesia.
  
  
  CONCLUSIONS
  PPH may be at least as safe as MMH. However, the efficacy of PPH compared with MMH could not be determined absolutely. More rigorous studies with longer follow-up periods and larger sample sizes need to be conducted.
authors.affiliation: Department of Gastrointestinal Surgery, First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road II, Guangzhou, 510080, People's Republic of China. lpzm@yahoo.com
authors.forename: Ping
authors.initials: P
authors.lastname: Lan
authors.forename: Xjiaojian
authors.initials: X
authors.lastname: Wu
authors.forename: Xuyu
authors.initials: X
authors.lastname: Zhou
authors.forename: Jianping
authors.initials: J
authors.lastname: Wang
authors.forename: Longjuan
authors.initials: L
authors.lastname: Zhang
mesh_terms: D013505:Digestive System Surgical Procedures / Q000379:methods*; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013536:Suture Techniques; D016896:Treatment Outcome