Systematic review and meta-analysis of randomized controlled trials comparing stapled haemorrhoidopexy with conventional haemorrhoidectomy.
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).


CONCLUSIONS
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.
Shao
W-J
WJ
Department of Coloproctology, Nanjing TCM University Hospital, Nanjing, China.
Li
G-C H
GC
Zhang
Z H-K
ZH
Yang
B-L
BL
Sun
G-D
GD
Chen
Y-Q
YQ
D001003:Anal Canal / Q000293:injuries; D000700:Analgesics / Q000627:therapeutic use; D003248:Constipation / Q000209:etiology; D005401:Fissure in Ano / Q000209:etiology; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D010149:Postoperative Pain / Q000517:prevention & control; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology*; D019106:Postoperative Hemorrhage / Q000209:etiology; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation; D024162:Second-Look Surgery; D017792:Surgical Stapling; D013927:Thrombosis / Q000209:etiology; D016055:Urinary Retention / Q000209:etiology
D000700:Analgesics