Stapled haemorrhoidopexy for the treatment of haemorrhoids: a systematic review.
OBJECTIVE
This systematic review aimed to evaluate the short- and long-term safety, efficacy and costs of stapled haemorrhoidopexy (SH) compared with conventional haemorrhoidectomy.


METHODS
We searched 26 electronic databases and websites for studies in any language up to July 2006. Inclusion criteria were predefined, and each stage of the review process was conducted in duplicate.


RESULTS
Twenty-seven randomized controlled trials were included (n = 2279). All had some methodological flaws. Postoperatively, 19 trials (95%) reported less pain, 17 (89%) reported a shorter operating time, 14 (88%) a shorter hospital stay, and 14 (93%) a shorter convalescence time following SH. However, prolapse was significantly more common after SH (OR 3.38; 95% CI: 1.00, 11.47). In the longer term, prolapse was significantly more common after SH (OR 4.34; 95% CI: 1.67, 11.28) as was reintervention for prolapse (OR 6.78; 95% CI: 2.00, 23.00). There were no differences in the rate or type of complications. Conventional haemorrhoidectomy and SH had similar costs during the initial admission.


CONCLUSIONS
Compared with conventional haemorrhoidectomy, SH resulted in less postoperative pain, shorter operating time, a shorter hospital stay, and a shorter convalescence, but a higher rate of prolapse and reintervention for prolapse.
Burch
J
J
Centre for Reviews and Dissemination, University of York, York, UK. jb67@york.ac.uk
Epstein
D
D
Sari
A Baba-Akbari
AB
Weatherly
H
H
Jayne
D
D
Fox
D
D
Woolacott
N
N
D016063:Blood Loss, Surgical / Q000503:physiopathology*; D003107:Colorectal Surgery / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006484:Hemorrhoids / Q000175:diagnosis / Q000601:surgery*; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000191:economics / Q000379:methods; D010149:Postoperative Pain / Q000503:physiopathology; D017060:Patient Satisfaction; D019106:Postoperative Hemorrhage / Q000503:physiopathology*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D017792:Surgical Stapling / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D013537:Sutures; D016896:Treatment Outcome