Procedure for prolapsed haemorrhoids versus excisional haemorrhoidectomy--a systematic review and meta-analysis.
BACKGROUND
The procedure for prolapse and haemorrhoids (PPH) was introduced to address the postoperative pain following excisional haemorrhoidectomy (EH).


OBJECTIVE
To assess the efficacy of both procedures to treat haemorrhoids.


METHODS
Literature review using MEDLINE. Articles addressing PPH and ER were included.


METHODS
RCTs comparing PH and PPH with > or = 20 patients.


METHODS
Primary endpoints were pain, operative time, hospital stay, satisfaction with procedure and time to return to normal activity. Secondary endpoints such as recurrence and complications were collated for descriptive analysis. A meta-analysis was performed using the random effects model on studies reporting 'mean' and SD or ESM.


RESULTS
PPH was associated with less postoperative pain, less operative time, shorter hospital stay and earlier return to normal activities compared with EH. There appears to be no significant difference in satisfaction with the procedure. There was no difference between the two procedures in terms of complications. There were more recurrences after PPH.


CONCLUSIONS
Compared with PH, PPH is associated with less postoperative pain, reduced operative time and hospital stay and earlier return to normal activity, and a trend towards improved patient satisfaction. The rate of recurrence appears higher with PPH.
Madiba
T E
TE
Department of Surgery, University of KwaZulu-Natal, Durban. madiba@ukzn.ac.za
Esterhuizen
T M
TM
Thomson
S R
SR
D013505:Digestive System Surgical Procedures / Q000379:methods*; D006484:Hemorrhoids / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D011391:Prolapse; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*