Haemorrhoids.
BACKGROUND
Haemorrhoids are cushions of submucosal vascular tissue located in the anal canal starting just distal to the dentate line. Incidence is difficult to ascertain as many people with the condition will never consult with a medical practitioner, although one study found 10 million people in the USA complaining of the disease.


METHODS
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for haemorrhoidal disease? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2008 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).


RESULTS
We found 44 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.


CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: closed haemorrhoidectomy, haemorrhoidal artery ligation, infrared coagulation/photocoagulation, injection sclerotherapy, open excisional (Milligan-Morgan/diathermy) haemorrhoidectomy, radiofrequency ablation, rubber band ligation, and stapled haemorrhoidectomy.
Reese
George E
GE
Department of Biosurgery and Surgical Technology, Imperial College, London, UK.
von Roon
Alexander C
AC
Tekkis
Paris P
PP
D001003:Anal Canal / Q000098:blood supply; D001158:Arteries / Q000601:surgery; D005500:Follow-Up Studies; D061865:Hemorrhoidectomy; D006484:Hemorrhoids / Q000453:epidemiology; D006801:Humans; D008026:Ligation; D012007:Rectum; D016896:Treatment Outcome