title: Residual skin tags following procedure for prolapse and hemorrhoids: differentiation from recurrence.
abstract: OBJECTIVE
  The aim of this study was to compare the incidence of recurrence and residual skin tag after the procedure for prolapse and hemorrhoids (PPH) versus conventional hemorrhoidectomy (CH) in the Chinese- and English-language literature to explore the definition of recurrence after PPH.
  
  
  METHODS
  Related Chinese- and English-language literature was collected by several methods. Meta-analysis was used to compare the incidence of recurrence and residual skin tag of PPH versus CH.
  
  
  RESULTS
  In China, 13.94% of hemorrhoids had a skin tag after PPH. The mean recurrence rate after PPH was 3.23% (range 0.40-26.44%). Our meta-analysis of PPH versus CH of the Chinese studies showed that PPH had a significantly lower recurrence rate-13 studies, odds ratio (OR) 0.27, 95% confidence interval (CI) 0.17-0.42, p < 0.00001-and a higher incidence of skin tags with no significance-6 studies, OR 3.42, 95% CI 0.49-24.04, p = 0.22. Our meta-analysis of PPH versus CH among the English-language studies showed that PPH had a significantly higher recurrence rate-17 studies, 636 patients in the PPH group vs. 625 patients in the CH group, OR 2.96, 95% CI 1.57-5.56, p = 0.0008-and a significantly higher incidence of residual skin tags-8 studies, 297 patients in the PPH group vs. 289 patients in the CH group, OR 1.88, 95% CI 1.15-3.05, p = 0.01. However, the recurrence of prolapse was stated to be ascertained by anorectal examination in only six studies; meta-analysis of the six studies showed that PPH was not associated with a higher recurrence-six studies, 230 patients in the PPH group vs. 220 patients in the CH group; OR 1.87, 95% CI 0.70-5.00, p = 0.22.
  
  
  CONCLUSIONS
  PPH is not associated with a higher recurrence rate but is associated with a higher incidence of skin tags compared with CH. The reported high recurrence rates are probably caused by improper inclusion of residual skin tags into the recurrence data. Surgeons should perform anorectal examinations to differentiate a residual skin tag from a recurrence.
authors.affiliation: Department of Colorectal Surgery of Changhai Hospital, Second Military Medical University, 200433, Shanghai, China.
authors.forename: Xian Hua
authors.initials: XH
authors.lastname: Gao
authors.forename: Chuan Gang
authors.initials: CG
authors.lastname: Fu
authors.forename: Paul Fallah-Wandalachi
authors.initials: PF
authors.lastname: Nabieu
mesh_terms: D003937:Diagnosis, Differential; D006484:Hemorrhoids / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D011391:Prolapse; D012008:Recurrence; D012871:Skin Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D017792:Surgical Stapling