title: A systematic review comparing transanal haemorrhoidal de-arterialisation to stapled haemorrhoidopexy in the management of haemorrhoidal disease.
abstract: BACKGROUND
  The aim of this study was to systematically analyse the clinical trials on the effectiveness of transanal haemorrhoidal de-arterialisation (THD) and stapled haemorrhoidopexy (SH) in the management of haemorrhoidal disease (HD).
  
  
  METHODS
  Clinical trials on the effectiveness of THD and SH in the management of HD were analysed systematically using RevMan(®), and combined outcomes were expressed as risk ratio (RR) and mean difference (MD).
  
  
  RESULTS
  Three randomised, controlled trials encompassing 150 patients were analysed systematically. There were 80 THD patients and 70 SH patients. There was no significant heterogeneity (P = 0.40) among included trials. Therefore, in the fixed effects model, THD and SH were statistically equivalent in terms of treatment success rate (P = 0.19), operation time (P = 0.55), postoperative complications (P = 0.11) and recurrence (P = 0.46) of HD. THD was associated with significantly less postoperative pain (MD, -2.00; 95% CI, -2.06, -1.94; z = 63.59; P < 0.00001) compared to SH.
  
  
  CONCLUSIONS
  Both THD and SH are equally effective and can be attempted for the management of HD. However, THD is associated with significantly lesser postoperative pain and therefore may be considered a preferred procedure. This conclusion is based only on treating 150 patients by THD or SH in three moderate-quality randomised trials. A major, multicenter, randomised trial is required to validate this conclusion and investigate other variables like hospital stay, cost-effectiveness and health-related quality of life measurement.
authors.affiliation: Department of Laparoscopic Colorectal Surgery, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK. surgeon1wrh@hotmail.com
authors.forename: M S
authors.initials: MS
authors.lastname: Sajid
authors.forename: U
authors.initials: U
authors.lastname: Parampalli
authors.forename: P
authors.initials: P
authors.lastname: Whitehouse
authors.forename: P
authors.initials: P
authors.lastname: Sains
authors.forename: M R
authors.initials: MR
authors.lastname: McFall
authors.forename: M K
authors.initials: MK
authors.lastname: Baig
mesh_terms: D001003:Anal Canal / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery*; D006484:Hemorrhoids / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008026:Ligation / Q000009:adverse effects; D010149:Postoperative Pain / Q000209:etiology; D012008:Recurrence; D017792:Surgical Stapling / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler