Systematic Review on the Procedure for Prolapse and Hemorrhoids (Stapled Hemorrhoidopexy)

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Purpose:The procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy) has been introduced as an alternative to conventional hemorrhoidectomy. This is a systematic review on stapled hemorrhoidopexy of all randomized, controlled trials that have been published until August 2006.Methods:All published, randomized, controlled trials comparing stapled hemorrhoidopexy to conventional hemorrhoidectomy were identified from Ovid MEDLINE, EMBASE, CINAHL, and all Evidence-Based Medicine Reviews (Cochrane Central Register of Controlled Trial, Cochrane Database of Systemic Review, and Database of Abstracts of Reviews of Effects) between January 1991 and August 2006. Meta-analysis was performed by using the Forest plot review if feasible.Results:A total of 25 randomized, controlled trials with 1,918 procedures were reviewed. The follow-up duration was from 1 to 62 months. Stapled hemorrhoidopexy was associated with less operating time (weighted mean difference, −11.35 minutes;P= 0.006), earlier return of bowel function (weighted mean difference −9.91 hours;P< 0.00001), and shorter hospital stay (weighted mean difference, −1.07 days;P= 0.0004). There was less pain after stapled hemorrhoidopexy, as evidenced by lower pain scores at rest and on defecation and 37.6 percent reduction in analgesic requirement. The stapled hemorrhoidopexy allowed a faster functional recovery with shorter time off work (weighted mean difference, −8.45 days;P< 0.00001), earlier return to normal activities (weighted mean difference, −15.85 days;P= 0.03), and better wound healing (odds ratio, 0.1;P= 0.0006). The patients' satisfaction was significantly higher with stapled hemorrhoidopexy than conventional hemorrhoidectomy (odds ratio, 2.33;P= 0.003). Although there was increase in the recurrence of hemorrhoids at one year or more after stapled procedure (5.7vs.1 percent; odds ratio, 3.48;P= 0.02), the overall incidence of recurrent hemorrhoidal symptoms—early (fewer than 6 months; stapledvs.conventional: 24.8vs.31.7 percent;P= 0.08) or late (1 year or more) recurrence rate (stapledvs.conventional: 25.3vs.18.7 percent;P= 0.07)—was similar. The overall complication rate did not differ significantly from that of conventional procedure (stapledvs.conventional: 20.2vs.25.2 percent;P= 0.06). Compared with conventional surgery, stapled hemorrhoidopexy has less postoperative bleeding (odds ratio, 0.52;P= 0.001), wound complication (odds ratio, 0.05;P= 0.005), constipation (odds ratio, 0.45;P= 0.02), and pruritus (odds ratio, 0.19;P= 0.02). The overall need of surgical (odds ratio, 1.27;P= 0.4) and nonsurgical (odds ratio, 1.07;P= 0.82) reintervention after the two procedures was similar.Conclusions:The Procedure for Prolapse and Hemorrhoid (stapled hemorrhoidopexy) is safe with many short-term benefits. The long-term results are similar to conventional procedure.

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