Long-term Outcomes of Stapled Hemorrhoidopexy vs Conventional Hemorrhoidectomy – A Meta analysis of Radomized Controlled Trials

Giordano P., MD, FRCSED, FRCS., Gravante G., MD., Segre R., PHD., Ovens L., MBCHB, MRCS., Nastro P., MD, MRCS.
Arch Surg. 2009; 144 (3): 266-272

To asses the long-term results of stapled hemorrhoidectomy (SH) compared with conventional hemorrhoidectomy (CH) and to define the role of SH in the tratment of hemorrhoids.

Published randomized controlled trials of CH vs SH with a minimum clinical follow-up of 12 months were searched and selected in the MEDLINE, EMBASE, and Cochrane Library database using the keywords hemorrhoid, stapl, and anopexy, without language restrictions.

Potentially relevant studies were identified by the title and the abstract, and full articles were obtained and assessed in detail.

Studies were scored according to the presence of 3 key methodological features of randomization, blinding accountability of all patients, including withdrawals, and the scores ranged from 0 to 5. Studies that received a score from 3 to 5 were considered high-quality studies, whereas those with a score of 2 or less were considered of low quality. A specifically designed data fomr was used to collect all relevant data, including details of the experimental design, patient demographics, technical aspects, outcome measures, and complications.

Fifteen articles met the inclusion criteria for a total of 1201 patients. Outcomes at a minimun of 1 year showed a significantly higher trate of prolapse recerrences in the SH group (14 studies, 1063 patients; odds ratio, 5.5; P<.001) and patients were more likely to undergo further treatment to correct recurrent prolapses compared with the CH group (10 studies, 824 patients; odds ratio, 1.9; P= .02).

Stapled hemorrhoidopexy is a safe technique for the treatment of hemorrhoids but carries a significantly higher incidence or recurrences and additional operations compared with CH. It is the patient’s choice whether to accept a higher recurrence rate to take advantage of the short-term benefit of SH.