2009

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

OBJECTIVE:
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.

DATA SOURCES:
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.

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

DATA EXTRACTION:
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.

DATA SYNTHESIS:
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).

CONCLUSION:
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.

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