Stapled haemorrhoidopexy for the treatment of haemorrhoids: a systematic review

• Published in: Colorectal disease 2009-03, Vol.11 (3), p.233-243
• Main Authors: Burch, J., Epstein, D., Baba-Akbari Sari, A., Weatherly, H., Jayne, D., Fox, D., Woolacott, N.
• Format: Article
• Language: English
• Subjects: Blood Loss, Surgical - physiopathology; circular stapler; Colorectal Surgery - adverse effects; Colorectal Surgery - methods; Female; Ferguson; Follow-Up Studies; Haemorrhoidectomy; Hemorrhoids - diagnosis; Hemorrhoids - surgery; Hospital Costs; Humans; Length of Stay; Male; Milligan-Morgan; Minimally Invasive Surgical Procedures - economics; Minimally Invasive Surgical Procedures - methods; Pain, Postoperative - physiopathology; Patient Satisfaction; Postoperative Hemorrhage - physiopathology; PPH; Randomized Controlled Trials as Topic; Recurrence; Surgical Stapling - adverse effects; Surgical Stapling - economics; Surgical Stapling - methods; Sutures; Treatment Outcome
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/j.1463-1318.2008.01638.x

Objective  This systematic review aimed to evaluate the short‐ and long‐term safety, efficacy and costs of stapled haemorrhoidopexy (SH) compared with conventional haemorrhoidectomy. Method  We searched 26 electronic databases and websites for studies in any language up to July 2006. Inclusion criteria were predefined, and each stage of the review process was conducted in duplicate. Results  Twenty‐seven randomized controlled trials were included (n = 2279). All had some methodological flaws. Postoperatively, 19 trials (95%) reported less pain, 17 (89%) reported a shorter operating time, 14 (88%) a shorter hospital stay, and 14 (93%) a shorter convalescence time following SH. However, prolapse was significantly more common after SH (OR 3.38; 95% CI: 1.00, 11.47). In the longer term, prolapse was significantly more common after SH (OR 4.34; 95% CI: 1.67, 11.28) as was reintervention for prolapse (OR 6.78; 95% CI: 2.00, 23.00). There were no differences in the rate or type of complications. Conventional haemorrhoidectomy and SH had similar costs during the initial admission. Conclusion  Compared with conventional haemorrhoidectomy, SH resulted in less postoperative pain, shorter operating time, a shorter hospital stay, and a shorter convalescence, but a higher rate of prolapse and reintervention for prolapse.