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Stapled versus conventional surgery for hemorrhoidsJayaraman S, Colquhoun PH.D., Malthaner R
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SummaryStapled versus conventional surgery for hemorrhoidsStapled hemorrhoidopexy is associated with a higher risk of hemorrhoid recurrence and prolapse compared to conventional excisional hemorrhoidectomy. While both operations are safe, the traditional excisional techniques were found to be superior to the stapled technique in preventing most clinically important symptoms. If hemorrhoid recurrence and prolapse are considered the most important clinical outcomes, then conventional excisional hemorrhoidectomy remains the "gold standard" treatment for hemorrhoids. However, there may be a sub-set of patients for whom the stapled method is superior, therefore, further study is warranted.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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October 18. 2006 AbstractBackgroundHemorrhoids are one of the most common anorectal disorders. The Milligan-Morgan open hemorrhoidectomy is the most widely practiced surgical technique used for the management of hemorrhoids and is considered the current "gold standard". Circular stapled hemorrhoidopexy was first described by Longo in 1998 as alternative to conventional excisional hemorrhoidectomy. Early, small randomized-controlled trials comparing stapled hemorrhoidopexy with traditional excisional surgery have shown it to be less painful and that it is associated with quicker recovery. The reports also suggest a better patient acceptance and a higher compliance with day-case procedures potentially making it more economical ObjectivesTo compare the use of circular stapling devices and conventional excisional techniques in patients with symptomatic hemorrhoids. Search strategyWe searched all the major electronic databases (MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) from 1998 to May 2006. Selection criteriaAll randomized controlled trials comparing stapled hemorrhoidopexy to conventional excisional hemorrhoidal surgeries were included. Data collection and analysisData were collected on a data sheet. When appropriate, an Odds Ratio was generated using a random effects model. Main resultsPatients undergoing circular stapled hemorrhoidopexy (SH) were significantly more likely to have recurrent hemorrhoids in long term follow up at all time points than those receiving conventional hemorrhoidectomy (CH) (7 trials, 537 patients, OR 3.85, CI 1.47-10.07, p=0.006). There were 23 recurrences out of 269 patients in the stapled group versus only 4 out of 268 patients in the conventional group. Similarly, in trials where there was follow up of one year or more, SH was associated with a greater proportion of patients with hemorrhoid recurrence(5 trials, 417 patients, OR 3.60, CI 1.24-10.49, p=0.02). Furthermore, a significantly higher proportion of patients with SH complained of the symptom of prolapse at all time points (8 studies, 798 patients, OR 2.96, CI 1.33-6.58, p=0.008). In studies with follow up of greater than one year, the same significant outcome was found (6 studies, 628 patients, OR 2.68, CI 0.98-7.34, p=0.05). Non significant trends in favor of SH were seen in pain, pruritis ani, and fecal urgency. All other clinical parameters showed trends favoring CH Authors' conclusionsStapled hemorrhoidopexy is associated with a higher long-term risk of hemorrhoid recurrence and the symptom of prolapse. It is also likely to be associated with a higher likelihood of long-term symptom recurrence and the need for additional operations compared to conventional excisional hemorrhoid surgeries. Patients should be informed of these risks when being offered the stapled hemorrhoidopexy as surgical therapy. If hemorrhoid recurrence and prolapse are the most important clinical outcomes, then conventional excisional surgery remains the "gold standard" in the surgical treatment of internal hemorrhoids. |