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

PURPOSE: METHODS: 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 patientsʼ 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 (5.7 vs. 1 percent; odds ratio, 3.48; P = 0.02), the overall incidence of recurrent hemorrhoidal symptoms—early (fewer than 6 months; stapled vs. conventional24.8 vs. 31.7 percent; P = 0.08) or late (1 year or more) recurrence rate (stapled vs. conventional25.3 vs. 18.7 percent; P = 0.07)—was similar. The overall complication rate did not differ significantly from that of conventional procedure (stapled vs. conventional20.2 vs. 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: