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Diseases of the Colon & Rectum
Published in: Diseases of the Colon & Rectum 9/2007

01-09-2007 | Original Contributions

Stapled Hemorrhoidopexy Is Associated with a Higher Long-Term Recurrence Rate of Internal Hemorrhoids Compared with Conventional Excisional Hemorrhoid Surgery

Authors: Shiva Jayaraman, M.D., Patrick H. D. Colquhoun, M.D., Richard A. Malthaner, M.D.

Published in: Diseases of the Colon & Rectum | Issue 9/2007

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Purpose

The purpose of this systematic review was to compare the long-term results of stapled hemorrhoidopexy with conventional excisional hemorrhoidectomy in patients with internal hemorrhoids.

Methods

A systematic review of all randomized, controlled trials comparing stapled hemorrhoidopexy and conventional hemorrhoidectomy with long-term results was performed by using the Cochrane methodology. The minimum follow-up was six months. Primary outcomes were hemorrhoid recurrence, hemorrhoid symptom recurrence, complications, and pain.

Results

Twelve trials were included. Follow-up varied from six months to four years. Conventional hemorrhoidectomy was more effective in preventing long-term recurrence of hemorrhoids (odds ratio (OR), 3.85; 95 percent confidence interval (CI), 1.47–10.07; P < 0.006). Conventional hemorrhoidectomy also prevents hemorrhoids in studies with follow-up of one year or more (OR, 3.6; 95 percent CI, 1.24–10.49; P < 0.02). Conventional hemorrhoidectomy is superior in preventing the symptom of prolapse (OR, 2.96; 95 percent CI, 1.33–6.58; P < 0.008). Conventional hemorrhoidectomy also is more effective at preventing prolapse in studies with follow-up of one year or more (OR, 2.68; 95 percent CI, 0.98–7.34; P < 0.05). Nonsignificant trends in favor of conventional hemorrhoidectomy were seen in the proportion of asymptomatic patients, bleeding, soiling/difficultly with hygiene/incontinence, the presence of perianal skin tags, and the need for further surgery. Nonsignificant trends in favor of stapled hemorrhoidopexy were seen in pain, pruritus ani, and symptoms of anal obstruction/stenosis.

Conclusions

Conventional hemorrhoidectomy is superior to stapled hemorrhoidopexy for prevention of postoperative recurrence of internal hemorrhoids. Fewer patients who received conventional hemorrhoidectomy complained of hemorrhoidal prolapse in long-term follow-up compared with stapled hemorrhoidopexy.
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Metadata
Title
Stapled Hemorrhoidopexy Is Associated with a Higher Long-Term Recurrence Rate of Internal Hemorrhoids Compared with Conventional Excisional Hemorrhoid Surgery
Authors
Shiva Jayaraman, M.D.
Patrick H. D. Colquhoun, M.D.
Richard A. Malthaner, M.D.
Publication date
01-09-2007
Publisher
Springer-Verlag
Published in
Diseases of the Colon & Rectum / Issue 9/2007
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-007-0308-4

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