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

• Published in: Diseases of the colon & rectum Vol. 50; no. 9; pp. 1297 - 1305
• Main Authors: Jayaraman, Shiva, Colquhoun, Patrick H. D, Malthaner, Richard A
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Secaucus, NJ The ASCRS 01.09.2007; Springer; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Biological and medical sciences; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Hemorrhoids - epidemiology; Hemorrhoids - surgery; Humans; Medical sciences; Other diseases. Semiology; Randomized Controlled Trials as Topic; Recurrence; Stomach, duodenum, intestine, rectum, anus; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Suture Techniques - instrumentation; Sutures; Time Factors; Vascular Surgical Procedures - methods; Hemorrhoidopexy; Skin disease; Relapse; Procedure for prolapse and hemorrhoids; Cardiovascular disease; Hemorrhage; Venous disease; Vascular disease; Molluscum pendulum; Pain; Surgery; Anal itching; Intestinal disease; Tumor; Staple; Anorectal disease; Human; Postoperative; Long term; Prolapse; Prolapsus; Symptomatology; Treatment; Anus; Digestive diseases; Hemorrhoid; Hemorrhoidectomy
• ISSN: 0012-3706; 1530-0358
• DOI: 10.1007/s10350-007-0308-4

PURPOSE: METHODS: 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: