Abstract
Aims
This review compares the most popular techniques in managing the wounds after excisional haemorrhoidectomy, which are either to lay the wounds open or to close them.
Methods
Randomized controlled trials were identified from the major electronic databases using the search terms “hemorrhoid*” and “haemorrhoid*.” Duration of operation, pain, length of hospital stay, time off work, time for wound healing, patient satisfaction, continence, manometry findings and complications were assessed. Quantitative meta-analysis was performed as appropriate or possible.
Results
Six trials including 686 patients met the inclusion criteria. The median follow-up time ranged from 1.5 to 19.5 months. Quantitative meta-analysis showed that there was no significant difference in cure rates between the two techniques (relative risk, 1.4; 95% CI, 0.86 to 2.2; p=0.191). Open haemor-rhoidectomy was more quickly performed (weighted mean difference, 1.03 min; 95% CI, 0.51 to 1.54; p<0.001). Closed haemorrhoidectomy wounds showed faster healing (weighted mean difference, 1.2 weeks; 95% CI, 0.88 to 1.55; p<0.001). Hospital stay, maximum pain score, total and individual complication rates were not significantly different.
Conclusions
Apart from faster wound healing after closed haemorrhoidectomy, open and closed techniques appeared equally effective and safe. However, there were only a few studies which presented information in different ways, and statistical heterogeneity was high.
Similar content being viewed by others
References
MacRae HM, McLeod RS (1995) Comparison of hemorrhoidal treatment modalities: a meta-analysis. Dis Colon Rectum 38:687–694
Nisar PJ, Acheson AG, Neal KR, Schoefield JH (2004) Stapled hemorrhoidopexy compared with conventional hemorrhoidectomy: systemic review of randomized controlled trials. Dis Colon Rectum 47:1837–1845
Milligan ETC, Morgan CN, Jones LE, Officer R (1937) Surgical anatomy of the anal canal and the operative treatment of haemorrhoids. Lancet ii:1119–1124
Ferguson JA, Heaton JR (1959) Closed hemorrhoidectomy. Dis Colon Rectum 2:176–179
Clarke MD, Oxman AS (2002) Cochrane reviewers’ handbook. In: The Cochrane Library, Issue 2. Update Software, Oxford
Parks AG (1956) Surgical treatment of haemorrhoids. Br J Surg 43:337–351
Mathai V, Ong BC, Ho YH (1996) Randomized controlled trial of lateral internal sphincterotomy with haemorrhoidectomy. Br J Surg 83:380–382
Moher D, Schulz KF, Altman DG (2001) The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet 357:1191–1194
Jadad AR, Moore RA, Carroll D et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12
Mikuni N, Oya M, Komatsu J, Yamana T (2002) A prospective randomized comparison between an open hemorrhoidectomy and a semi-closed (semi-open) hemorrhoidectomy. Surg Today 32:40–47
Reis Neto JA, Quilici FA, Cordeiro F, Reis Junior JA (1992) Open versus semi-open hemorrhoidectomy: a random trial. Int Surg 77:84–90
Arbman G, Krook, H, Haapaniemi S (2000) Closed vs. open hemorrhoidectomy — is there any difference? Dis Colon Rectum 43:31–34
Ho YH, Seow-Choen F, Tan M, Leong AFPK (1997) Randomized controlled trial of open and closed haemorrhoidectomy. Br J Surg 84:1729–1730
Carapeti EA, Kamm MA, McDonald PJ, Chadwick SJD, Phillips RKS (1999) Randomized trial of open versus closed day-case haemorrhoidectomy. Br J Surg 86:612–613
Gencosmanoglu R, Sad O, Koc D, Inceoglu R (2002) Hemorrhoicectomy: open or closed technique? A prospective randomized clinical trial. Dis Colon Rectum 45:70–75
Arroyo A, Perez F, Miranda E et al (2004) open versus closed day-case haemorrhoidectomy: is there any difference? Results of a prospective randomized study. Int J Colorect Dis 19:370–373
Uba AF, Obekpa PO, Ardill W (2004) open versus closed haemorrhoidectomy. Nigerian Postgrad Med J 11:79–83
Johannsson HO, Pahlman L, Graf W (2006) Randomized clinical trial of the effects on anal function of Milligan-Morgan versus Ferguson haemorrhoidectomy. Br J Surg 93:1208–1214
Alderson P, Green S (eds) (2000) The Cochrane Collaboration Open Learning Material. Available at: http://www.cochranenet.org/openlearning/HTML/mod0.htm. (Accessed, 17 November 2006)
Nisaar PJ, Acheson AG, Neal KR, Scholefield JH (2004) Stapled hemorrhoidopexy compared with conventional hemorrhoidectomy: systemic review of randomized controlled trials. Dis Colon Rectum 47:1837–1845
Ho KS, Ho YH (2006) Prospective randomized trial comparing stapled hemorrhoidopexy versus closed Ferguson hemorrhoidectomy. Tech Coloproctol 10:193–197
Ho YH, Goh HS (1995) Unilateral anal electrosensation. Modified technique to improve quantification of anal sensory loss. Dis Colon Rectum 38:239–244
Ho YH, Cheong WK, Tsang C et al (2000) Stapled haemorrhoidectomy — cost and effectiveness. Randomized, controlled trial including incontinence scoring, anorectal manometry, and endoanal ultrasound assessments at up to three months. Dis Colon Rectum 43:1666–1675
Cook DJ, Guyatt GH, Laupacis A, Sackett DL (1992) Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest 102:305S–311S
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ho, Y.H., Buettner, P.G. Open compared with closed haemorrhoidectomy: meta-analysis of randomized controlled trials. Tech Coloproctol 11, 135–143 (2007). https://doi.org/10.1007/s10151-007-0343-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10151-007-0343-0