World Journal of Surgery

, Volume 41, Issue 2, pp 603–614 | Cite as

Evidence-Based Management of Pain After Excisional Haemorrhoidectomy Surgery: A PROSPECT Review Update

  • Tarik Sammour
  • Ahmed W. H. BarazanchiEmail author
  • Andrew G. Hill
  • on behalf of the PROSPECT group (Collaborators)
Scientific Review



The aim of this systematic review was to update previous PROSPECT ( review recommendations for the management of pain after excisional haemorrhoidectomy.


Randomized studies and reviews published in the English language from July 2006 (end date of last review) to March 2016, assessing analgesic, anaesthetic, and operative interventions pertaining to excisional haemorrhoidectomy in adults, and reporting pain scores, were retrieved from the EMBASE and MEDLINE databases.


An additional 464 studies were identified of which 74 met the inclusion criteria. There were 48 randomized controlled trials and 26 reviews. Quantitative analyses were not performed, as there were limited numbers of trials with a sufficiently homogeneous design.


Pudendal nerve block, with or without general anaesthesia, is recommended for all patients undergoing haemorrhoidal surgery. Either closed haemorrhoidectomy, or open haemorrhoidectomy with electrocoagulation of the pedicle is recommended as the primary procedure. Combinations of analgesics (paracetamol, non-steroidal anti-inflammatory drugs, and opioids), topical lignocaine and glyceryl trinitrate, laxatives, and oral metronidazole are recommended post-operatively. The recommendations are largely based on single intervention, not multimodal intervention, studies.


Lateral Internal Sphincterotomy Trimebutine Diosmin Liposomal Bupivacaine Open Haemorrhoidectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


PROSPECT group (Collaborators)

Professor Henrik Kehlet, Dr Barrie Fischer, Professor Stephan Schug, Professor Girish Joshi, Professor Marc Van de Velde, Professor Marcel Vercauteren, Dr Philipp Lirk, Professor Narinder Rawal, and Professor Francis Bonnet.

Compliance with ethical standards

Conflict of interest



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Copyright information

© Société Internationale de Chirurgie 2016

Authors and Affiliations

  • Tarik Sammour
    • 1
  • Ahmed W. H. Barazanchi
    • 2
    Email author
  • Andrew G. Hill
    • 3
    • 4
  • on behalf of the PROSPECT group (Collaborators)
  1. 1.Department of Surgical OncologyMD Anderson Cancer CenterHoustonUSA
  2. 2.Department of SurgeryPalmerston North Public HospitalPalmerston NorthNew Zealand
  3. 3.Department of Surgery, South Auckland Clinical School, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
  4. 4.Middlemore HospitalAucklandNew Zealand

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