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Stapled Hemorrhoidopexy Compared With Conventional Hemorrhoidectomy: Systematic Review of Randomized, Controlled Trials

  • Original Contributions
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Diseases of the Colon & Rectum

PURPOSE

This study was designed to determine whether conventional hemorrhoidectomy or stapled hemorrhoidopexy is superior for the management of hemorrhoids.

METHODS

A systematic review of all randomized trials comparing conventional hemorrhoidectomy with stapled hemorrhoidopexy was performed. MEDLINE, EMBASE, and Cochrane Library databases were searched using the terms “hemorrhoid*” or “haemorrhoid*” and “stapl*.” A list of clinical outcomes was extracted. Meta-analysis was calculated if possible.

RESULTS

Fifteen trials recruiting 1,077 patients were included. Follow-up ranged from 6 weeks to 37 months. Qualitative analysis showed that stapled hemorrhoidopexy is less painful compared with hemorrhoidectomy. Stapled hemorrhoidopexy has a shorter inpatient stay (weighted mean difference, –1.02 days; 95 percent confidence interval, –1.47 to –0.57; P = 0.0001), operative time (weighted mean difference, –12.82 minutes; 95 percent confidence interval, –22.61 to –3.04; P = 0.01), and return to normal activity (standardized mean difference, –4.03 days; 95 percent confidence interval, –6.95 to –1.10; P = 0.007). Studies in a day-case setting do not prove that stapled hemorrhoidopexy is more feasible than conventional hemorrhoidectomy. Stapled hemorrhoidopexy has a higher recurrence rate (odds ratio, 3.64; 95 percent confidence interval, 1.40–9.47; P = 0.008) at a minimum follow-up of six months.

CONCLUSIONS

Although stapled hemorrhoidopexy is widely used, the data available on long-term outcomes is limited. The variability in case selection and reported end points are difficulties in interpreting results. Stapled hemorrhoidopexy has unique potential complications and is a less effective cure compared with hemorrhoidectomy. With this understanding, it may be offered to patients seeking a less painful alternative to conventional surgery. Hemorrhoidectomy remains the “gold standard” of treatment.

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Authors and Affiliations

  1. Section of Surgery, University Hospital, Queen’s Medical Centre, Nottingham, United Kingdom

    Pasha J. Nisar M.R.C.S., Austin G. Acheson F.R.C.S. & John H. Scholefield F.R.C.S.

  2. Department of Epidemiology, University Hospital, Queen’s Medical Centre, Nottingham, United Kingdom

    Keith R. Neal F.R.C.P.

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  1. Pasha J. Nisar M.R.C.S.
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  2. Austin G. Acheson F.R.C.S.
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  3. Keith R. Neal F.R.C.P.
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Correspondence to Pasha J. Nisar M.R.C.S..

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Nisar, P., Acheson, A., Neal, K. et al. Stapled Hemorrhoidopexy Compared With Conventional Hemorrhoidectomy: Systematic Review of Randomized, Controlled Trials. Dis Colon Rectum 47, 1837–1845 (2004). https://doi.org/10.1007/s10350-004-0679-8

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