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

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Diseases of the Colon & Rectum

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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References

  1. JF Johanson (2002) ArticleTitleEvidence based approach to the treatment of hemorrhoidal disease Evid Based Gastroenterol 3 26–31 Occurrence Handle10.1097/00132579-200202000-00006

    Article  Google Scholar 

  2. TC Sardinha ML Corman (2002) ArticleTitleHemorrhoids Surg Clin North Am 82 1153–1167 Occurrence Handle12516845 Occurrence Handle10.1016/S0039-6109(02)00082-8

    Article  PubMed  Google Scholar 

  3. LM Sutherland AK Burchard K Masuda et al. (2002) ArticleTitleA systematic review of stapled hemorrhoidectomy Arch Surg 137 1395–1406 Occurrence Handle12470107 Occurrence Handle10.1001/archsurg.137.12.1395 Occurrence Handle1:STN:280:DC%2BD38jgvVKgug%3D%3D

    Article  PubMed  CAS  Google Scholar 

  4. A Polglase (1997) ArticleTitleHaemorrhoids: a clinical update Med J Aust 167 85–88 Occurrence Handle9251694 Occurrence Handle1:STN:280:ByiA1MrlsFI%3D

    PubMed  CAS  Google Scholar 

  5. HM MacRae RS McLeod (1995) ArticleTitleComparison of hemorrhoidal treatment modalities: a meta-analysis Dis Colon Rectum 38 687–694 Occurrence Handle7607026 Occurrence Handle10.1007/BF02048023 Occurrence Handle1:STN:280:ByqA3s7gslE%3D

    Article  PubMed  CAS  Google Scholar 

  6. Longo A. Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device: a new procedure. In: Proceedings of the 6th World Congress of Endoscopic Surgery. Bologna, Italy. Monduzzi Publishing Co., 1998;777–84

  7. JM Correa-Rovelo O Tellez L Obregon et al. (2002) ArticleTitleStapled rectal mucosectomy vs. closed hemorrhoidectomy Dis Colon Rectum 45 1367–1376 Occurrence Handle12394436 Occurrence Handle10.1007/s10350-004-6426-3

    Article  PubMed  Google Scholar 

  8. BJ Mehigan JR Monson JE Hartley (2000) ArticleTitleStapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomised controlled trial Lancet 355 782–785 Occurrence Handle10711925 Occurrence Handle10.1016/S0140-6736(99)08362-2 Occurrence Handle1:STN:280:DC%2BD3c7nsFSruw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  9. M Rowsell M Bello DM Hemingway (2000) ArticleTitleCircumferential mucosectomy (stapled haemorrhoidectomy) versus conventional haemorrhoidectomy: randomised controlled trial Lancet 355 779–781 Occurrence Handle10711924 Occurrence Handle10.1016/S0140-6736(99)06122-X Occurrence Handle1:STN:280:DC%2BD3c7nsFSrug%3D%3D

    Article  PubMed  CAS  Google Scholar 

  10. M Pescatori (2002) ArticleTitleStapled hemorrhoidectomy: a word of caution Int J Colorectal Dis 17 362–363 Occurrence Handle12420732 Occurrence Handle10.1007/s00384-002-0419-2

    Article  PubMed  Google Scholar 

  11. MJ Cheetham NJ Mortensen P-O Nystrom et al. (2000) ArticleTitlePersistent pain and faecal urgency after stapled haemorrhoidectomy Lancet 356 730–733 Occurrence Handle11085693 Occurrence Handle10.1016/S0140-6736(00)02632-5 Occurrence Handle1:STN:280:DC%2BD3M%2FjvVKquw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  12. Alderson P, Green S, Higgins JP. Cochrane Reviewers’ Handbook 4.2.2. In: The Cochrane Database of Systematic Reviews, Issue 1. Chichester, UK: John Wiley & Sons, 2004

  13. P Boccasanta PG Capretti M Venturi et al. (2001) ArticleTitleRandomised controlled trial between stapled circumferential mucosectomy and conventional circular hemorrhoidectomy in advanced hemorrhoids with external mucosal prolapse Am J Surg 182 64–68 Occurrence Handle11532418 Occurrence Handle10.1016/S0002-9610(01)00654-7 Occurrence Handle1:STN:280:DC%2BD3MvovFOnuw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  14. MJ Cheetham CR Cohen MA Kamm RK Phillips (2003) ArticleTitleA randomized, controlled trial of diathermy hemorrhoidecomy vs. stapled hemorrhoidectomy in an intended day-care setting with longer-term follow-up Dis Colon Rectum 46 491–497 Occurrence Handle12682543 Occurrence Handle10.1007/s10350-004-6588-z Occurrence Handle1:STN:280:DC%2BD3s7msVeisg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  15. E Ganio F Altomare E Gabrielli et al. (2001) ArticleTitleProspective randomized multicentre trial comparing stapled with open haemorrhoidectomy Br J Surg 88 669–674 Occurrence Handle11350437 Occurrence Handle10.1046/j.0007-1323.2001.01772.x Occurrence Handle1:STN:280:DC%2BD3M3mslentw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  16. FH Hetzer N Demartines AE Handschin P-A Clavien (2002) ArticleTitleStapled vs excision hemorrhoidectomy Arch Surg 137 337–340 Occurrence Handle11888463 Occurrence Handle10.1001/archsurg.137.3.337

    Article  PubMed  Google Scholar 

  17. M Kairaluoma K Nuorva I Kellokumpu (2003) ArticleTitleDay-case stapled (circular) vs. diathermy hemorrhoidectomy Dis Colon Rectum 46 93–99 Occurrence Handle12544528 Occurrence Handle10.1007/s10350-004-6502-8

    Article  PubMed  Google Scholar 

  18. H Ortiz J Marzo P Armendariz (2002) ArticleTitleRandomized clinical trial of stapled haemorrhoidopexy versus conventional diathermy haemorrhoidopexy Br J Surg 89 1376–1381 Occurrence Handle12390376 Occurrence Handle10.1046/j.1365-2168.2002.02237.x Occurrence Handle1:STN:280:DC%2BD38njt1agtA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  19. A Racalbuto I Aliotta G Corsaro R Lanteri A Cataldo ParticleDi A Licata (2004) ArticleTitleHemorrhoidal stapler prolapsectomy vs. Milligan Morgan hemorrhoidectomy: a long-term randomized trial Int J Colorectal Dis 19 239–244 Occurrence Handle14605834 Occurrence Handle10.1007/s00384-003-0547-3 Occurrence Handle1:STN:280:DC%2BD2c7mtlGmtQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  20. AJ Senagore M Singer H Abcarian et al. (2004) ArticleTitleA prospective, randomized, controlled multicenter trial comparing stapled hemorrhoidopexy and ferguson hemorrhoidectomy: perioperative and one-year results Dis Colon Rectum 47 1824–1836 Occurrence Handle15622574 Occurrence Handle10.1007/s10350-004-0694-9 Occurrence Handle1:STN:280:DC%2BD2cnktlKgsA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  21. R Shalaby A Desoky (2001) ArticleTitleRandomized clinical trial of stapled versus Milligan-Morgan haemorrhoidectomy Br J Surg 88 1049–1053 Occurrence Handle11488788 Occurrence Handle10.1046/j.0007-1323.2001.01830.x Occurrence Handle1:STN:280:DC%2BD3MvktlWhsQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  22. EF Smyth RP Baker BJ Wilken JE Hartley TJ White JR Monson (2003) ArticleTitleStapled versus excision haemorrhoidectomy: long-term follow-up of a randomised controlled trial Lancet 361 1437–1438 Occurrence Handle12727401 Occurrence Handle10.1016/S0140-6736(03)13106-6

    Article  PubMed  Google Scholar 

  23. I Au-Yong M Rowsell DM Hemingway (2004) ArticleTitleRandomised controlled clinical trial of stapled haemorrhoidectomy vs conventional haemorrohoidectomy; a three and a half year follow up Colorectal Dis 6 37–38 Occurrence Handle14692951 Occurrence Handle10.1111/j.1463-1318.2004.00496.x Occurrence Handle1:STN:280:DC%2BD3snhtVaqsg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  24. SR Brown K Ballan E Ho et al. (2001) ArticleTitleStapled mucosectomy for acute thrombosed circumferentially prolapsed piles: a prospective randomized comparison with conventional haemorrhoidectomy Colorectal Dis 3 175–178 Occurrence Handle12790985 Occurrence Handle10.1046/j.1463-1318.2001.00224.x Occurrence Handle1:STN:280:DC%2BD3s3msFShsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  25. YH Ho WK Cheong C Tsang et al. (2000) ArticleTitleStapled hemorrhoidectomy—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 Occurrence Handle11156449 Occurrence Handle10.1007/BF02236847 Occurrence Handle1:STN:280:DC%2BD3M%2FpvFGrtQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  26. T Pavlidis B Papaziogas A Souparis et al. (2002) ArticleTitleModern stapled Longo procedure vs. conventional Milligan-Morgan hemorrhoidectomy: a randomized controlled trial Int J Colorectal Dis 17 50–53 Occurrence Handle12018455 Occurrence Handle10.1007/s003840100342 Occurrence Handle1:STN:280:DC%2BD383nslGlsQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  27. MS Wilson V Pope HE Doran et al. (2002) ArticleTitleObjective comparison of stapled anopexy and open hemorrhoidectomy: a randomized, controlled trial Dis Colon Rectum 45 1437–1444 Occurrence Handle12432288 Occurrence Handle10.1007/s10350-004-6446-z Occurrence Handle1:STN:280:DC%2BD38nntFShuw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  28. KH Khalil A O’Bichere D Sellu (2000) ArticleTitleRandomised clinical trial of sutured versus stapled closed haemorrhoidectomy Br J Surg 87 1352–1355 Occurrence Handle11044160 Occurrence Handle10.1046/j.1365-2168.2000.01624.x Occurrence Handle1:STN:280:DC%2BD3crgtVGlug%3D%3D

    Article  PubMed  CAS  Google Scholar 

  29. Shanmugam V, Thaha MA, Rabindranath KS, Campbell KL, Steele RJ, Loudon MA. Rubber band ligation versus excisional haemorrhoidectomy for haemorrhoids. In: The Cochrane Database of Systematic Reviews, Issue 1. Chichester: John Wiley & Sons, 2005

  30. PJ Nisar AG Acheson KR Neal JH Scholefield (2004) ArticleTitleStapled hemorrhoidopexy compared with conventional hemorrhoidectomy: systematic review of randomized controlled trials Dis Colon Rectum 47 1837–1845 Occurrence Handle15622575 Occurrence Handle10.1007/s10350-004-0679-8

    Article  PubMed  Google Scholar 

  31. SY You SH Kim CS Chung DK Lee (2005) ArticleTitleOpen vs. closed hemorrhoidectomy Dis Colon Rectum 48 108–113 Occurrence Handle15690666 Occurrence Handle10.1007/s10350-004-0794-6

    Article  PubMed  Google Scholar 

  32. G Arbman H Krook S Haapaniemi (2000) ArticleTitleClosed vs. open hemorrhoidectomy—is there any difference? Dis Colon Rectum 43 31–34 Occurrence Handle10813120 Occurrence Handle10.1007/BF02237240 Occurrence Handle1:STN:280:DC%2BD3c3ntFahug%3D%3D

    Article  PubMed  CAS  Google Scholar 

  33. MO Guerin R Rosenthal B Kern R Peterli M Flue Particlevon C Ackermann (2005) ArticleTitleFerguson hemorrhoidectomy: long-term results and patient satisfaction after Ferguson’s hemorrhoidectomy Dis Colon Rectum 48 1523–1527 Occurrence Handle10.1007/s10350-005-0084-y

    Article  Google Scholar 

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Acknowledgment

The authors thank Henning Keinke Andersen, Ph.D., from the Cochrane Colorectal Cancer Group for assistance.

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Authors and Affiliations

  1. Department of Surgery, University of Western Ontario, 339 Windermere Road, Room C8-114, London, Ontario, N6A 5A5, Canada

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

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  1. Shiva Jayaraman M.D.
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  2. Patrick H. D. Colquhoun M.D.
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  3. Richard A. Malthaner M.D.
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Corresponding author

Correspondence to Shiva Jayaraman M.D..

Additional information

Podium presentations at the Canadian Surgical Forum, Montreal, Quebec, Canada, September 8 to 11, 2005, and the Tripartite Colorectal Meeting, Dublin, Ireland, July 5 to 7, 2005.

This paper is based on a Cochrane Review published in The Cochrane Library 2006, Issue 4. Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, The Cochrane Library should be consulted for the most recent version of the review.

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Jayaraman, S., Colquhoun, P.H.D. & Malthaner, R.A. Stapled Hemorrhoidopexy Is Associated with a Higher Long-Term Recurrence Rate of Internal Hemorrhoids Compared with Conventional Excisional Hemorrhoid Surgery. Dis Colon Rectum 50, 1297–1305 (2007). https://doi.org/10.1007/s10350-007-0308-4

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