Current Status of Surgical Treatment for Hemorrhoids - Systematic Review and Meta-analysis

Hemorrhoids are one of the most common anorectal disorders.Conventional hemorrhoidectomy is the most commonlypracticed surgical technique. Stapled hemorrhoidectomy (procedurefor prolapse and hemorrhoids [PPH]) and Ligasurehemorrhoidectomy are newly developed methods for the surgicalmanagement of hemorrhoids. The objective of this studywas to compare the effectiveness and safety of these two noveltechniques with that of conventional hemorrhoidectomy. Fromthe MEDLINE data-base, we obtained papers publishedbetween January 2000 and September 2009 and retrospectivelystudied randomized, controlled clinical trials that comparedPPH versus conventional hemorrhoidectomy or Ligasure hemorrhoidectomyversus conventional hemorrhoidectomy. BothPPH and Ligasure hemorrhoidectomy were superior to conventionalhemorrhoidectomy with regard to operation time, earlypostoperative pain, urinary retention, and time to return to normal activity. However, skintags and recurrent prolapse occurred at higher rates in the PPH group. Although both newtechniques have short-term benefits, especially in reducing extreme postoperative pain, morepowerful clinical studies with long-term follow up and larger sample sizes should be conductedfor further evaluation of outcomes.