 |
|
A Systematic Review of Stapled Hemorrhoidectomy
L. M. Sutherland, BSc;
A. K. Burchard;
K. Matsuda;
J. L. Sweeney, MBBS,FRACS;
E. L. Bokey, MBBS,FRACS;
P. A. Childs, MBBS,FRACS;
A. K. Roberts, MBBS,FRCS,FRACS,FACS;
B. P. Waxman, BMedSc,MBBS,FRCS,FRACS,FACS,MRACMA;
G. J. Maddern, PhD,MS,FRACS
Arch Surg. 2002;137:1395-1406.
Hypothesis Use of circular stapled hemorrhoidectomy will result in the same or improved safety and efficacy outcomes as those of the conventional methods for hemorrhoidectomy in patients with hemorrhoids.
Data Sources Studies on stapled hemorrhoidectomy were identified using PREMEDLINE and MEDLINE (June 1966–June 2001), EMBASE (January 1980–June 2001), Current Contents (June 1993–June 2001), Ovid HEALTHSTAR (January 1975–June 2001), the National Institutes of Health Clinical Trials database (searched June 13, 2001), and The National Coordinating Centre for Health Technology Assessment database (searched June 14, 2001). The search terms were as follows: haemorrhoid* and (stapl* or convent*) or hemorrhoid* and (stapl* or convent*). The Cochrane Library (2001, issue 2) was searched using the search terms haemorrhoid* or hemorrhoid*.
Study Selection Articles detailing randomized controlled trials were included if they compared circular stapled with conventional hemorrhoidectomy and provided relevant safety and efficacy outcome information.
Data Extraction Data from all included studies were extracted using standardized data extraction tables that were developed a priori. In addition, the randomized controlled trials were examined with respect to the adequacy of allocation concealment, handling of those unavailable for follow-up, and any other aspect of the study design or execution that may have introduced bias.
Data Synthesis Seven randomized controlled trials met the inclusion criteria. A meta-analysis was conducted when the studies had comparable outcomes, inclusion criteria, and follow-up. There was reasonably clear evidence in favor of the stapled procedure for bleeding at 2 weeks (relative risk, 0.55; 95% confidence interval, 0.37-0.82) and length of hospital stay (weighted mean difference, -0.89 days; 95% confidence interval, -1.42 to -0.36). Other less robust results in favor of the stapled hemorrhoidectomy related to pain, bleeding, anal discharge, wound healing, tenderness to per rectal examination, incontinence scores, earlier return of bowel function, analgesic requirement, and resumption of normal activities. One trial showed that prolapse occurred at significantly higher rates in the stapled hemorrhoidectomy group. However, the outcomes were poorly reported and generally showed statistically significant heterogeneity.
Conclusions Stapled hemorrhoidectomy may be at least as safe as conventional hemorrhoidal surgical techniques. However, the efficacy of the stapled procedure compared with the conventional techniques could not be determined. More rigorous studies with longer follow-up periods and larger sample sizes need to be conducted.
From ASERNIP-S, Royal Australasian College of Surgeons, North Adelaide, South Australia (Ms Sutherland); Medical School, University of Adelaide (Ms Burchard and Mr Matsuda), and East Terrace Colo Rectal Associates, St Andrew's Medical Centre (Dr Sweeney), Adelaide, South Australia; the Department of Surgery, Concord Hospital, Concord, New South Wales (Mr Bokey); Glengarry Specialist Centre, Duncraig, Western Australia (Dr Childs); Vascular Surgery Unit, Austin and Repatriation Medical Centre, Heidelberg, Victoria (Mr Roberts); Academic Surgical Unit, Monash University, Dandenong Hospital, Dandenong, Victoria (Mr Waxman); and the Department of Surgery, University of Adelaide, Queen Elizabeth Hospital, Adelaide, South Australia (Dr Maddern), Australia.
RELATED ARTICLE
A Systematic Review of Stapled Hemorrhoidectomy—Invited Critique
Susan Galandiuk
Arch Surg. 2002;137(12):1407.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Novel Technology and Innovations in Colorectal Surgery: The Circular Stapler for Treatment of Hemorrhoids and Fibrin Glue for Treatment of Perianal Fistulae
Person and Wexner
SURG INNOV 2004;11:241-252.
ABSTRACT
|
