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A Meta-analysis of Randomized Controlled Trials

Pasquale Giordano, MD, FRCSEd, FRCS; Gianpiero Gravante, MD; Roberto Sorge, PhD; Lauren Ovens, MBChB, MRCS; Piero Nastro, MD, MRCS

Arch Surg. 2009;144(3):266-272.

Objectives  To assess the long-term results of stapled hemorrhoidopexy (SH) compared with conventional hemorrhoidectomy (CH) and to define the role of SH in the treatment of hemorrhoids.

Data Sources  Published randomized controlled trials of CH vs SH with a minimum clinical follow-up of 12 months were searched and selected in the MEDLINE, EMBASE, and Cochrane Library databases using the keywords hemorrhoid, stapl, and anopexy, without language restrictions.

Study Selection  Potentially relevant studies were identified by the title and the abstract, and full articles were obtained and assessed in detail.

Data Extraction  Studies were scored according to the presence of 3 key methodologic features of randomization, blinding, and accountability of all patients, including withdrawals, and the scores ranged from 0 to 5. Studies that received a score from 3 to 5 were considered high-quality studies, whereas those with a score of 2 or less were considered of low quality. A specifically designed data form was used to collect all relevant data, including details of the experimental design, patient demographics, technical aspects, outcome measures, and complications.

Data Synthesis  Fifteen articles met the inclusion criteria for a total of 1201 patients. Outcomes at a minimum of 1 year showed a significantly higher rate of prolapse recurrences in the SH group (14 studies, 1063 patients; odds ratio, 5.5; P < .001) and patients were more likely to undergo further treatment to correct recurrent prolapses compared with the CH group (10 studies, 824 patients; odds ratio, 1.9; P = .02).

Conclusion  Stapled hemorrhoidopexy is a safe technique for the treatment of hemorrhoids but carries a significantly higher incidence of recurrences and additional operations compared with CH. It is the patient's choice whether to accept a higher recurrence rate to take advantage of the short-term benefits of SH.

Author Affiliations: Department of Colorectal Surgery, Whipps Cross University Hospital, London, England (Drs Giordano, Gravante, Ovens, and Nastro); and Laboratory of Biometry, University of Tor Vergata, Rome, Italy (Dr Sorge).

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RELATED LETTER

Hospital Costs of Conventional and Stapled 1-Day Hemorrhoidectomy—Reply
Pasquale Giordano, Gianpiero Gravante, Lauren Ovens, and Piero Nastro
Arch Surg. 2009;144(10):980.
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