A systematic review of the literature assessing the outcomes of stapled haemorrhoidopexy versus open haemorrhoidectomy
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REVIEW
A systematic review of the literature assessing the outcomes of stapled haemorrhoidopexy versus open haemorrhoidectomy Q. Z. Ruan1 · W. English1,2 · A. Hotouras1,2 · C. Bryant1 · F. Taylor1 · S. Andreani1 · S. D. Wexner3 · S. Banerjee4 Received: 30 June 2020 / Accepted: 16 July 2020 © The Author(s) 2020
Abstract Background Symptomatic haemorrhoids affect a large number of patients throughout the world. The aim of this systematic review was to compare the surgical outcomes of stapled haemorrhoidopexy (SH) versus open haemorrhoidectomy (OH) over a 20-year period. Methods Randomized controlled trials published between January 1998 and January 2019 were extracted from Pubmed using defined search criteria. Study characteristics and outcomes in the form of short-term and long-term complications of the two techniques were analyzed. Any changes in trend of outcomes over time were assessed by comparing article groups 1998–2008 and 2009–2019. Results Twenty-nine and 9 relevant articles were extracted for the 1998–2008 (period 1) and 2009–2019 (period 2) cohorts, respectively. Over the two time periods, SH was found to be a safe procedure, associated with statistically reduced operative time (in 13/21 studies during period 1 and in 3/8 studies during period 2), statistically less intraoperative bleeding (3/7 studies in period 1 and 1/1 study in period 2) and consistently less early postoperative pain on the visual analogue scale (12/15 studies in period 1 and 4/5 studies in period 2) resulting in shorter hospital stay (12/20 studies in period 1 and 2/2 studies in period 2) at the expense of a higher cost. In the longer term, although chronic pain in SH and OH patents is comparable, patient satisfaction with SH may decline with time and at 2-year follow-up OH appeared to be associated with greater patient satisfaction. Conclusions SH appears to be safe with potential advantages, at least in the short term, but the evidence is lacking at the moment to suggest its routine use in clinical practice. Keywords Haemorrhoidectomy · Stapled · Open · Outcomes
Introduction Symptomatic haemorrhoids account for approximately 3.3 million outpatient encounters annually in the United States [1], while up to 37% of the general population in the United Kingdom may be affected by the same disease process [2].
* A. Hotouras [email protected] 1
Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
2
National Bowel Research Centre, Blizard Institute, QMUL, 2 Newark Street, London E1 2AT, UK
3
Cleveland Clinic Florida, Fort Lauderdale, FL, USA
4
Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
Grade III and IV haemorrhoidal disease (Goligher classification) responds more favourably to surgical treatment [3]. Traditional open haemorrhoidectomy (OH) is still the gold standard operation but it is associated with significant postoperative pain and a small risk of injury to the anal sphincter complex [4, 4]. Novel surgical procedures such as the haemorrhoidal artery ligatio
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