harmonic scalpel hemorrhoidectomy: a randomized trial. Updat Surg 63(3):151–154Ĭhung CC, Cheung HY, Chan ES, Kwok SY, Li MK (2005) Stapled hemorrhoidopexy vs. Ann R Coll Surg Engl 92(5):W39–W41Ĭalomino N, Martellucci J, Fontani A, Papi F, Cetta F, Tanzini G (2011) Care with regard to details improves the outcome of Longo mucoprolapsectomy: long term follow up. Color Dis 13(6):697–702īerstock JR, Bunni J, Torrie AP (2010) The squelching hip: a sign of life threatening sepsis following haemorrhoidectomy. World J Gastrointest Surg 8(9):614–620īehboo R, Zanella S, Ruffolo C, Vafai M, Marino F, Scarpa M (2011) Stapled haemorrhoidopexy: extent of tissue excision and clinical implications in the early postoperative period. This process is experimental and the keywords may be updated as the learning algorithm improves.Īlbuquerque A (2016) Rubber band ligation of hemorrhoids: a guide for complications. These keywords were added by machine and not by the authors. For this reason, I am trying to write in an objective way about the pros and cons of the procedure, explaining its rationale. In fact, a careful selection of patients can lead to a good outcome with a reduction of recurrence rate and risk of complications. So, in my opinion, the stapled surgery is a good surgical option when performed by expert surgeons and especially with right indications. For this reason also literature has undergone these currents of thought, becoming unreliable for those who would have a clear and unequivocal view of this procedure. Surgeons in favor have always emphasized the advantages over the traditional excisional surgery (less pain at rest and on defecation, earlier return to bowel function and normal activities, etc.) while surgeons opposed to the procedure have always documented its limits and severe complications. Hemorrhoidectomy remains the “gold standard” of treatment.Stapled hemorrhoidopexy has always been a hotly debated topic among surgeons in favor and against this kind of procedure. With this understanding, it may be offered to patients seeking a less painful alternative to conventional surgery. Stapled hemorrhoidopexy has unique potential complications and is a less effective cure compared with hemorrhoidectomy. The variability in case selection and reported end points are difficulties in interpreting results. CONCLUSIONS:Īlthough stapled hemorrhoidopexy is widely used, the data available on long-term outcomes is limited. Stapled hemorrhoidopexy has a higher recurrence rate (odds ratio, 3.64 95 percent confidence interval, 1.40-9.47 P = 0.008) at a minimum follow-up of six months. Studies in a day-case setting do not prove that stapled hemorrhoidopexy is more feasible than conventional hemorrhoidectomy. Stapled hemorrhoidopexy has a shorter inpatient stay (weighted mean difference, -1.02 days 95 percent confidence interval, -1.47 to -0.57 P = 0.0001), operative time (weighted mean difference, -12.82 minutes 95 percent confidence interval, -22.61 to -3.04 P = 0.01), and return to normal activity (standardized mean difference, -4.03 days 95 percent confidence interval, -6.95 to -1.10 P = 0.007). Qualitative analysis showed that stapled hemorrhoidopexy is less painful compared with hemorrhoidectomy. Follow-up ranged from 6 weeks to 37 months. RESULTS:įifteen trials recruiting 1,077 patients were included. Meta-analysis was calculated if possible. MEDLINE, EMBASE, and Cochrane Library databases were searched using the terms “hemorrhoid*” or “haemorrhoid*” and “stapl*.” A list of clinical outcomes was extracted. METHODS:Ī systematic review of all randomized trials comparing conventional hemorrhoidectomy with stapled hemorrhoidopexy was performed. This study was designed to determine whether conventional hemorrhoidectomy or stapled hemorrhoidopexy is superior for the management of hemorrhoids.
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