Metaanalysis of hemorrhoid removal
Conventional hemorrhoidectomy provides a more effective, long-term cure for hemorrhoids than stapled hemorrhoidopexy, but has greater postoperative pain and a longer rehabilitation, according to a metaanalysis of 15 randomized trials.
Stapled hemorrhoidopexy, or procedure for prolapsing hemorrhoids (PPH), had a recurrence rate of 12% for third-degree and 50% for fourth-degree hemorrhoids, compared with 0% for both grades with conventional surgery after a mean of 16 months of follow-up. Overall, 10% of PPH patients and 4% of conventional patients had immediate postoperative hemorrhage, while 18% of PPH and 33% of conventional patients experienced bleeding 1-2 weeks after surgery.
Surgeons performed PPH significantly faster than conventional surgery. Patients who underwent PPH had significantly shorter hospital stays and amount of time taken to return to work or normal activity (Dis. Colon Rectum [online] 2004;10.1007/s10350-004-0679-8).
At 24 hours after the operation, PPH patients experienced less pain: Scores of average or cumulative pain at 1 and 2 weeks after surgery were significantly better for PPH patients. Not all trials reported the same outcomes. Pasha J. Nisar, M.D., and associates at Queen’s Medical Centre, Nottingham, England, concluded that PPH “may be offered to patients seeking a less painful alternative to conventional surgery.”
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