Introduction
Methods
Selection criteria
Search strategy
Study selection
Data extraction
Quality assessment
Statistical analysis
Results
Reference | Country | Year | Study details | Conventional technique | Number of patients | Age (years) | Number of male patients | Number of patients with grade III (IV) hemorrhoids |
---|---|---|---|---|---|---|---|---|
19 | UK | 2002 | Truly random, follow-up assessment blinded | Open diathermy, pedicles transfixed | LS 20, CH 20 | Mean (range): LS 48 (26–75), CH 43 (33–77) | LS 11, CH 10 | LS 16 (4), CH 16 (4) |
20 | Italy | 2002 | Truly random, not blinded | Open diathermy, pedicles not ligated | LS 29, CH 27 | Mean (SD)a: LS 52 (9.9), CH 48 (10.8) | LS 13, CH17a
| LS 14 (15), CH 13 (14)a
|
21 | UK | 2002 | Truly random, patients blinded | Open diathermy, pedicles not ligated | LS 18, CH 16 | Mean (range): LS 44 (33–58), CH 49 (302-73) | LS 6, CH 6 | NR |
2 | Spain | 2002 | Alternate allocation, not blinded | Open diathermy, pedicles not ligated | LS 56, CH 56 | Overall mean: 50 | Overall 66 | NR |
22 | Hong Kong | 2002 | Truly random, double blinded | Open, scissors excision, pedicles transfixed | LS 30, CH 27 | Mean (SD)a: LS 50.7 (12.2), CH 44.7 (14.5) | LS 16, CH13a
| LS30, CH27 |
13 | Taiwan | 2003 | Alternate allocation, not blinded | Closed Ferguson, scissor excision | LS 30, CH 31 | Mean (SD)a: LS 47 (16.6), CH 44 (10.4) | LS 18, CH 12a
| LS 8 (22), CH 8 (23)a
|
23 | UK | 2003 | Truly random, not blinded | Closed modified Ferguson (monopolar) diathermy | LS 17, CH 17 | NRa
| MF ratio 1:1 | NRa
|
16 | Taiwan | 2006 | Truly random, pain assessment blinded | Closed Ferguson diathermy | LS 42, CH 42 | Mean (SEM)a: LS 47 (2.4), CH 47 (2.3) | LS20, CH21a
| LS 34 (8), CH 35 (7)a
|
24 | Thailand | 2006 | Truly random, not blinded | Fansler (semiclosed/open), scissors excision | LS 23, CH 22 | Mean (SD)a: LS 41.9 (12.9), CH 45.7 (14.6) | LS 12, CH12a
| LS 20 (3), CH21(1)a
|
8 | Italy | 2007 | Truly random, outcome assessment blinded | Open diathermy, scissors excision, pedicles not transfixed | LS 125, CH 125 | Mean (range)a: LS 47 (21–66), CH 47 (25–68) | LS60, CH53a
| LS 88 (37), CH 81 (44)a
|
9 | Italy | 2007 | Truly random, not blinded | Open diathermy, pedicles not ligated | LS 146, CH 127 | Mediana: LS 49, CH48 | LS 80, CH76a
| LS 44 (59), CH 50 (60)a
|
Quality of studies
Patient characteristics of eligible studies
Reference | Number of haemorrhoids excised | Duration of operation (min) | Blood loss during operation (ml) | First bowel movement (days) | In-hospital stay (days) |
---|---|---|---|---|---|
19 | Median: LS 3, CH3a
| Median (range): LS 10(8–11), CH 20 (182–25)* | Median (range): LS 0 (0–5), CH 20 (12–22)* | Median (range): LS 2 (1–5), CH 2 (1–4)a
| Median (range): LS 0 (0–1), CH 0 (0–2)* LS 0 (0–5), CH 20 (12–22)* |
20 | NR | Mean (SD): LS 9.2 (3.4), CH 12.1 (3.6)* | NR | Mean: LS 2, CH 2a
| Mean (range): LS 1.8(1,3), CH 1.3(1–4)a
|
21 | Median: LS 3, CH3 | Median (range): LS 5.1 (2–9), CH 9.2 (7.6–14.1)* | NR | NR | Median (range): LS 1 (0–1), CH 1 (1–1) |
12 | NR | Mean (SD) per cushion: LS 1.7 (0.3), CH 5.2 (1.1)* | Mean: LS 0, CH10 | NR | Median: LS 2, CH 2 |
22 | All patients: 3 | Mean (SD): LS 15.2(7.1), CH 17.6 (8.3)a
| Mean (SD): LS 13.5 (27.5), CH 46.5 (27.5)* | Mean (SD): LS 2.2 (1.1), CH 2.5 (2.4)a
| Mean (SD): LS 3.6 (2), CH 3.8 (2)a
|
13 | Median (range): LS 3 (3–4), CH 3 (3–4)a
| Mean (SD): LS 15.0 (5.4), CH 21.2 (8.2)* | NR (“LS less bleeding”) | NR | Mean (SD): LS 3.2 (0.8), CH3.5(1.0)a
|
23 | NR | Median (range): LS 6 (4–10), CH 11 (7–20)* | NR | NR | Median (range): LS 1 (1–5), CH 1 (1–5) |
16 | Median (range): LS 3 (2–4), CH 3 (2–4)a
| Mean (SEM): LS 11.3 (0.4), CH 34.2 (0.7)* | Mean (SEM): LS 1.8 (0.3), CH 25.7 (1.3)* | NR | Mean (SEM): LS 2.2 (0.1), CH 2.9 (0.1)* |
24 | Mean (SD): LS 2.9 (1.4), CH 2.2 (0.9)* | Mean (SD): LS 21.7 (11.8), CH 35.7 (14.3)* | NR | NR | NR |
8 | NR | Mean (range): LS 11.5 (8–33), CH 20 (19.5–48)* | NR | NR | Mean (range): LS 0.3 (0.25–0.5), CH 0.4 (0.25–0.5)a
|
9 | Mean: LS3.2, CH3.1 | Mean: LS 30, CH31a
| NR | Mean: LS 1.5, CH 1.7a
| Mean: LS 21 hours, CH 1 daya
|
Haemorrhoidectomy procedures
Operative and postoperative parameters
Reference | Postoperative pain scored
| Postoperative analgesic use | Wound healing (days) | Retum to normal activities | Median follow-up (months) |
---|---|---|---|---|---|
19 | Median (range), day 1:LS5(1–9), CH 7 (4–9)a
| NRa
| NR | Back at work at 3 weeksa: LS 17 of 20, CH 15 of 20 | LS 3, CH 3; long-termb: LS 37, CH 36 |
20 | Median (range), day 1:LS4.7(2–8), CH 5.2 (2–8)a
| Median (range) number used: LS 14.1 (10–20), CH 16.8 (12–22)* | Median (range): LS 16.3 (14–22), CH 37.5 (25–52)* | Median days (range): LS 8.3 (5–14), CH 18.3 (10–30)* | LS 6, CH 6 |
21 | Median (range): LS 5.2 (2–8), CH 4.6 (1–8.4)a
| Median (range) 7-days tramadol (mg): LS 850 (0–2,750), CH 1600 (0–2100)* | NR | NR | LS1.5, CH1.5; long-termc: LS 15, CH 16 |
12 | Mean (SD), day 1:LS2.3(0.8), CH 6.9 (0.8)* | Mean (SD) no. of dipyrone tablets: LS 2.1 (0.5), CH 4.6 (0.8)* | LS “better and faster” | NR | LS 6, CH 6 |
22 | Mean (SD): LS 4.5 (2), CH 4.0 (2.3)a
| Mean (SD) pethidine injectionsa and dologesic tabletsa: LS 0.7 (1) and 12.6 (10.7), CH 1.2 (2.1) and 13.3 (11.1) | CH impaired at 4 weeks | Mean (SD) days: LS 11.6(5.4), CH 10.3 (4.5)a
| LS 3, CH 3 |
13 | Mean (SD), day 1:LS6.5(0.4), CH 8 (0.5)* | NR | Both groups “complete after 6 weeks” | Median: LS 1–2 weeks, CH 1–2 weeksa
| LS 4, CH 4 |
23 | Median (range), day 1:LS2.5(0–6), CH 7.5 (6–9)* | NR | NR | NR | LS 3, CH 3 |
16 | Mean (SEM): LS 5.1 (0.2), CH 7.2 (0.2)* | Parenteral: LS 12, CH 32* | Both groups “complete after 6 weeks”a
| Mean days (SEM): LS 8.8 (0.2), CH 13.7 (0.4)* | LS 2, CH 2 |
24 | Median, day 1: LS3.65, CH3.14a
| Mean total dose (mg) of pethidine: LS 65, CH75a
| Both groups “complete after 4 weeks”a
| NR | LS 1, CH 1 |
8 | Mean (range), day 1:LS 1.5(0–3), CH 3.3 (2–6)* | NR | Mean (range): LS 14.8 (10–21), CH 25.6 (14–40)* | Mean (range): LS 12.3 (5–21), CH 16.4 (10–30)* | LS 36, CH 36 |
9 | Median, day 1: LS 2.8, CH 3.4 | Median number of tablets, day 3: LS 0.5, CH 1* | Incomplete healing after 4 weeks: LS 9 patients, CH 8 patientsa
| Median days: LS 10.8, CH 14.5* | LS 1, CH 1 |
Reference | Number of patients | Bleeding | Urinary retention | Faecal impaction | Fissure | Nausea/vomit | Anal stenosis | Poor wound healinga
| Incontinence | All complications |
---|---|---|---|---|---|---|---|---|---|---|
19 | LS20, CH20 | LS 1, CH 1 | LS 1, CH0 | LS0, CH0 | LS 1, CH 1 | LS0, CH0 | LS0, CH0 | LS 0, CH 0 | LS 0, CH 0 | LS 3, CH 2 |
20 | LS29, CH27 | LS 1, CH2 | LS1, CH1 | LS29, CH1 | LS0, CH0 | LS0, CH0 | LS0, CH0 | LS 0, CH 0 | LS 0, CH 0 | LS 4, CH 4 |
21 | LS 18, CH16 | LS0, CH2 | LS0, CH 1 | LS0, CH0 | LS0, CH0 | LS0, CH0 | LS0, CH0 | LS 0, CH 0 | LS 0, CH 0 | LS 0, CH 3 |
12 | LS56, CH56 | LS0, CH0 | LS0, CH0 | LS0, CH5 | LS0, CH0 | LS0, CH0 | LS0, CH0 | LS 0, CH 0 | LS 0, CH 0 | LS 0, CH 5 |
22 | LS30, CH27 | LS0, CH0 | LS1, CH2 | LS0, CH0 | LS0, CH0 | LS0, CH0 | LS 0, CH0 | LS 0, CH 1 | LS 0, CH 0 | LS 3b, CH 3 |
13 | LS30, CH31 | LS30, CH3 | LS 1, CH2 | LS 1, CH2 | LS0, CH0 | LS0, CH0 | LS0, CH0 | LS 0, CH 0 | LS 0, CH 0 | LS 5, CH 7 |
23 | LS 17, CH17 | LS0, CH0 | LS0, CH0 | LS0, CH0 | LS0, CH0 | LS0, CH0 | LS0, CH0 | LS 0, CH 0 | LS 0, CH 0 | LS 0, CH 0 |
16 | LS42, CH42 | LS; 1, CH 1 | LS42, CH5 | LS1, CH5 | LS0, CH0 | LS0, CH0 | LS; 1, CH2 | LS 2, CH 2 | LS 2, CH 0 | LS 9, CH 15 |
24 | LS23, CH22 | LS0, CH0 | LS 1, CH2 | LS0, CH0 | LS0, CH0 | LS0, CH0 | LS0, CH0 | LS 0, CH 0 | LS 0, CH 0 | LS 6, CH 6c
|
8 | LS 125, CH125 | LS3, CH7 | LSI, CH2 | LS0, CH0 | LS0, CH0 | LS3, CH3 | LS 125, CH1 | LS 0, CH 0 | LS 0, CH 0 | LS 8, CH 13 |
9 | LS 146, CH 127 | 146, CH4 | LS 146, CH6 | LS0, CH0 | LS22, CH3 | LS0, CH0 | LS22, CH 1 | LS 9, CH 8 | LS 9, CH 0 | LS 22, CH 23d
|
Complications
Outcome | Number of studies (out of 11)a
| Effect size [95% confidence interval]; p-value | Heterogeneity statistic (Q); p-value | Effect size [95% confidence interval]; p-value | |
---|---|---|---|---|---|
Open haemorrhoidectomy (out of 7) | Closed haemorrhoidectomy (out of 3)b
| ||||
Duration of operation (min) | 11 | −2.2 [−3.1, −1.4]; 0.001 | 321.7; 0.001 | −2.1 [−3.3,−0.9]; 0.001 | −3.0 [−4.8, −1.2]; 0.001 |
9 | −2.1 [−3.0, −1.2]; 0.001 | 227.4; 0.001 | |||
In-hospital stay (days) | 10c
| −0.2 [−0.6, 0.1]; 0.205 | 57.6; 0.001 | −0.1 [−0.5,0.3]; 0.608 | −0.5 [−1.2, 0.2]; 0.136 |
8 | −0.2 [−0.7, 0.2]; 0.281 | 54.0; 0.001 | |||
Postoperative pain score | 11 | −1.3 [−2.0, −0.6]; 0.001 | 258.5; 0.001 | −1.0 [−1.9, −0.2]; 0.018 | −2.4 [−3.8, −1.1]; 0.001 |
9 | −0.6 [−1.0, −0.1]; 0.010 | 71.8; 0.001 | |||
Blood loss during | 4d
| −5.3 [−8.3, −2.3]; 0.001 | 140.2; 0.001 | −5.9 [−10.8, −1.0]; 0.019; (n=3)d
| −3.9 [−12.4, 4.5]; 0.362 (n=1)d
|
operation (ml) | 3 (excluding Thorbeck and Montes [12]) | −4.8 [−7.9, −1.6]; 0.003 | 76.2; 0.001 | ||
Wound healing (days) | 2e
| −3.3 [−5.5, −1.1]; 0.004 | 18.5; 0.001 | –e
| – |
Return to normal activities | 5f
| −1.2 [−2.0, −0.5]; 0.001 | 71.7; 0.001 | −0.9 [−0.6, −0.3]; 0.007 (n=4)f
| −2.4 [−3.8, −1.0]; 0.001 (n=1)f
|
Incidence of complications | 10g
| 0.74 [0.55, 1.0]; 0.056 | 5.3; 0.807 | 0.76 [0.51, 1.1]; 0.166 (n=7) | 0.71 [0.43, 1.2]; 0.185 (n=3)g |
8 | 0.76 [0.55, 1.1]; 0.100 | 3.2; 0.863 |