Hemorrhoidectomy in day surgery

Day-case hemorrhoidectomy has shown to be safe and acceptable to patients. There are principally two procedures: Milligan-Morgan hemorrhoidectomy (MMH) and Longo stapled hemorrhoidopexy (SH). Furthermore great progress has been done in surgical technologies with the use of the Ligasure and the Doppler-guided hemorrhoidal artery ligation. The aim of this study is to analyze randomized controlled trials using all the major electronic databases (MEDLINE, EMBASE, CENTRAL) about hemorrhoidopexy and conventional excisional surgery, and randomized controlled trials about the Ligasure versus the conventional hemorrhoidectomy, and some reports about the use of a new device (Doppler transducer) in an outpatient setting.

We found 17 studies from 2004 up to 2008, 1276 patients, 409 in the stapled group, 389 in the conventional group, 268 in hemorrhoidal artery ligation procedure and 210 in Ligasure hemorrhoidectomy group. This study confirms that SH is associated with less postoperative pain and shorter postoperative symptoms, compared with MMH. SH may be a viable alternative to the conventional surgical therapy for hemorrhoids with some advantages and some disadvantages in postoperative complications and costs. An other suitable alternative to conventional procedures is the use of Ligasure, although long-term evaluation of outcomes and morbidity is still needed. Hemorrhoidal artery ligation procedure is safe and easy to learn and to perform, even with a recurrence rate of 12, but randomized trials are mandatory.