Current status of surgical treatment for hemorrhoids--systematic review and meta-analysis

Hemorrhoids are one of the most common anorectal disorders. Conventional hemorrhoidectomy is the most commonly practiced surgical technique. Stapled hemorrhoidectomy (procedure for prolapse and hemorrhoids [PPH]) and Ligasure hemorrhoidectomy are newly developed methods for the surgical management of hemorrhoids. The objective of this study was to compare the effectiveness and safety of these two novel techniques with that of conventional hemorrhoidectomy. From the MEDLINE data-base, we obtained papers published between January 2000 and September 2009 and retrospectively studied randomized, controlled clinical trials that compared PPH versus conventional hemorrhoidectomy or Ligasure hemorrhoidectomy versus conventional hemorrhoidectomy. Both PPH and Ligasure hemorrhoidectomy were superior to conventional hemorrhoidectomy with regard to operation time, early postoperative pain, urinary retention, and time to return to normal activity. However, skin tags and recurrent prolapse occurred at higher rates in the PPH group. Although both new techniques have short-term benefits, especially in reducing extreme postoperative pain, more powerful clinical studies with long-term follow up and larger sample sizes should be conducted for further evaluation of outcomes.