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An update on surgical treatment of hemorrhoidal disease: a systematic review and meta-analysis

Bianca Aibuedefe1, Sarah M Kling2, Matthew M Philp3

  • 1Temple University Lewis Katz School of Medicine, 3500 N Broad St, Philadelphia, PA, 19140, USA. tuh24999@temple.edu.

International Journal of Colorectal Disease
|June 8, 2021
PubMed

Insights

Surgical treatments for severe hemorrhoids (grades 3/4) show varied outcomes. While some techniques reduce pain and recurrence, no single method is a definitive "gold standard," necessitating personalized patient-physician discussions.

Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Evidence-Based Medicine

Background:

  • Pathologic hemorrhoids affect adults aged 45-65, categorized by type (internal/external) and grade (1-4).
  • Surgical intervention is typically reserved for advanced hemorrhoid cases (grades 3 and 4).

Purpose of the Study:

  • To systematically compare the clinical outcomes of diverse surgical treatments for grade 3 and 4 hemorrhoids.
  • To identify superior surgical techniques based on pain, recurrence, complications, and return to work.

Main Methods:

  • A systematic review of randomized clinical trials comparing surgical interventions for grade 3/4 hemorrhoids.
  • Bayesian network meta-analysis performed using NetMetaXL and WinBUGS.

Main Results:

  • 26 studies (3137 participants) evaluated 14 surgical treatments for grade 3/4 hemorrhoids.
  • Techniques like laser, infrared photocoagulation, and stapling showed reduced pain compared to open/closed hemorrhoidectomies.
  • Lower recurrence rates were observed with Starion and harmonic scalpel; fewer complications with infrared photocoagulation and LigaSure.
  • Doppler-guided and stapled techniques facilitated earlier return to work than open hemorrhoidectomy and laser.

Conclusions:

  • Current literature indicates multiple effective surgical options for severe hemorrhoids, but no single "gold standard" technique.
  • Individualized patient care decisions should be made through open discussion between patients and physicians.
Abstract

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