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Interventional treatments for prolapsing haemorrhoids: network meta-analysis.

J Z Jin1, S Bhat1, K-T Lee1

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For symptomatic hemorrhoids (grade II-III), closed hemorrhoidectomy offers the lowest recurrence but higher pain and complications. Discuss treatment risks and benefits with patients for informed decisions.

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Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Evidence-Based Medicine

Background:

  • Hemorrhoid treatment options vary in efficacy and risk.
  • Symptomatic hemorrhoids (grade II-III) require effective interventions.

Purpose of the Study:

  • To compare clinical outcomes of interventional treatments for grade II-III hemorrhoids.
  • To evaluate the relative effectiveness and safety of various hemorrhoid procedures.

Main Methods:

  • Systematic review and Bayesian network meta-analysis of RCTs (1980-2020).
  • Inclusion of 79 RCTs (9232 patients) comparing 14 treatments.
  • Primary outcomes: recurrence, pain (VAS), and complications (bleeding, retention, incontinence).

Main Results:

  • Closed hemorrhoidectomy showed lowest recurrence; open hemorrhoidectomy and stapled hemorrhoidopexy had highest recurrence.
  • Direct current electrotherapy, DG-HAL with mucopexy, and infrared coagulation had lowest pain scores.
  • Open hemorrhoidectomy and stapled hemorrhoidopexy presented higher risks of bleeding, urinary retention, and bowel incontinence.

Conclusions:

  • Hemorrhoidectomy (open/closed) and stapled hemorrhoidopexy offer low recurrence but increased pain and complications.
  • Treatment decisions require a thorough discussion of risks and benefits with patients.