A systematic review of the literature assessing the outcomes of stapled haemorrhoidopexy versus open haemorrhoidectomy

Abstract

Background Symptomatic haemorrhoids affect a large number of patients throughout the world. The aim of this systematic review was to compare the surgical outcomes of stapled haemorrhoidopexy (SH) versus open haemorrhoidectomy (OH) over a 20-year period. Methods Randomized controlled trials published between January 1998 and January 2019 were extracted from Pubmed using defined search criteria. Study characteristics and outcomes in the form of short-term and long-term complications of the two techniques were analyzed. Any changes in trend of outcomes over time were assessed by comparing article groups 1998–2008 and 2009–2019. Results Twenty-nine and 9 relevant articles were extracted for the 1998–2008 (period 1) and 2009–2019 (period 2) cohorts, respectively. Over the two time periods, SH was found to be a safe procedure, associated with statistically reduced operative time (in 13/21 studies during period 1 and in 3/8 studies during period 2), statistically less intraoperative bleeding (3/7 studies in period 1 and 1/1 study in period 2) and consistently less early postoperative pain on the visual analogue scale (12/15 studies in period 1 and 4/5 studies in period 2) resulting in shorter hospital stay (12/20 studies in period 1 and 2/2 studies in period 2) at the expense of a higher cost. In the longer term, although chronic pain in SH and OH patents is comparable, patient satisfaction with SH may decline with time and at 2-year follow-up OH appeared to be associated with greater patient satisfaction. Conclusions SH appears to be safe with potential advantages, at least in the short term, but the evidence is lacking at the moment to suggest its routine use in clinical practice.

Clinical Anatomy and Medical Malpractice—A Narrative Review with Methodological Implications

“…Different surgical approaches are available, which rely on specific anatomical landmarks for complication prevention. For instance, for internal hemorrhoids, stapled hemorrhoidopexy is a circumferential resection of rectal mucosa which is performed superiorly to the dentate line; if the suture extends to the dentate line, chronic anal pain may arise as a complication, as the squamous epithelium of the anatomical anal canal is highly innervated by sensitive terminals [ 25 , 26 ]. Moreover, proctalgia and bleeding are also associated with the presence of muscle fibers in the excised tissue [ 27 ].…”

Surgical Treatment of Iatrogenic Complex Recurrent Extrasphincter Anorectal Fistula: A Clinical Case

“…При этом по данным исследований нет достоверной взаимосвязи возникновения свищей и конкретным видом методики операции. [1,4].…”

“…Так, в исследованиях Aytac et al и Kim et al не было выявлено ни одного случая формирования свищей через 7,7 лет после закрытой геморроидэктомии, через 6,3 года после степлерной геморроидопексии и через 5 лет после открытой геморроидэктомии [9,10]. Единичные случаи формирования прямокишечного свища после степлерной (срок наблюдения 6-36 месяцев) и открытой геморроидэктомии описываются в исследованиях Bilgin et al, Ripetti et al [4,11,12]. После геморроидэктомии с использованием Ligasure свищи прямой кишки встречались лишь в 1% случаев через 1-2 месяца и в 0,2% более чем через 2 месяца.…”

Mucocele: a rare complication following stapled haemorrhoidopexy

“…Haemorrhoids are the commonest anorectal disorder where it is estimated that 50% of the population over the age of 50 years suffer from the condition [ 1 ]. Traditional open haemorrhoidectomy remains the gold standard in the surgical management of circumferential prolapsed haemorrhoids [ 2 ], moreover, many surgeons are attempting to use stapled heamorrhoidopexy (SH) because of reported advantages over open variants of hameorrhoidectomy which include a shorter operating time, less postoperative pain, better wound healing and an earlier return to work [ 3 , 4 ]. In general, SH increased relative risk of haemorrhoid recurrence compared with traditional open haemorrhoidectomy [ 5 , 6 ].…”