Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery

PURPOSE: The purpose of this systematic review was to compare the long-term results of stapled hemorrhoidopexy with conventional excisional hemorrhoidectomy in patients with internal hemorrhoids. METHODS: A systematic review of all randomized, controlled trials comparing stapled hemorrhoidopexy and conventional hemorrhoidectomy with long-term results was performed by using the Cochrane methodology. The minimum follow-up) was six months. Primary outcomes were hemorrhoid recurrence, hemorrhoid symptom recurrence, complications, and pain. RESULTS: Twelve trials were included. Follow-up varied from six months to four years. Conventional hemorrhoidectomy was more effective in preventing long-term recurrence of hemorrhoids (odds ratio (OR), 3.85; 95 percent confidence interval (CI), 1.47-10.07; P<0.006). Conventional hemorrhoidectomy also prevents hemorrhoids in Studies with follow-up of one year or more (OR, 3.6; 95 percent CI, 1.24-10.49; P<0.02). Conventional hemorrhoidectomy is superior in preventing the symptom of prolapse (OR, 2.96; 9:5 percent CI, 1.33-6-58; P<0.008). Conventional hemorrhoidectomy also is more effective at preventing prolapse in studies with follow-up of one year or more (OR, 2.68; 95 percent CI, 0.98-7-34; P<0.05). Nonsignificant trends in favor of conventional hemorrhoidectomy, were seen in the proportion of asymptomatic patients, bleeding, soiling/difficulty with hygiene/incontinence, the presence of perianal skin tags, and the need for further surgery. Nonsignificant trends in favor of stapled hemorrhoidopexy, were seen in pain, pruritus ani, and symptoms of anal obstruction/stenosis. CONCLUSIONS: Conventional hemorrhoidectomy is superior to stapled hemorrhoidopexy for prevention of postoperative recurrence of internal hemorrhoids. Fewer patients who received conventional hemorrhoidectomy complained of hemorrhoidal prolapse in long-term follow-up compared with stapled hemorrhoidopexy. [Key words: Hemorrhoid; Hemorrhoidectomy; Hemorrhoidopexy; Procedure for prolapse and hemorrhoids; Staple; Prolapse]