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A meta-analysis of hemorrhoidal treatments

Seminars in Colon and Rectal Surgery
Elsevier - WB Saunders
Publication Date
  • Medicine
  • Physics


Abstract A meta-analysis of all randomized controlled trials assessing 2 or more treatment modalities for symptomatic hemorrhoids was performed. The main outcome measures were response to therapy, need for further therapy, complications, and pain. Twenty-three trials were available for analysis. Hemorrhoidectomy was found to be significantly more effective than manual dilatation of the anus ( P = .0017) and associated with less need for further therapy ( P = .034), with no significant difference in complications ( P = .60) but more pain ( P < .001). With short-term follow-up, stapled hemorrhoidectomy was found to be associated with significantly less pain than conventional hemorrhoidectomy, with no significant difference in complication rate or response to treatment. There were no significant differences between open and closed hemorrhoidectomy. Patients who underwent hemorrhoidectomy had a better response to treatment than did patients who were treated with rubber-band ligation ( P = .001), although complications were greater ( P = .02), as was pain ( P < .00001). Rubber-band ligation was more effective than sclerotherapy and infrared coagulation, without an increase in complications. Rubber-band ligation is recommended as the initial mode of therapy for grades 1 to 3 hemorrhoids. Although hemorrhoidectomy showed better response, it is associated with more complications and pain than rubber-band ligation. Stapled hemorrhoidectomy appears to cause less pain than conventional hemorrhoidectomy. However, further follow-up will be required to assess its effectiveness compared with conventional hemorrhoidectomy and rubber-band ligation. Copyright © 2002 by W.B. Saunders Company

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