Meta-analysis of stapled hemorrhoidopexy vs LigaSure hemorrhoidectomy

Abstract

Aim: To compare outcome of stapled hemorrhoidopexy (SH) vs LigaSure hemorrhoidectomy (LH) by a meta-analysis of available randomized controlled trials (RCTs).

Methods: Databases, including PubMed, EMBASE, the Cochrane Library, and the Science Citation Index updated to December 2012, were searched. The main outcomes measured were operating time, early postoperative pain, postoperative urinary retention and bleeding, wound problems, gas or fecal incontinence, anal stenosis, length of hospital stay, residual skin tags, prolapse, and recurrence. The meta-analysis was performed using the free software Review Manager. Differences observed between the two groups were expressed as the odds ratio (OR) with 95%CI. A fixed-effects model was used to pool data when statistical heterogeneity was not present. If statistical heterogeneity was present (P < 0.05), a random-effects model was used.

Results: The initial search identified 10 publications. After screening, five RCTs published as full articles were included in this meta-analysis. Among the five studies, all described a comparison of the patient baseline characteristics and showed that there was no statistically significant difference between the two groups. Although most of the analyzed outcomes were similar between the two operative techniques, the operating time for SH was significantly longer than for LH (P < 0.00001; OR= -6.39, 95%CI: -7.68 - -5.10). The incidence of residual skin tags and prolapse was significantly lower in the LH group than in the SH group [2/111 (1.8%) vs 16/105 (15.2%); P = 0.0004; OR= 0.17, 95%CI: 0.06-0.45). The incidence of recurrence after the procedures was significantly lower in the LH group than in the SH group [2/173 (1.2%) vs 13/174 (7.5%); P = 0.003; OR= 0.21, 95%CI: 0.07-0.59].

Conclusion: Both SH and LH are probably equally valuable techniques in modern hemorrhoid surgery. However, LigaSure might have slightly favorable immediate postoperative results and technical advantages.

Keywords: Hemorrhoids; Ligasure hemorrhoidectomy; Meta-analysis; Stapled hemorrhoidopexy.

Figure 1

Search protocol for the meta-analysis.

Figure 2

Comparison of outcome between LigaSure hemorrhoidectomy and stapled hemorrhoidopexy. A: Operating time; B: Early postoperative pain; C: Postoperative urinary; D: Postoperative bleeding; E: Wound problems; F: Postoperative gas or fecal incontinence; G: Postoperative anal stenosis; H: Hospitalization; I: Residual skin tags and prolapse; J: Recurrence. LH: LigaSure hemorrhoidectomy SH: Stapled hemorrhoidopexy.