The efficacy of topical sucralfate in improving pain and wound healing after haemorrhoidectomy procedure: A systematic review, meta-analysis, and meta-regression of randomised clinical trials

Abstract

Pain and wound after haemorrhoidectomy constantly bothered the patient's convenience. Recurrently, topical sucralfate is used to treat excoriations and burns. It is considered to enhance epidermal growth and tissue granulation, thus, alleviating patients' problems. This study evaluated topical sucralfate's feasibility, safety, and superiority after haemorrhoidectomy. We searched randomised controlled trial (RCT) studies in PubMed, Google Scholar, Europe PMC, and ClinicalTrials.gov until March 29th, 2022. We investigated the influence of topical sucralfate on pain score postoperatively (24 hours, 7 days, and 14 days), pethidine usage, diclofenac usage, and wound healing rate compared to placebo. This study was conducted following the PRISMA guidelines. This study sorted the final six studies with 439 patients underwent haemorrhoidectomy. Topical sucralfate demonstrated significant outcomes on VAS 24 hours post-operative [Std. Mean Difference -1.00 (95% CI -1.70, -0.31), P = .005], VAS 7 days post-operative [Std. Mean Difference -2.29 (95% CI -3.34, -1.25), P < .0001], VAS 14 days post-operative [Std. Mean Difference -1.88 (95% CI -2.74, -1.01), P < .0001], pethidine usage within 24 hours post-operative [Std. Mean Difference -0.62 (95% CI -0.96, -0.27), P = .0004], diclofenac usage 7 days post-operative [Std. Mean Difference -1.76 (95% CI -2.61, -0.92), P < .0001], diclofenac usage 14 days post-operative [Std. Mean Difference -1.64 (95% CI -2.38, -0.91), P < .0001], and wound healing rate at 28-day post-operative [RR 1.45 (95% CI 1.25-1.68), P < .00001]. Topical sucralfate alleviated pain, improved wound healing, and minimised the usage of pethidine and diclofenac compared to placebo.

Keywords: haemorrhoidectomy; pain; systematic review; topical sucralfate; wound healing.

FIGURE 1

PRISMA diagram of the detailed process of selection of studies for inclusion in the systematic review and meta‐analysis

FIGURE 2

Forest plot that demonstrates the comparison between using topical sucralfate and placebo after haemorrhoidectomy in terms of VAS at 24 hours‐post‐operative (A), VAS at 7 days post‐operative (B), VAS at 14 days post‐operative (C), pethidine used (mg) within 24 hours post‐operative (D), diclofenac used (mg) at 7 days post‐operative (E), diclofenac used (mg) at 14 days post‐operative (F), and wound healing rate at 28 days post‐operative (G) outcomes

FIGURE 3

Funnel plot analysis for each outcome of interest in this study: VAS at 24 hours post‐operative (A), VAS at 7 days post‐operative (B), VAS at 14 days post‐operative (C), pethidine used (mg) within 24 hours post‐operative (D), diclofenac used (mg) at 7 days post‐operative (E), diclofenac used (mg) at 14 days post‐operative (F), and wound healing rate at 28 days post‐operative (G)