An update on surgical treatment of hemorrhoidal disease: a systematic review and meta-analysis.

Background: Pathologic hemorrhoids are common among adults age 45–65. Hemorrhoids are characterized as internal or external, and grades 1–4 based on severity. The type and grade dictate treatment, with surgical treatment reserved for grades 3/4. The aim of this study is to compare clinical outcomes of various surgical treatments. Methods: A systematic review was conducted to identify randomized clinical trials that compare surgical treatments for grade 3/4 hemorrhoids. A Bayesian network meta-analysis was done using NetMetaXL and WinBUGS. Results: A total of 26 studies with 3137 participants and 14 surgical treatments for grade 3/4 hemorrhoids were included. Pain was less in patients with techniques such as laser (OR 0.34, CI 0.01–6.51), infrared photocoagulation (OR 0.38, CI 0.02–5.61), and stapling (OR 0.48, CI 0.19–1.25), compared to open and closed hemorrhoidectomies. There was less recurrence with Starion (OR 0.01, CI 0.00–0.46) and harmonic scalpel (OR 0.00, CI 0.00–0.49), compared to infrared photocoagulation and transanal hemorrhoidal dearterialization. Fewer postoperative clinical complications were seen with infrared photocoagulation (OR 0.04, CI 0.00–2.54) and LigaSure (OR 0.16, CI 0.03–0.79), compared to suture ligation and open hemorrhoidectomy. With Doppler-guided (OR 0.26, CI 0.05–1.51) and stapled (OR 0.36, CI 0.15–0.84) techniques, patients return to work earlier when compared to open hemorrhoidectomy and laser. Conclusion: There are multiple favorable techniques without a clear "gold standard" based on current literature. Open discussion should be had between patients and physicians to guide individualized care. [ABSTRACT FROM AUTHOR]