Conventional Excisional Haemorrhoidectomy versus Transanal Haemorrhoidal Dearterialization for Haemorrhoids: A Systematic Review and Meta-Analysis.

IF 1.8 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Digestive Surgery Pub Date : 2024-01-01 Epub Date: 2024-07-31 DOI:10.1159/000540256
Juliana Jee, Lauren Vourneen O'Connell, Ishapreet Kaur, Shaheel Mohammad Sahebally
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Abstract

Introduction: Although effective, conventional excisional haemorrhoidectomy (CEH) is associated with significant postoperative pain. Novel techniques such as transanal haemorrhoidal dearterialization (THD) are suggested to reduce pain but may result in higher recurrence rates. We aimed to compare short- and long-term outcomes of CEH and THD in the present meta-analysis.

Methods: A PRISMA-compliant meta-analysis was performed, searching PubMed, Embase, and CENTRAL databases for randomised controlled trials (RCTs) from 1995 to December 2022. The primary objective was recurrence. Secondary objectives included complication rates, length of stay (LOS), operative time, and time to return to baseline. Random-effects models were used to calculate pooled effect size estimates. Subgroup analysis was also performed.

Results: A total of 6 RCTs encompassing 465 patients were captured. There were 142 (59%) males in the CEH group and 129 (54%) in the THD group. On random-effects analysis, THD had a higher recurrence rate (odds ratio = 2.76, 95% confidence interval [CI] = 1.03-7.38, p = 0.04) albeit a shorter return to baseline compared to CEH (mean difference = -14.05 days, 95% CI = -20.38 to -7.72, p < 0.0001). There were no differences in bleeding (p = 0.12), urinary retention (p = 0.97), incontinence (p = 0.41), anal stenosis (p = 0.19), thrombosed residual haemorrhoids (p = 0.16), operating time (p = 0.19), or LOS (p = 0.22). Results remained similar on subgroup analysis.

Conclusions: CEH is associated with lower recurrence but similar complication rates to THD, although patients take longer to return to baseline function postoperatively.

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治疗痔疮的传统切除术与经肛门痔核切除术--系统回顾和荟萃分析。
导言:传统的痔切除术(CEH)虽然有效,但可能会带来明显的术后疼痛。经肛门痔核切除术(THD)等新技术被认为可以减轻疼痛,但可能导致更高的复发率。我们的目的是在本荟萃分析中比较 CEH 和 THD 的短期和长期疗效。方法 通过搜索 PubMed、EMBASE 和 CENTRAL 数据库中 1995 年至 2022 年 12 月的随机对照试验 (RCT),进行了一项符合 PRISMA 标准的荟萃分析。首要目标是复发。次要目标包括并发症发生率、住院时间(LOS)、手术时间和恢复到基线的时间。随机效应模型用于计算汇集效应大小估计值。同时还进行了分组分析。结果 共收集了 6 项 RCT,涉及 465 名患者。CEH组有142名男性(59%),THD组有129名男性(54%)。随机效应分析显示,与 CEH 相比,THD 的复发率更高(OR = 2.76,95% CI = 1.03 至 7.38,p = 0.04),但恢复到基线的时间更短(MD = -14.05 天,95% CI = -20.38 至 -7.72,p <0.0001)。在出血(p = 0.12)、尿潴留(p = 0.97)、尿失禁(p = 0.41)、肛门狭窄(p = 0.19)、血栓性残余痔(p = 0.16)、手术时间(p = 0.19)或住院时间(p = 0.22)方面没有差异。亚组分析结果仍然相似。结论 CEH 复发率较低,并发症发生率与 THD 无差异,但患者术后恢复至基线功能的时间较长。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Digestive Surgery
Digestive Surgery 医学-外科
CiteScore
4.90
自引率
3.70%
发文量
25
审稿时长
3 months
期刊介绍: ''Digestive Surgery'' presents a comprehensive overview in the field of gastrointestinal surgery. Interdisciplinary in scope, the journal keeps the specialist aware of advances in all fields that contribute to improvements in the diagnosis and treatment of gastrointestinal disease. Particular emphasis is given to articles that evaluate not only recent clinical developments, especially clinical trials and technical innovations such as new endoscopic and laparoscopic procedures, but also relevant translational research. Each contribution is carefully aligned with the need of the digestive surgeon. Thus, the journal is an important component of the continuing medical education of surgeons who want their practice to benefit from a familiarity with new knowledge in all its dimensions.
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