Article ; Online: Post-hemorrhoidectomy pain: can surgeons reduce it? A systematic review and network meta-analysis of randomized trials.
International journal of colorectal disease
2021 Volume 36, Issue 12, Page(s) 2553–2566
Abstract: Purpose: Hemorrhoidectomy remains the gold standard treatment for grade III-IV hemorrhoids. However, despite strong recommendations for the suitability of outpatient surgery, post-operative pain has been a limitation to the widespread inclusion of this ... ...
| Abstract | Purpose: Hemorrhoidectomy remains the gold standard treatment for grade III-IV hemorrhoids. However, despite strong recommendations for the suitability of outpatient surgery, post-operative pain has been a limitation to the widespread inclusion of this condition in day surgery programs. The aims of the study were to analyze and compare the post-operative pain of conventional open hemorrhoidectomy, considered the reference technique, against other surgical procedures such as closed hemorrhoidectomy, open hemorrhoidectomy using bipolar or ultrasonic sealant, hemorrhoidopexy, or HAL-RAR, when performed exclusively as outpatients. Methods: A systematic review and meta-analysis was conducted according to PRISMA methodology. All prospective and randomized studies of patients operated on for hemorrhoids in day surgery and specifying the value of post-operative pain, using a validated scale, were included. Conventional meta-analyses and a random-effects network meta-analysis were carried out. Results: Twenty-nine studies were included (3309 patients). None of the procedures described severe pain in the post-operative period. Hemorrhoidopexy was the least painful. Conventional open hemorrhoidectomy was the most painful on the first and seventh post-operative days. Pain was reduced after closed hemorrhoidectomy technique and when bipolar or harmonic scalpel was used. Furthermore, transfixive ligation of the hemorrhoidal pedicle was associated with increased post-operative pain. Conclusion: Hemorrhoidal surgery is feasible in day surgery units and post-operative pain can be adequately managed in an outpatient setting. Hemorrhoidopexy was the least painful; however, data should be carefully evaluated by the high rate of long-term recurrence described in literature. Closed hemorrhoidectomy, performed with bipolar or ultrasonic sealing, avoiding transfixive ligation of the hemorrhoidal pedicle, may improve post-operative pain control. Trial registration: CRD42020185160. |
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| MeSH term(s) | Hemorrhoidectomy/adverse effects ; Hemorrhoids/surgery ; Humans ; Network Meta-Analysis ; Pain, Postoperative/etiology ; Prospective Studies ; Randomized Controlled Trials as Topic ; Surgeons ; Treatment Outcome |
| Language | English |
| Publishing date | 2021-08-20 |
| Publishing country | Germany |
| Document type | Journal Article ; Meta-Analysis ; Review ; Systematic Review |
| ZDB-ID | 84975-3 |
| ISSN | 1432-1262 ; 0179-1958 |
| ISSN (online) | 1432-1262 |
| ISSN | 0179-1958 |
| DOI | 10.1007/s00384-021-04013-6 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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