Who needs a stapling device for haemorrhoidectomy, if one has the radiofrequency device?

A Sunny, H. Sellars, R. Polson, A J M Watson

Research output: Contribution to journalArticle

Abstract

Background
Multiple operations exist to treat haemorrhoids. Although comparisons of conventional excision and other techniques have been performed, there are less comparative outcome data available for stapled haemorrhoidopexy (SH) and radiofrequency haemorrhoidectomy (RFH). Use of a radiofrequency energy device for haemorrhoidectomy is an alternative to standard diathermy, scissors or scalpel. It provides vessel sealing between the jaws of the instrument and aims to minimise wider tissue damage.

Objective
To systematically review the literature comparing SH and RFH, assessing complications, outcomes, patient experience and costs.

Methods
A tailored search of medical databases identified literature containing relevant primary and secondary data comparing SH and RFH. Papers were screened for relevance and completeness of published data. Those missing methodological information, outcome data or statistical analysis were subsequently excluded. A narrative review was then performed.

Results
The primary data in this review originate from six randomised control trials (RCTs) and five meta-analyses. Evidence was conflicting, with a trend towards more early postoperative pain in the RFH vs. the SH group (three RCTs reported increased early pain scores in the RFH group). Significantly higher rates of residual and recurrent haemorrhoids and prolapse in the SH group were observed in two RCTs and four meta-analyses. Bleeding, urinary retention, incontinence and anal stenosis did not significantly differ. No detailed contemporary cost analysis was found.

Conclusion
The trials are small, with significant heterogeneity in the techniques used and outcome data recorded. However, despite the limited available evidence, RFH appears superior to SH due to significantly lower rates of residual and recurrent haemorrhoids and prolapse.
Original languageEnglish
Journalcoloproctology
Early online date29 Nov 2019
DOIs
Publication statusE-pub ahead of print - 29 Nov 2019

Fingerprint

Hemorrhoidectomy
Equipment and Supplies
Hemorrhoids
Prolapse
Meta-Analysis
Diathermy
Costs and Cost Analysis
Statistical Data Interpretation
Urinary Retention
Urinary Incontinence
Postoperative Pain
Jaw
Pathologic Constriction
Databases
Hemorrhage
Pain

Keywords

  • haemorrhoids
  • pain
  • cost
  • postoperative complications
  • prolapse

Cite this

Who needs a stapling device for haemorrhoidectomy, if one has the radiofrequency device? / Sunny, A; Sellars, H.; Polson, R.; Watson, A J M.

In: coloproctology, 29.11.2019.

Research output: Contribution to journalArticle

@article{ecf48fece06a4557b1ec86e2f09d2938,
title = "Who needs a stapling device for haemorrhoidectomy, if one has the radiofrequency device?",
abstract = "BackgroundMultiple operations exist to treat haemorrhoids. Although comparisons of conventional excision and other techniques have been performed, there are less comparative outcome data available for stapled haemorrhoidopexy (SH) and radiofrequency haemorrhoidectomy (RFH). Use of a radiofrequency energy device for haemorrhoidectomy is an alternative to standard diathermy, scissors or scalpel. It provides vessel sealing between the jaws of the instrument and aims to minimise wider tissue damage.ObjectiveTo systematically review the literature comparing SH and RFH, assessing complications, outcomes, patient experience and costs.MethodsA tailored search of medical databases identified literature containing relevant primary and secondary data comparing SH and RFH. Papers were screened for relevance and completeness of published data. Those missing methodological information, outcome data or statistical analysis were subsequently excluded. A narrative review was then performed.ResultsThe primary data in this review originate from six randomised control trials (RCTs) and five meta-analyses. Evidence was conflicting, with a trend towards more early postoperative pain in the RFH vs. the SH group (three RCTs reported increased early pain scores in the RFH group). Significantly higher rates of residual and recurrent haemorrhoids and prolapse in the SH group were observed in two RCTs and four meta-analyses. Bleeding, urinary retention, incontinence and anal stenosis did not significantly differ. No detailed contemporary cost analysis was found.ConclusionThe trials are small, with significant heterogeneity in the techniques used and outcome data recorded. However, despite the limited available evidence, RFH appears superior to SH due to significantly lower rates of residual and recurrent haemorrhoids and prolapse.",
keywords = "haemorrhoids, pain, cost, postoperative complications, prolapse",
author = "A Sunny and H. Sellars and R. Polson and Watson, {A J M}",
note = "Open Access via Springer Compact Agreement.",
year = "2019",
month = "11",
day = "29",
doi = "10.1007/s00053-019-00420-0",
language = "English",
journal = "coloproctology",
issn = "0174-2442",
publisher = "Springer",

}

TY - JOUR

T1 - Who needs a stapling device for haemorrhoidectomy, if one has the radiofrequency device?

AU - Sunny, A

AU - Sellars, H.

AU - Polson, R.

AU - Watson, A J M

N1 - Open Access via Springer Compact Agreement.

PY - 2019/11/29

Y1 - 2019/11/29

N2 - BackgroundMultiple operations exist to treat haemorrhoids. Although comparisons of conventional excision and other techniques have been performed, there are less comparative outcome data available for stapled haemorrhoidopexy (SH) and radiofrequency haemorrhoidectomy (RFH). Use of a radiofrequency energy device for haemorrhoidectomy is an alternative to standard diathermy, scissors or scalpel. It provides vessel sealing between the jaws of the instrument and aims to minimise wider tissue damage.ObjectiveTo systematically review the literature comparing SH and RFH, assessing complications, outcomes, patient experience and costs.MethodsA tailored search of medical databases identified literature containing relevant primary and secondary data comparing SH and RFH. Papers were screened for relevance and completeness of published data. Those missing methodological information, outcome data or statistical analysis were subsequently excluded. A narrative review was then performed.ResultsThe primary data in this review originate from six randomised control trials (RCTs) and five meta-analyses. Evidence was conflicting, with a trend towards more early postoperative pain in the RFH vs. the SH group (three RCTs reported increased early pain scores in the RFH group). Significantly higher rates of residual and recurrent haemorrhoids and prolapse in the SH group were observed in two RCTs and four meta-analyses. Bleeding, urinary retention, incontinence and anal stenosis did not significantly differ. No detailed contemporary cost analysis was found.ConclusionThe trials are small, with significant heterogeneity in the techniques used and outcome data recorded. However, despite the limited available evidence, RFH appears superior to SH due to significantly lower rates of residual and recurrent haemorrhoids and prolapse.

AB - BackgroundMultiple operations exist to treat haemorrhoids. Although comparisons of conventional excision and other techniques have been performed, there are less comparative outcome data available for stapled haemorrhoidopexy (SH) and radiofrequency haemorrhoidectomy (RFH). Use of a radiofrequency energy device for haemorrhoidectomy is an alternative to standard diathermy, scissors or scalpel. It provides vessel sealing between the jaws of the instrument and aims to minimise wider tissue damage.ObjectiveTo systematically review the literature comparing SH and RFH, assessing complications, outcomes, patient experience and costs.MethodsA tailored search of medical databases identified literature containing relevant primary and secondary data comparing SH and RFH. Papers were screened for relevance and completeness of published data. Those missing methodological information, outcome data or statistical analysis were subsequently excluded. A narrative review was then performed.ResultsThe primary data in this review originate from six randomised control trials (RCTs) and five meta-analyses. Evidence was conflicting, with a trend towards more early postoperative pain in the RFH vs. the SH group (three RCTs reported increased early pain scores in the RFH group). Significantly higher rates of residual and recurrent haemorrhoids and prolapse in the SH group were observed in two RCTs and four meta-analyses. Bleeding, urinary retention, incontinence and anal stenosis did not significantly differ. No detailed contemporary cost analysis was found.ConclusionThe trials are small, with significant heterogeneity in the techniques used and outcome data recorded. However, despite the limited available evidence, RFH appears superior to SH due to significantly lower rates of residual and recurrent haemorrhoids and prolapse.

KW - haemorrhoids

KW - pain

KW - cost

KW - postoperative complications

KW - prolapse

U2 - 10.1007/s00053-019-00420-0

DO - 10.1007/s00053-019-00420-0

M3 - Article

JO - coloproctology

JF - coloproctology

SN - 0174-2442

ER -