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

A. Sunny, H. Sellars, G. Ramsay, R. Polson, A. J. M. Watson* (Corresponding Author)

*Corresponding author for this work

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
Pages (from-to)24-29
Number of pages6
Journalcoloproctology
Volume42
Early online date29 Nov 2019
DOIs
Publication statusPublished - Feb 2020

Keywords

  • haemorrhoids
  • pain
  • cost
  • postoperative complications
  • prolapse

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