Procedure for prolapsed haemorrhoids versus excisional haemorrhoidectomy--a systematic review and meta-analysis.

BACKGROUND The procedure for prolapse and haemorrhoids (PPH) was introduced to address the postoperative pain following excisional haemorrhoidectomy (EH). OBJECTIVE To assess the efficacy of both procedures to treat haemorrhoids. DATA SOURCES Literature review using MEDLINE. Articles addressing PPH and ER were included. STUDY SELECTION RCTs comparing PH and PPH with > or = 20 patients. DATA EXTRACTION Primary endpoints were pain, operative time, hospital stay, satisfaction with procedure and time to return to normal activity. Secondary endpoints such as recurrence and complications were collated for descriptive analysis. A meta-analysis was performed using the random effects model on studies reporting 'mean' and SD or ESM. DATA SYNTHESIS PPH was associated with less postoperative pain, less operative time, shorter hospital stay and earlier return to normal activities compared with EH. There appears to be no significant difference in satisfaction with the procedure. There was no difference between the two procedures in terms of complications. There were more recurrences after PPH. CONCLUSION Compared with PH, PPH is associated with less postoperative pain, reduced operative time and hospital stay and earlier return to normal activity, and a trend towards improved patient satisfaction. The rate of recurrence appears higher with PPH.