STAPLED HEMORRHOIDECTOMY : present status Antônio LACERDA - FILHO and

Aim To evaluate cost-effectiveness of stapled hemorrhoidectomy comparing its results with conventional technique. Source of data We retrospectively analyzed the MEDLINE data basis from 2000 to 2004 studying randomized clinical trials which compared pain intensity, recovery period, return to work and occurrence of anal incontinence, in addition to postoperative complications and costs evaluation between stapled and conventional hemorrhoidectomy during different periods of follow-up. Conclusions Stapled hemorrhoidectomy provides lesser postoperative pain and earlier return to work than conventional hemorrhoidectomy. However, its efficacy could not be determined, since rigorous prospective and randomized clinical trials with long-term follow-up periods and large size samples are not available at this time. HEADINGS – Hemorrhoids, surgery. Surgical staplers. Department of Surgery, Federal University of Minas Gerais School of Medicine, Belo Horizonte, MG, Brazil. Address for correspondence: Dr. Antônio Lacerda-Filho Rua Ten. Brito Melo, 1355 sl. 902 Santo Agostinho – 30180-150 Belo Horizonte, MG, Brazil. E-mail: [email protected] TABLE 1 Stapled versus conventional hemorrhoidectomy in randomized trials Authors Year n Degree Pain Return to work Incontinence Follow-up Rowsell et al. 2000 22 3 Less in SHG Earlier in SHG NA 6 weeks Mehigan et al. 2000 40 3 Less in SHG Earlier in SHG NS 10 weeks Ho et al 2000 119 4 Less in SHG NA NS 19 weeks Khalil et al. 2000 40 3 Less in SHG NA NS 6 months Kirsch et al. 2001 300 3 Less in SHG Earlier in SHG NA 6 months Ganio et al. 2001 100 3 and 4 Less in SHG Earlier in SHG NS 16 months Boccasanta et al. 2001 80 4 Less in SHG Earlier in SHG NA 54 weeks Hetzer et al. 2002 40 2 and 3 Less in SHG Earlier in SHG NS 12 months Wilson et al. 2002 99 3 NA Earlier in SHG NS NA Correa-Rovelo et al. 2002 84 3 Less in SHG Earlier in SHG NS 14 months Kairaluoma et al. 2003 60 3 Less in SHG NS NA 12 months Cheetham et al.(4) 2003 31 3 Less in SHG NS NA 6 months Palimento et al. 2003 52 3 and 4 Less in SHG NA NS 17.5 months Racalbuto et al. 2004 100 3 and 4 Less in SHG Earlier in SHG NS 48 months SHG stapled hemorrhoidectomy group; NS = not significant; NA = not available data