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Meta-analysis of short-term outcomes of randomized controlled trials of LigaSure vs conventional hemorrhoidectomy.
Arch Surg. 2007 Dec; 142(12):1209-18; discussion 1218.AS

Abstract

OBJECTIVE

To evaluate the short-term outcomes of hemorrhoidectomy performed using the LigaSure vessel sealing device (Valleylab, Boulder, Colorado) or the conventional approach.

DATA SOURCES

MEDLINE, EMBASE, Ovid, and Cochrane databases for studies published between 2002 and 2006.

STUDY SELECTION

Randomized controlled trials published between 2002 and 2006 comparing short-term outcomes for LigaSure vs conventional hemorrhoidectomy.

DATA EXTRACTION

Operative parameters, short-term complications, and postoperative recovery. Trials were assessed using a modified Jadad score. Random-effects meta-analytical techniques were used in the analysis.

DATA SYNTHESIS

Nine randomized controlled trials with matched selection criteria reporting on 525 patients, of whom 266 (50.7%) underwent LigaSure and 259 (49.3%) underwent conventional hemorrhoidectomy. Operative time (weighted mean difference [WMD], - 8.67 minutes; 95% confidence interval [CI], - 15.34 to - 2.00 minutes), blood loss (WMD, - 23.08 mL; 95% CI, - 27.24 to - 18.92 mL), and pain the day after the operation measured by the visual analog scale (WMD, - 2.31; 95% CI, - 3.37 to - 1.26) were significantly reduced following LigaSure hemorrhoidectomy. There was a decrease in time taken to return to work or normal activity (WMD, - 3.49 days; 95% CI, - 7.40 to 0.43), which was of marginal significance (P = .08). Incidence of postoperative hemorrhage was comparable as was incidence of anal stenosis and fecal and flatus incontinence between the 2 groups.

CONCLUSIONS

LigaSure hemorrhoidectomy results in a significant reduction in operative time and blood loss, but it may not confer any advantage over the conventional operation in terms of postoperative pain, length of hospital stay, or time taken to return to work or normal activity. The expediency of the device must be weighed against its additional cost. Long-term evaluation of outcomes and morbidity are still needed.

Authors+Show Affiliations

Department of Biosurgery and Surgical Technology, Imperial College London, St Mary's Hospital, 10th Floor QEQM Wing, Praed Street, London W2 1NY, England.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis

Language

eng

PubMed ID

18086990

Citation

Tan, Emile K., et al. "Meta-analysis of Short-term Outcomes of Randomized Controlled Trials of LigaSure Vs Conventional Hemorrhoidectomy." Archives of Surgery (Chicago, Ill. : 1960), vol. 142, no. 12, 2007, pp. 1209-18; discussion 1218.
Tan EK, Cornish J, Darzi AW, et al. Meta-analysis of short-term outcomes of randomized controlled trials of LigaSure vs conventional hemorrhoidectomy. Arch Surg. 2007;142(12):1209-18; discussion 1218.
Tan, E. K., Cornish, J., Darzi, A. W., Papagrigoriadis, S., & Tekkis, P. P. (2007). Meta-analysis of short-term outcomes of randomized controlled trials of LigaSure vs conventional hemorrhoidectomy. Archives of Surgery (Chicago, Ill. : 1960), 142(12), 1209-18; discussion 1218.
Tan EK, et al. Meta-analysis of Short-term Outcomes of Randomized Controlled Trials of LigaSure Vs Conventional Hemorrhoidectomy. Arch Surg. 2007;142(12):1209-18; discussion 1218. PubMed PMID: 18086990.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Meta-analysis of short-term outcomes of randomized controlled trials of LigaSure vs conventional hemorrhoidectomy. AU - Tan,Emile K, AU - Cornish,Julie, AU - Darzi,Ara W, AU - Papagrigoriadis,Savas, AU - Tekkis,Paris P, PY - 2007/12/19/pubmed PY - 2008/1/1/medline PY - 2007/12/19/entrez SP - 1209-18; discussion 1218 JF - Archives of surgery (Chicago, Ill. : 1960) JO - Arch Surg VL - 142 IS - 12 N2 - OBJECTIVE: To evaluate the short-term outcomes of hemorrhoidectomy performed using the LigaSure vessel sealing device (Valleylab, Boulder, Colorado) or the conventional approach. DATA SOURCES: MEDLINE, EMBASE, Ovid, and Cochrane databases for studies published between 2002 and 2006. STUDY SELECTION: Randomized controlled trials published between 2002 and 2006 comparing short-term outcomes for LigaSure vs conventional hemorrhoidectomy. DATA EXTRACTION: Operative parameters, short-term complications, and postoperative recovery. Trials were assessed using a modified Jadad score. Random-effects meta-analytical techniques were used in the analysis. DATA SYNTHESIS: Nine randomized controlled trials with matched selection criteria reporting on 525 patients, of whom 266 (50.7%) underwent LigaSure and 259 (49.3%) underwent conventional hemorrhoidectomy. Operative time (weighted mean difference [WMD], - 8.67 minutes; 95% confidence interval [CI], - 15.34 to - 2.00 minutes), blood loss (WMD, - 23.08 mL; 95% CI, - 27.24 to - 18.92 mL), and pain the day after the operation measured by the visual analog scale (WMD, - 2.31; 95% CI, - 3.37 to - 1.26) were significantly reduced following LigaSure hemorrhoidectomy. There was a decrease in time taken to return to work or normal activity (WMD, - 3.49 days; 95% CI, - 7.40 to 0.43), which was of marginal significance (P = .08). Incidence of postoperative hemorrhage was comparable as was incidence of anal stenosis and fecal and flatus incontinence between the 2 groups. CONCLUSIONS: LigaSure hemorrhoidectomy results in a significant reduction in operative time and blood loss, but it may not confer any advantage over the conventional operation in terms of postoperative pain, length of hospital stay, or time taken to return to work or normal activity. The expediency of the device must be weighed against its additional cost. Long-term evaluation of outcomes and morbidity are still needed. SN - 1538-3644 UR - https://www.unboundmedicine.com/medline/citation/18086990/Meta_analysis_of_short_term_outcomes_of_randomized_controlled_trials_of_LigaSure_vs_conventional_hemorrhoidectomy_ L2 - https://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/archsurg.142.12.1209 DB - PRIME DP - Unbound Medicine ER -