[A meta-analysis on short and long term efficacy and safety of procedure for prolapse and hemorrhoids].Zhonghua Wai Ke Za Zhi. 2013 Nov; 51(11):1034-8.ZW
To Systematic review and meta-analysis of short and long term efficacy and safety of procedure for prolapse and hemorrhoids.
Electronic databases including Cochrane Library, PubMed, OVID, SpringerLinker, ScinceDirect, EBSCO, CNKI, VIP, WanFang Data and CBM were searched. The date of search was between January 2000 and January 2013. Randomized controlled trials (RCTs) were indentified studying association of Compare PPH and Milligan-Mogan (MMH) treatment. Study selection and meta-analysis were conducted according to the Cochrane Handbook for RevMan 5.1 software.
The trials involving 1343 patients were included. The results of meta-analysis indicated: compared with MMH, PPH operative time (OR = -11.05, 95%CI: -15.15--6.95, P < 0.01), duration of hospitalization (OR = -3.07, 95%CI: -4.46--1.69, P < 0.01) and return to normal activity time (OR = -7.17, 95%CI: - 9.13--5.20, P < 0.01) was short, postoperative pain light (OR = -3.13, 95%CI: -4.38--1.88, P < 0.01), but the high cost of treatment (OR = 2534.2, 95%CI: 509.0-4559.4, P = 0.01). Long-term efficacy, PPH was higher patient satisfaction (OR = 2.21, 95%CI: 1.03-4.75, P = 0.04), but the recurrence rate of prolapse (OR = 3.75, 95%CI: 1.75-8.06, P < 0.01) and reoperation rate (OR = 7.90, 95%CI: 1.78-35.03, P < 0.01) higher. The incidence of anal stenosis and anal incontinence postoperative were higher than MMH (P > 0.05). The difference of post operative anal stenosis and anal incontinence and residual skin tag rate were not statistically significant (all P > 0.05).
PPH surgery can be used as replacement therapy of MMH for III°-IV° prolapsed hemorrhoids. But we should inform patients of prolapse recurrence and reoperation risk of PPH in the long term.