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Comparison of hemorrhoidal treatments: a meta-analysis.
Can J Surg. 1997 Feb; 40(1):14-7.CJ

Abstract

OBJECTIVE

To determine whether any method of hemorrhoid therapy has been shown to be superior in randomized trials.

METHOD

A meta-analysis of all randomized controlled trials assessing two or more treatment modalities for symptomatic hemorrhoids.

MAIN OUTCOME MEASURES

Response to therapy, the need for further therapy, complications and pain.

RESULTS

Eighteen trials were available for analysis. Hemorrhoidectomy was found to be significantly more effective than manual dilatation of the anus (p = 0.0017) and associated with less need for further therapy (p = 0.034), no significant difference in complications (p = 0.60) but more pain (p < 0.001). Patients who underwent hemorrhoidectomy had a better response to treatment than did patients who were treated with rubber-band ligation (p = 0.001), although complications were greater (p = 0.02), as was pain (p < 0.0001). Rubber-band ligation was better than sclerotherapy in response to treatment for all hemorrhoids (p = 0.005) and for hemorrhoids stratified by grade (grades 1 and 2, p = 0.007, grade 3, p = 0.042), with no difference in the complication rate (p = 0.35). Patients treated with sclerotherapy (p = 0.031) or infrared coagulation (p = 0.0014) were more likely to require further therapy than those treated with rubber-band ligation, although pain was greater after rubber-band ligation (p = 0.03 for sclerotherapy, p < 0.0001 for infrared coagulation).

CONCLUSIONS

Rubber-band ligation is recommended as the initial mode of therapy for grades 1 to 3 hemorrhoids. Although hemorrhoidectomy showed better response, it is associated with more complications and pain than rubber-band ligation. Thus, it should be reserved for patients whose hemorrhoids fail to respond to rubber-band ligation.

Authors+Show Affiliations

Department of Surgery, Mount Sinai Hospital, Toronto, Ont.No affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

9030078

Citation

MacRae, H M., and R S. McLeod. "Comparison of Hemorrhoidal Treatments: a Meta-analysis." Canadian Journal of Surgery. Journal Canadien De Chirurgie, vol. 40, no. 1, 1997, pp. 14-7.
MacRae HM, McLeod RS. Comparison of hemorrhoidal treatments: a meta-analysis. Can J Surg. 1997;40(1):14-7.
MacRae, H. M., & McLeod, R. S. (1997). Comparison of hemorrhoidal treatments: a meta-analysis. Canadian Journal of Surgery. Journal Canadien De Chirurgie, 40(1), 14-7.
MacRae HM, McLeod RS. Comparison of Hemorrhoidal Treatments: a Meta-analysis. Can J Surg. 1997;40(1):14-7. PubMed PMID: 9030078.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of hemorrhoidal treatments: a meta-analysis. AU - MacRae,H M, AU - McLeod,R S, PY - 1997/2/1/pubmed PY - 1997/2/1/medline PY - 1997/2/1/entrez SP - 14 EP - 7 JF - Canadian journal of surgery. Journal canadien de chirurgie JO - Can J Surg VL - 40 IS - 1 N2 - OBJECTIVE: To determine whether any method of hemorrhoid therapy has been shown to be superior in randomized trials. METHOD: A meta-analysis of all randomized controlled trials assessing two or more treatment modalities for symptomatic hemorrhoids. MAIN OUTCOME MEASURES: Response to therapy, the need for further therapy, complications and pain. RESULTS: Eighteen trials were available for analysis. Hemorrhoidectomy was found to be significantly more effective than manual dilatation of the anus (p = 0.0017) and associated with less need for further therapy (p = 0.034), no significant difference in complications (p = 0.60) but more pain (p < 0.001). Patients who underwent hemorrhoidectomy had a better response to treatment than did patients who were treated with rubber-band ligation (p = 0.001), although complications were greater (p = 0.02), as was pain (p < 0.0001). Rubber-band ligation was better than sclerotherapy in response to treatment for all hemorrhoids (p = 0.005) and for hemorrhoids stratified by grade (grades 1 and 2, p = 0.007, grade 3, p = 0.042), with no difference in the complication rate (p = 0.35). Patients treated with sclerotherapy (p = 0.031) or infrared coagulation (p = 0.0014) were more likely to require further therapy than those treated with rubber-band ligation, although pain was greater after rubber-band ligation (p = 0.03 for sclerotherapy, p < 0.0001 for infrared coagulation). CONCLUSIONS: Rubber-band ligation is recommended as the initial mode of therapy for grades 1 to 3 hemorrhoids. Although hemorrhoidectomy showed better response, it is associated with more complications and pain than rubber-band ligation. Thus, it should be reserved for patients whose hemorrhoids fail to respond to rubber-band ligation. SN - 0008-428X UR - https://www.unboundmedicine.com/medline/citation/9030078/Comparison_of_hemorrhoidal_treatments:_a_meta_analysis_ L2 - http://www.canjsurg.ca/vol40-issue1/40-1-14/ DB - PRIME DP - Unbound Medicine ER -