Table 6: Closed versus stapled haemorrhoidectomy
Study | n stapled/ closed | Study regimen | Analgesia given to all groups | Pain scores and type if specified | Postoperative supplemental analgesia | Functional outcomes | Other outcomes, including long-term effects |
LoE 1 | 42/42 | Stapled rectal mucosectomy (Longo’s) versus closed haemorrhoidectomy ( | 24 h IV infusion of 0.8 mg/kg ketorolac and 0.5 µg/kg fentanyl. IV bolus of 0.5 mg/kg ketorolac administered every 8 h as necessary. IV bolus of fentanyl 0.5 µg/kg administered as necessary. | Pain scores: stapled superior during the first 24 h and at 2 weeks (both p<0.001). Maximum pain during the first 24 h: stapled superior (p<0.001) | Analgesic requirements in first 24 h: stapled superior for ketorolac and fentanyl (both p<0.001). Number of days of ketorolac use: stapled superior (p<0.001) | Time to first bowel movement: stapled superior (p=0.002) Wounds healed at 2 months: NS Wound dehiscence: NS Faecal impaction: NS Anal stricture: NS Anal incontinence: NS at 2 months, and at last follow-up | Length of disability: stapled superior (p<0.001) Incidence of bleeding: stapled superior at 2 weeks (p=0.048), closed superior at last follow-up (6–14 months; p=0.043), NS at 2 months Incidence of pruritus: NS at 2 weeks, 2 months, and at last follow-up Urinary retention: NS |
LoE 1 | 20/20 | Stapled haemorrhoidectomy (Longo’s) versus closed excision | Paracetamol, and | Average amount of pain over days 1–4: stapled superior (p?0.001) | Not reported | Impaired wound healing in 4/20 patients with closed, 0/20 with stapled (no statistics reported) | Total postop complication rate (bleeding, urinary retention, suture dehiscence, perianal thrombosis): NS Time to return to work: stapled superior (p=0.001) Length of hospital stay: NS |
(Ho 2006) LoE 1 | 29/21 | Standard stapled haemorrhoidectomy versus closed | Naproxen 550 mg tablets or IM pethidine 1 mg/kg as required | VAS pain scores: stapled superior on day 3 (p=0.01), 4 (p=0.034) and 5 (p=0.035), but NS at 1, 2, 6–14 days | NS number of pethidine injections and oral analgesic use | Incomplete wound healing at 8 weeks: NS Incontinence scores at 8 weeks: NS | Minor bleeding: stapled superior at 2 weeks (p=0.047), NS at 8 weeks. Wound discharge: stapled superior at 2 weeks (p=0.043), NS at 8 weeks Pruritus: stapled superior at 8 weeks (p=0.002), NS at 2 weeks Length of hospital stay: NS Patient’s satisfaction at 2 weeks: NS |
LoE 1 | 300/296 | Stapled haemorrhoidopexy (Longo’s) versus closed Ferguson haemorrhoidectomy | Oral paracetamol, 500 mg four times daily; oral mefenamic acid, 250 mg four times daily. IM injection of pethidine (50 mg) administered as needed. | VAS: stapled superior at 6 and 24 h (both p<0.001), at 7 days (p<0.01), at 21 days (p<0.001) and at first motion (p<0.001) | Number of NSAID tablets consumed per day: stapled superior after 1st, 2nd and 3rd week (all p<0.001). Number of patients requiring additional pethidine injections: stapled superior (p=0.02) | Incidence of faecal impaction requiring enema/digital evacuation: stapled superior (p=0.03) Anal stricture: NS Anal sepsis: NS short term (?30 days) or long term (>30 days after surgery) | Intra-operative blood loss: stapled superior (p<0.001) Incidence of dysuria: stapled superior (p=0.02) Incidence of bleeding: NS Length of hospital stay: stapled superior (p<0.001) Time to return to work: stapled superior (p<0.001) Requirement for urinary catheterization: stapled superior (p=0.03) |
LoE 1 | 20/20 | Stapled versus sutured (closed) haemorrhoidectomy | Oral diclofenac 50 mg 3 times daily, 2 co-dydramol tablets 4 times daily, 2% lidocaine gel applied topically as needed | Pain scores: stapled superior (p=0.04) during POD 1–7 | Consumption of oral analgesics: stapled superior (p<0.05) NS number of patients requiring morphine injection | Time to wound healing: stapled superior (p<0.001) Late complications (anal stenosis, incontinence to flatus, anal fissure): NS | Early complications (urinary retention, fecal impaction, nausea and vomiting, bleeding): NS |
LoE 1 | 65/73 | Stapled haemorrhoidopexy (Longo’s) versus closed Ferguson haemorrhoidectomy | Not stated | Most intense pain score: stapled superior on days 1 (p=0.002), 3 (p=0.016), 5 (p=0.001), 7 (p<0.001) and 14 (p=0.023). Pain on bowel movement: stapled superior (p=0.003) | % patients taking postop analgesics: stapled superior on days 3 (p<0.001) and 5 (p=0.021), NS on days 1, 7 and 14 | Time to first bowel movement: stapled superior (p=0.02) Incidence of wound complications: stapled superior (p=0.028) | Intra-operative blood loss: stapled superior (p=0.016) Urinary retention, constipation, postop haemorrhage, dysuria, incontinence, perianal itching: NS Emesis/vomiting: NS Length of hospital stay: NS |