Knowledge Key:
Intra-Operative
Expand allPROSPECT Recommendations
- Injection of botulinum toxin is not recommended (Grade D, LoE 4), due to inconsistent procedure-specific evidence for analgesic benefit in the postoperative period
Clinical Practice
- The injection of botulinum toxin for pain after haemorrhoid surgery is not performed routinely in clinical practice
Transferable Evidence
- None cited
Haemorrhoid surgery-specific evidence
- Two out of two studies demonstrated a decrease in pain scores with Botox injection compared with placebo injection Davies 2003 Click here for more information
- One study out of two showed a decrease in rescue analgesic consumption with Botox compared with placebo Patti 2005 Click here for more information
- In one study out of one, the time to complete healing of wounds was significantly shorter with Botox compared with placebo (p<0.001;
- In one study out of one, the time to return to work was significantly shorter in a Botox group versus a placebo group (p<0.05;
- The time to first defecation was similar in groups receiving either Botox or placebo in two out of two studies (
- In one study out of one, the incidence of anal incontinence was similar with Botox and placebo (
- In one study out of one, the incidence of urinary retention was similar with Botox and placebo (
- In two studies out of two, there was no significant difference in the length of hospital stay with Botox and placebo (
- Study details Davies 2003 Click here for more information
PROSPECT Recommendations
- Stapled haemorrhoid surgery is recommended (Grade A) based on reduced pain compared with other surgical techniques (procedure-specific evidence, LoE 1)
- The choice of haemorrhoid operative techniques may depend on factors other than postoperative pain alone
Clinical Practice
- The choice of haemorrhoid operative technique may depend on factors other than postoperative pain alone
Transferable Evidence
- None cited
Haemorrhoid surgery-specific evidence
- Closed versus open haemorrhoidectomy
- Closed versus closed haemorrhoidectomy
PROSPECT Recommendations
- No recommendation can be made regarding the choice of haemorrhoid dissection technique based on their effect on postoperative pain alone
Clinical Practice
- None cited
Transferable Evidence
- None cited
Haemorrhoid surgery-specific evidence
- Summary of studies Click here for more information
- Diathermy dissection versus conventional scissors dissection
- Harmonic Scalpel™ dissection versus conventional scissors dissection
- Dissection with radiofrequency bistoury versus conventional scissors dissection
- Diathermy dissection versus Harmonic Scalpel™ dissection
- LigaSure™ diathermy dissection versus conventional diathermy dissection
- Cold scalpel dissection versus laser dissection
PROSPECT Recommendations
- Lateral sphincterotomy as an adjunct to haemorrhoid surgery is not recommended for analgesia (Grade D, LoE 4) due to limited and inconsistent procedure-specific evidence
- The use of an anal dilator as an adjunct to haemorrhoid surgery is not recommended for analgesia (Grade D, LoE 4) based on limited procedure-specific evidence
Clinical Practice
- None cited
Transferable Evidence
- None cited
Haemorrhoid surgery-specific evidence
- Open haemorrhoidectomy, with or without lateral sphincterotomy
- Closed haemorrhoidectomy, with or without lateral sphincterotomy
- Diathermy haemorrhoidectomy, with or without lateral sphincterotomy
- Anal dilator versus no treatment