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Can J Surg. 1997 Feb;40(1):14-7.

Comparison of hemorrhoidal treatments: a meta-analysis.

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  • 1Department of Surgery, Mount Sinai Hospital, Toronto, Ont.

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.

PMID:
9030078
[PubMed - indexed for MEDLINE]
PMCID:
PMC3949873
Free PMC Article
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