Conventional excisional haemorrhoidectomy versus transanal haemorrhoidal dearterialization for haemorrhoids - a systematic review and meta-analysis.

ABSTRACT

Introduction Although effective, conventional excisional haemorrhoidectomy (CEH) may be associated with significant postoperative pain. Novel techniques such as transanal haemorrhoidal dearterialization (THD) are suggested to reduce pain, but may result in higher recurrence rates. We aimed to compare short and long-term outcomes of CEH and THD in the present meta-analysis. Methods A PRISMA-compliant meta-analysis was performed, searching PubMed, EMBASE and CENTRAL databases for randomized controlled trials (RCTs) from 1995 until December 2022. The primary objective was recurrence. Secondary objectives included complication rates, length of stay (LOS), operative time and time to return to baseline. Random-effects models were used to calculate pooled effect size estimates. Subgroup analysis was also performed. Results 6 RCTs encompassing 465 patients were captured. There were 142 (59%) males in the CEH group and 129 (54%) in the THD group.. On random effects analysis, THD had a higher recurrence rate (OR = 2.76, 95% CI = 1.03 to 7.38, p = 0.04) albeit a shorter return to baseline comparative to CEH (MD = -14.05 days, 95% CI = -20.38 to -7.72, p < 0.0001). There were no differences in bleeding (p = 0.12), urinary retention (p = 0.97), incontinence (p = 0.41), anal stenosis (p = 0.19), thrombosed residual haemorrhoids (p = 0.16), operating time (p = 0.19) or LOS (p = 0.22). Results remained similar on subgroup analysis. Conclusions CEH is associated with lower recurrence rates and no difference in complication rate to THD, although patients take longer to return to baseline function postoperatively.