Systematic Review And Meta-analysis Of Randomized Controlled Trials Comparing Procedure For Prolapse And Hemorrhoids With Milligan-Morgan Haemorrhoidectomy

OBJECTIVE This systematic review and meta-analysis aimed to compare procedure for prolapse and hemorrhoids with Milligan-Morgan haemorrhoidectomy for the treatment of haemorrhoids. The outcome measures extracted were duration of procedure, length of inpatient stay, time to return to work or normal activity, postoperative pain score and analgesic requirement, satisfaction and incontinence, individual complications (bleeding, urinary retention, anal stenosis, skin tags, anal fissure, wound discharge, haemorrhoidal thrombosis) and recurrent prolapse.METHODS All published, randomized, controlled trials comparing procedure for prolapse and hemorrhoids with Milligan-Morgan haemorrhoidectomy were identified from PubMed, EMBASE, Cochrane Library, CNKI, CBM,VIP and Wanfang database between January 1998 and January 2015. Hand search was applied in Chinese Journal of Gastrointestinal Surgery, Chinese Journal of Coloproctology and Journal of Colorectal & Anal Surgery. Date were extracted independently by two Reviewer. The included trials were evaluated the methodological quality according to the Cochrane handbook for systematic reviews of interventions. Meta-analysis was performed using Revman5.3 software provided by the Cochrane collaboration.RESULTS Sixteen randomized clinical trials recruiting 1411 patients were identified. 702 patients underwent procedure for prolapse and hemorrhoids, and other 709 patients belong to Milligan-Morgan haemorrhoidectomy. Meta-analysis showed that procedure for prolapse and hemorrhoids was less painful than Milligan-Morgan haemorrhoidectomy. procedure for prolapse and hemorrhoids required a shorter inpatient stay (WMD-1.48 (95 per cent c.i.-1.81to-1.14) days; P<0.00001) and operating time (WMD-12.34 (95 per cent c.i.-17.87toto6.80) min; P<0.0001). It was also associated with a faster return to normal activities (WMD-14.11 (95 per cent c.i.-24.51to-3.70) days; P=0.008) and better wound healing(relative risk 0.19(95 percentc.i. 0.07to0.51);P=0.0009). No significant difference was noted between the two techniques in terms of the complications except anal incontinence(relative risk 0.62(95 percentc.i.0.38tol.01);P=0.05)and anal stenosis (relative risk 0.62(95 percentc.i. 0.15to0.99);P=0.05). Patient satisfaction after surgery for PPH was higher than MMH, but PPH was associated with a higher rate of recurrent disease.CONCLUSION PPH offers some short-term benefits over MMH, but the complication rates are similar for both techniques, PPH appears at lease as safe as MMH. PPH is associated with a higher rate of recurrent disease.