Haemorrhoids

Overview

Abstract | Cite as | Substantive changes

Abstract

INTRODUCTION: Haemorrhoids are cushions of submucosal vascular tissue located in the anal canal starting just distal to the dentate line. Incidence is difficult to ascertain as many people with the condition will never consult with a medical practitioner, although one study found 10 million people in the USA complaining of the disease. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for haemorrhoidal disease? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2008 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 44 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review, we present information relating to the effectiveness and safety of the following interventions: closed haemorrhoidectomy; haemorrhoidal artery ligation; infrared coagulation/photocoagulation; injection sclerotherapy; open excisional (Milligan–Morgan/diathermy) haemorrhoidectomy; radiofrequency ablation; rubber band ligation; and stapled haemorrhoidectomy.

Cite as

Reese GE, von Roon AC and Tekkis PP. Haemorrhoids. Clinical Evidence 2009; 01:415.

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Substantive changes

Closed haemorrhoidectomy One systematic review (search date 2006) added comparing closed haemorrhoidectomy versus open excisional (Milligan–Morgan) haemorrhoidectomy,[3]and one systematic review (search date 2006) added comparing conventional closed excisional haemorrhoidectomy versus closed excisional haemorrhoidectomy by LigaSure™.[8] Five systematic reviews (search date 2002;[9]search date 2004;[10]search date 2006)[11][12][13] added comparing stapled haemorrhoidectomy versus conventional hamorrhoidectomy (including both closed and open haemorrhoidectomy), and three subsequent RCTs added[14][15][16] comparing closed haemorrhoidectomy versus stapled haemorrhoidectomy. Categorisation of "closed haemorrhoidectomy" unchanged (Likely to be beneficial).

Open excisional haemorrhoidectomy One systematic review (search date 2006) added comparing open excisional (Milligan–Morgan) haemorrhoidectomy versus closed haemorrhoidectomy,[3] and one systematic review (search date 2006)[8] and one subsequent RCT[21] added comparing conventional (diathermy) open excisional haemorrhoidectomy versus open excisional haemorrhoidectomy by LigaSure™. One systematic review (search date 2004) [23] and one subsequent RCT[24] added comparing open haemorrhoidectomy versus rubber band ligation. Six systematic reviews (search date 2002;[9] search date 2004;[10][25] search date 2006)[11][12][13] added comparing stapled haemorrhoidectomy versus conventional haemorrhoidectomy (including open and closed haemorrhoidectomy), one 7-year follow-up of an included RCT added comparing open haemorrhoidectomy versus stapled haemorrhoidectomy,[26] and three subsequent RCTs added comparing open haemorrhoidectomy versus stapled haemorrhoidectomy.[14][27][28]Categorisation of "open excisional (Milligan–Morgan/diathermy) haemorrhoidectomy" unchanged (Likely to be beneficial).

Rubber band ligation One systematic review (search date 2005)[23] and one subsequent RCT[24] added comparing rubber band ligation versus open excisional (Milligan–Morgan) haemorrhoidectomy. Two RCTs added comparing rubber band ligation versus infrared coagulation.[32][33] One RCT added comparing rubber band ligation versus radiofrequency ablation.[31] Categorisation of "rubber band ligation" unchanged (Beneficial).

Infrared coagulation/photocoagulation Two RCTs added comparing infrared coagulation versus rubber band ligation.[32][33] Categorisation of "infrared coagulation/photocoagulation" unchanged (Likely to be beneficial).

Stapled haemorrhoidectomy Six systematic reviews added (search date 2002;[9]search date 2004;[10][25] search date 2006),[11][12][13] one 7-year follow-up of an included RCT added,[26] and five subsequent RCTs [14][15][16][27][28] added comparing stapled haemorrhoidectomy versus conventional haemorrhoidectomy (open or closed haemorrhoidectomy, results combined in analysis) or stapled versus open haemorrhoidectomy alone or stapled versus closed haemorrhoidectomy alone. Categorisation of "stapled haemorrhoidectomy" changed to Likely to be beneficial.

Radiofrequency ablation New option. Two RCTs comparing radiofrequency ablation versus open haemorrhoidectomy,[17][18] and one RCT comparing radiofrequency ablation versus rubber band ligation, added.[31] Radiofrequency ablation categorised as Unknown effectiveness.

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