A Cochrane review [Abstract] 1 included 22 studies. Patients undergoing circular stapled hemorrhoidopexy (SH) were significantly more likely to have recurrent hemorrhoids in long term follow up at all time points than those receiving conventional hemorrhoidectomy (CH) (12 trials, 955 patients, OR 3.22, CI 1.59 to 6.51). There were 37 recurrences out of 479 patients in the stapled group versus only 9 out of 476 patients in the conventional group. Similarly, in trials where there was follow up of one year or more, SH was associated with a greater proportion of patients with hemorrhoid recurrence (5 trials, 417 patients, OR 3.60, CI 1.24 to 10.49). Furthermore, a significantly higher proportion of patients with SH complained of the symptom of prolapse at all time points (13 studies, 1 191 patients, OR 2.65, CI 1.45 to 4.85). In studies with follow up of greater than one year, the same significant outcome was found (7 studies, 668 patients, OR 3.14, CI 1.20 to 8.22). Patients undergoing SH were more likely to require an additional operative procedure compared to those who underwent CH (8 papers, 553 patients, OR 2.75, CI 1.31 to 5.77). When all symptoms were considered, patients undergoing CH surgery were more likely to be asymptomatic (12 trials, 1097 patients, OR 0.59, CI 0.40 to 0.88). Non significant trends in favor of SH were seen in pain, pruritis ani, and fecal urgency. All other clinical parameters showed trends favoring CH.
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