090 Transarterial Haemorrhoidal Dearterialization Versus Open Haemorrhoidectomy for Symptomatic Haemorrhoids- a Meta-Analysis of Randomized Controlled Trials

Abstract

Although effective, open haemorrhoidectomy (OH) is associated with significant postoperative pain. Novel non-excisional techniques such as transarterial haemorrhoidal dearterialization (THD) are increasingly advocated due to a lower incidence of pain and complications. We aimed to compare short and long-term outcomes of THD and OH in the present meta-analysis.

A PRISMA-compliant systematic review and meta-analysis was performed including randomised controlled trials (RCTs) from inception until June 2022. The primary objective was recurrence, whilst secondary objectives included complication rates, mean length of stay (LOS), operative time and time to return to baseline. Random-effects models were used to calculate pooled effect size estimates. A p-value < 0.05 was considered statistically significant.

6 RCTs encompassing 474 patients were captured. There were 129 (54%) males in the THD group and 142 (59%) in the OH group. On random effects analysis, OH had a lower recurrence rate (OR = 2.76, p = 0.04) whereas THD was associated with a quicker return to baseline (MD = -14.05 days, p < 0.0001). There were no differences in bleeding (OR = 0.58,p = 0.09), urinary retention (OR = 1.01, p = 0.99), incontinence (OR = 0.49, p = 0.41), anal stenosis (OR = 0.14, p = 0.19), number of patients with chronic pain (OR = 1.30, p = 0.40), operating time (MD = 11.79 mins, p = 0.20) or LOS (MD = -0.23 days, p = 0.22).

THD is a safe technique that affords a quicker return to baseline post procedure but is associated with a higher recurrence rate compared to OH.