Harmonic Scalpel Hemorrhoidectomy versus Stapled Hemorrhoidopexy in Grade III / IV Hemorrhoids: Systematic Review and Meta-Analysis of Randomized Controlled Trials

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Abstract
Introduction: Third- and fourth-degree hemorrhoids often require surgery due to prolapse, bleeding and discomfort. Among the available procedures, there is no consensus on which surgical technique offers better results. This systematic review with meta-analysis aims to compare harmonic scalpel hemorrhoidectomy (HSH) versus stapled hemorrhoidopexy (SH). Methods: A search was conducted in the PubMed, Scopus, and Cochrane Library databases. Inclusion criteria were (a) randomized controlled trials, (b) comparing HSH and SH, (c) in patients with grade III/IV hemorrhoids, and (d) reporting at least one outcome of interest. Statistical analyses were performed in Review Manager 5.4.1 and RStudio, using a random-effects model to calculate the risk ratio and mean differences with 95% confidence intervals (CIs). Results: We included six randomized controlled trials with a total of 375 patients. HSH was associated with a lower recurrence compared to SH. However, there were no significant differences in bleeding, fecal incontinence, operative time, hospital stay, and urinary retention. SH group was associated with less postoperative severe pain and overall pain. Conclusion: HSH and SH are comparable in the treatment of grade III/IV hemorrhoids, analyzing postoperative bleeding, fecal incontinence, operative time, hospital stay, and urinary retention. However, SH presented less severe and overall pain, showing better results in the short term and HSH presented lower recurrence, highlighting as a better outcome in the long term.

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