A Comparative Analysis of Gastrointestinal Recovery and Pain Management Outcomes in Stapled Versus Open Hemorrhoidectomy: A Meta-Analysis
Bibliographic record
Abstract
Stapled hemorrhoidectomy (SH) and open hemorrhoidectomy (OH) are widely used surgical techniques for managing hemorrhoidal disease. SH is often preferred for its potential benefits, such as reduced postoperative pain and faster recovery, while OH is traditionally employed in advanced or complex cases. However, the comparative impact of these techniques on gastrointestinal function and pain management remains unclear, necessitating further evaluation. This meta-analysis is aimed at comparing the clinical outcomes of SH and OH in patients with grade III and IV hemorrhoids, focusing on operative parameters, postoperative pain, recovery, complications, and recurrence. A systematic search was performed across PubMed, Cochrane CENTRAL, Scopus, ProQuest, and Google Scholar, using relevant keywords and Medical Subject Headings (MeSH) terms. Studies included were randomized controlled trials, cohort studies, and quasi-experimental studies published in English until July 2023, comparing gastrointestinal recovery and pain outcomes between SH and OH. The primary outcomes were gastrointestinal recovery, measured by time to resumption of normal diet and bowel movements, and pain management, assessed by postoperative pain scores. Secondary outcomes included hospital stay, complication rates, and recurrence. Data from eligible studies were pooled, and random-effects models were used to estimate the weighted mean differences and odds ratios (OR) for each outcome. Statistical heterogeneity was assessed using Cochran's Q and I² tests. Seven studies involving 292 patients met the inclusion criteria. SH consistently demonstrated advantages over OH regarding pain management, gastrointestinal recovery, and hospital stay. SH patients reported significantly lower pain scores, reduced analgesic use by 35% on average, and faster recovery, with statistically significant results (p<0.05). SH patients also had a shorter time to the first bowel movement, with a reduced OR (OR=0.60, 95% CI: 0.38-0.98) compared to OH. Regarding complications, SH had lower incontinence rates (OR=0.48, 95% CI: 0.26-0.88), though a higher recurrence rate was noted in the SH group, especially at 12-18 months post-surgery. The risk of bias was generally low in most studies, with only a few showing moderate concerns. SH offers significant short-term benefits over OH, including reduced postoperative pain, faster recovery, and fewer complications. However, the higher recurrence rates in SH suggest that clinicians should carefully consider long-term outcomes when choosing the optimal surgical approach for hemorrhoidectomy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.029 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.020 | 0.066 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".