Stapled haemorrhoidectomy (haemorrhoidopexy) for the treatment of haemorrhoids: a systematic review and economic evaluation
BackgroundThe aim of this review was to appraise the clinical and cost-effectiveness of stapled haemorrhoidopexy in comparison with traditionally used surgical haemorrhoidectomy techniques. Outcomes considered included: pain, bleeding, recurrent prolapse, wound healing time, time to normal bowel function, and complications of surgery. The economic evaluations considered: the time period over which recurrences of haemorrhoid prolapse may occur, and the impact of performing haemorrhoidectomy in inpatient or day-case settings.
Stapled haemorrhoidopexy was associated with less pain in the immediate postoperative period, but a higher rate of residual prolapse, prolapse in the longer term, and reintervention for prolapse. There was no clear difference in the rate or type of complications associated with stapled haemorrhoidopexy and conventional haemorrhoidectomy. The absolute and relative rates of recurrence and reintervention are still uncertain.
Stapled haemorrhoidopexy and conventional haemorrhoidectomy had very similar costs and QALYs, the cost of the staple gun being offset by savings in hospital stay. Should the price of the gun change, the conclusions of the economic analysis may change. Some training may be required in the use of the staple gun; this is not expected to have major resource implications for the NHS.
Given the currently available clinical evidence and the results of the economic analysis, the decision as to whether stapled haemorrhoidopexy or conventional haemorrhoidectomy is conducted could primarily be based upon the priorities and preferences of the patient and surgeon. Further research is recommended.Conducted by: J Burch1 , D Epstein1, A Baba-Akbari1, H Weatherly1, D Fox1, S Golder1, D Jayne1, M Drummond1, N Woolacott1
1. Centre for Reviews and Dissemination; 2. Centre for Health Economics, University of York; 3. St James's University Hospital
Further detailsProject page on the NIHR HTA Programme website
Related guidanceCommissioned to inform NICE Technology Appraisal Guidance 128: Stapled haemorrhoidopexy for the treatment of haemorrhoids. London: National Institute for Clinical Excellence; 2007
Burch J , Epstein D, Akbari Sari AB, Weatherly H, Fox D, Golder S, Jayne D, Drummond M, Woolacott N. Stapled haemorrhoidectomy (haemorrhoidopexy) for the treatment of haemorrhoids. Health Technol Assess. 2008; 12(8): 1-214Burch J, Epstein D, Baba-Akbari A, Weatherly H, Fox D, Jayne D, Woolacott N. Stapled haemorrhoidopexy for the treatment of haemorrhoids: a systematic review. Colorectal Dis. 2008; 11(3): 233-244
Commissioned by the HTA Programme on behalf of NICE's Technology Assessment Report (TAR) process