A Comparative Analysis of Gastrointestinal Recovery and Pain Management Outcomes in Stapled Versus Open Hemorrhoidectomy: A Meta-Analysis.

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.