The examination area should have available a range of proctoscopes, rigid sigmoidoscopes, haemorrhoidal banding, probes, local anaesthetic and instrumentation to allow excision of cutaneous pathology such as perianal haematomas, small skin tags, banding of haemorrhoids, simple haemorrhoidectomy, low fistulotomy, sphincterotomy and excision of anal warts, abscess drainage, etc.
Although anorectal procedures that are suitable for day surgery can be performed without bowel preparation, it is of benefit to provide oral bowel prep or to administer an enema on arrival to reduce the need for early postoperative evacuation and to lessen the chance of impaction following haemorrhoidectomy.
All articles addressing haemorrhoidectomy were identified using the MEDLINE electronic search engine.
The indications for haemorrhoidectomy were inconsistent in that second-, third- and fourth-degree haemorrhoids were included.
As there is no bail-out procedure for haemorrhoidectomy it seems that the initial analysis was by 'intention to treat' and, since not all patients returned for follow-up in all studies, it is implicit that follow-up analysis must have been 'per protocol'.
All the meta-analyses including the present meta-analysis are in agreement that there was significant heterogeneity between the results of trials available for the meta-analysis caused by relatively small sample sizes, variation in severity of disease, type of haemorrhoidectomy performed and method of reporting outcomes, and that trial results are difficult to interpret owing to variation in patient selection and methods of reporting endpoints, short follow-up times and poor reporting of complications.
Long-term effects of stapled haemorrhoidectomy on internal anal function and sensitivity.
Stapled haemorrhoidectomy compared with Milligan-Morgan excision for the treatment of prolapsing haemorrhoids: a prospective study.
Randomised controlled clinical trial of stapled haemorrhoidectomy vs conventional haemorrhoidectomy: a three and half year follow-up.
Prospective randomised multicentre trial comparing stapled with open haemorrhoidectomy.
Long-term outcome of a multicentre randomised clinical trial of stapled haemorrhoidectomy versus Milligan-Morgan haemorrhoidectomy.