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Dennis M. Jensen - One of the best experts on this subject based on the ideXlab platform.
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Randomized Prospective Study of Endoscopic Rubber Band Ligation Compared With Bipolar Coagulation for Chronically Bleeding Internal Hemorrhoids
The American journal of gastroenterology, 2009Co-Authors: Rome Jutabha, Dennis M. Jensen, Disaya ChavalitdhamrongAbstract:Randomized Prospective Study of Endoscopic Rubber Band Ligation Compared With Bipolar Coagulation for Chronically Bleeding Internal Hemorrhoids
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Definitive therapy for Internal Hemorrhoids--new opportunities and options.
Reviews in gastroenterological disorders, 2009Co-Authors: Gordon V. Ohning, Gustavo A. Machicado, Dennis M. JensenAbstract:Hemorrhoids are common in Western societies. Appropriate assessment and treatment of symptomatic Hemorrhoids can substantially reduce morbidity and improve patient well-being. In this article, the clinical presentation, differential diagnoses, and current treatment options, including the CRH-O'Regan banding device, an emerging technology for the anoscopic treatment of symptomatic Internal Hemorrhoids, are reviewed.
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Current medical, anoscopic, endoscopic, and surgical treatments for bleeding Internal Hemorrhoids
Techniques in Gastrointestinal Endoscopy, 2001Co-Authors: Rome Jutabha, Chiaki Miura-jutabha, Dennis M. JensenAbstract:Internal Hemorrhoids are extremely common in adults and are the most frequent cause of self-limited hematochezia in ambulatory adults. Most patients with gastrointestinal bleeding from Internal Hemorrhoids have bright red blood per rectum that stops and is not associated with anemia. However, approximately 15% to 20% of patients with bleeding Internal Hemorrhoids have more severe bleeding that requires hospitalization and transfusion for severe anemia. In a CURE Hemostasis Research Group study of patients with severe hematochezia, Internal Hemorrhoids represented the second most common colorectal cause of severe hematochezia. Bleeding Internal Hemorrhoids are most effectively diagnosed by slotted anoscopy; however, in adults, other colonic lesions need to be excluded by colonoscopy. Endoscopic and anoscopic techniques for treatment of bleeding Internal Hemorrhoids include sclerotherapy, banding, direct current probe, infrared coagulator, bipolar probe, and heater probe. Endoscopic diagnosis, treatment techniques, results, and complications are presented in this report, and medical and surgical treatments are discussed.
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3638 Randomized, prospective trial of endoscopic rubber band ligation compared to bipolar coagulation for bleeding Internal Hemorrhoids
Gastrointestinal Endoscopy, 2000Co-Authors: Rome Jutabha, Dennis M. Jensen, Florence Lam, Mary Ellen Jensen, Gwen AlofaituliAbstract:Internal Hemorrhoids are the most common cause of recurrent hematochezia (BRB) in ambulatory adults.We compared the efficacy and safety of bipolar coagulation (BICAP) with endoscopic rubber band ligation (RBL) for hemostasis of bleeding Internal Hemorrhoids (IH). Methods: This was a randomized prospective trial of patients with IH bleeding, documented by anoscopy and colonoscopy, who continued to have BRB inspite of at least 60 days of medical therapy (bulk agents, suppositories, stool softeners). Exclusions were rectal fissures, AIDS, inflammatory disease, or incidental IH and another source of bleeding found. After grading of IH with a slotted anoscope, patients were randomized to anoscopic treatment with BICAP (16W, 1 secs pulses) or RBL (via videoendoscope) and treatments were applied above the dentate line on 3 IH segments/session. Endpoints were control of BRB, severe complication or refusal to continue the treatment, and reduction of all IH segments to grade ≤ 1 in ≥ 3 treatment sessions. Failures were crossed over to other therapies. Results: 37 patients with mean age of 51 and chronic IH symptoms for ≤ 9 yrs were treated, 18 with BICAP and 19 with RBL. See table for results. Significantly fewer treatment sessions with RBL were required for control of BRB. Conclusions: For patients with chronic Internal Hemorrhoids and recurrent hematochezia unresponsive to medical therapy: 1) bipolar coagulation and rubber band ligation were similar in efficacy and safety for hemostasis, 2) non-significantly more bipolar than RBL patients had treatment failures and were crossed-over to other treatments, and 3) RBL required significantly fewer sessions to control hematochezia and reduce the size of Internal Hemorrhoids than bipolar coagulation. Funded in part by NIH DK41301 (Human Studies Core), American Digestive Health Foundation Endoscopy Research Award, and NIH-GCRC M01-RR008658.
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Prospective randomized comparative study of bipolar electrocoagulation versus heater probe for treatment of chronically bleeding Internal Hemorrhoids
Gastrointestinal endoscopy, 1997Co-Authors: Dennis M. Jensen, Rome Jutabha, Mary Ellen Jensen, Gordon V. Ohning, Gustavo A. Machicado, S Cheng, Jeffrey Gornbein, Ken Hirabayashi, Gayle M. RandallAbstract:Abstract Background : Our purpose was to compare the efficacy, complications, failure rates, and crossovers of heater and bipolar probe treatments of chronically bleeding Internal Hemorrhoids. Methods : Eighty-one patients (31 female, 50 male) with mean age of 53 years had large (grade 2 to 3) Internal Hemorrhoids with bleeding for a mean of 12 years, had failed medical management, and were randomized in a prospective study of anoscopic treatments to heater versus bipolar probes. Failure was defined as a major complication or failure to reduce the size of all Internal Hemorrhoids with three or more treatments. Results : With similar background variables and no difference in treatment times, rectal bleeding and other symptoms were controlled in a shorter time with the heater probe than with the bipolar probe (77 versus 121 days). Five complications (fissures, bleeding, or rectal spasm) occurred with the bipolar probe, and two occurred with the heater probe. The heater probe caused more pain during treatments but had significantly fewer failures and crossovers. Conclusions : For patients who had failed medical management of chronically bleeding Internal Hemorrhoids, the techniques and complications of heater and bipolar probes were similar, but pain was more common, failures and crossovers were less frequent, and the time to symptom relief was shorter with the heater probe than with the bipolar probe. (Gastrointest Endosc 1997;46:435-43.)
Xuemin Wang - One of the best experts on this subject based on the ideXlab platform.
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superior rectal artery embolization for bleeding Internal Hemorrhoids
Techniques in Coloproctology, 2021Co-Authors: Xinqiang Han, F. Xia, Gang Chen, Yuguo Sheng, Wenming Wang, Z. Wang, Mengpeng Zhao, Xuemin WangAbstract:The aim of the present study was to evaluate clinical efficacy and safety of superselective embolization of the superior rectal artery (SRA) for the treatment of Internal hemorrhoidal bleeding. Patients with stage II and stage III Internal Hemorrhoids, treated by interventional embolization of the SRA in our department between January 2017 and June 2019 were retrospectively evaluated. All patients suffering from disabling chronic hematochezia and some with relative contraindications for operation (n = 17) or rejection of conventional hemorrhoidectomy (n = 15). Superselective SRA branch embolization was performed using gelatin sponge particles (350–560 μm) and metallic coils (2–3 mm). This treatment process was planned by a multidisciplinary team consisting of proctologist, gastroenterologist and radiologist. The surgical efficacy, postoperative complications and follow-up outcomes were observed. There were 32 patients (18 males, mean age 52 ± 12 years, range: 22–78 years), 12 (37%) with stage II Hemorrhoids and 20 (63%) with stage III Hemorrhoids. Embolization was successful in all patients, and bleeding symptoms resolved in 27 (84.4%) patients. The remaining 5 (15.6%) patients underwent either stapled hemorrhoidopexy (n = 4) or sclerotherapy (n = 1). Some patients experienced different degrees of pain (n = 4;12.5%), low fever (n = 11;34.4%), and tenesmus (n = 17;53.1%), which all spontaneously regressed without further treatment. All patients were followed up for at least 1 year. There were no serious complications, such as infection, intestinal ischemia or massive hemorrhage. Four patients (14.8%) had rebleeding during the first months of follow-up. All patients with re-bleeding were successfully treated with Internal iliac arteriography and branch embolization and did not experience further bleeds after a minimum follow up 3 months follow-up. The short-term efficacy of superselective SRA embolization for grade II–III Internal Hemorrhoids is good, and this method is safe and feasible.
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Superior rectal artery embolization for bleeding Internal Hemorrhoids.
Techniques in coloproctology, 2020Co-Authors: Xinqiang Han, F. Xia, Gang Chen, Yuguo Sheng, Wenming Wang, Z. Wang, Mengpeng Zhao, Xuemin WangAbstract:BACKGROUND The aim of the present study was to evaluate clinical efficacy and safety of superselective embolization of the superior rectal artery (SRA) for the treatment of Internal hemorrhoidal bleeding. METHODS Patients with stage II and stage III Internal Hemorrhoids, treated by interventional embolization of the SRA in our department between January 2017 and June 2019 were retrospectively evaluated. All patients suffering from disabling chronic hematochezia and some with relative contraindications for operation (n = 17) or rejection of conventional hemorrhoidectomy (n = 15). Superselective SRA branch embolization was performed using gelatin sponge particles (350-560 μm) and metallic coils (2-3 mm). This treatment process was planned by a multidisciplinary team consisting of proctologist, gastroenterologist and radiologist. The surgical efficacy, postoperative complications and follow-up outcomes were observed. RESULTS There were 32 patients (18 males, mean age 52 ± 12 years, range: 22-78 years), 12 (37%) with stage II Hemorrhoids and 20 (63%) with stage III Hemorrhoids. Embolization was successful in all patients, and bleeding symptoms resolved in 27 (84.4%) patients. The remaining 5 (15.6%) patients underwent either stapled hemorrhoidopexy (n = 4) or sclerotherapy (n = 1). Some patients experienced different degrees of pain (n = 4;12.5%), low fever (n = 11;34.4%), and tenesmus (n = 17;53.1%), which all spontaneously regressed without further treatment. All patients were followed up for at least 1 year. There were no serious complications, such as infection, intestinal ischemia or massive hemorrhage. Four patients (14.8%) had rebleeding during the first months of follow-up. All patients with re-bleeding were successfully treated with Internal iliac arteriography and branch embolization and did not experience further bleeds after a minimum follow up 3 months follow-up. CONCLUSIONS The short-term efficacy of superselective SRA embolization for grade II-III Internal Hemorrhoids is good, and this method is safe and feasible.
S Kurata - One of the best experts on this subject based on the ideXlab platform.
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sclerosing therapy of Internal Hemorrhoids with a novel sclerosing agent comparison with ligation and excision
International Journal of Colorectal Disease, 2006Co-Authors: M Takano, Hideo Takamura, Haruo Ieda, Hideo Ohba, Junichi Iwadare, K. Matsuo, Y Masuda, T. Kanai, Y Hattori, S KurataAbstract:Patients with prolapsing Internal Hemorrhoids were treated with a novel sclerosing agent (OC-108), and the results were compared with surgery of ligation and excision. This study included 20 years or older patients with prolapsing Internal Hemorrhoids who visited ten medical institutions in Japan from October 2000 to October 2002. Investigation on surgery was also performed. Comparing OC-108 and surgery in patients with third- and fourth-degree Internal Hemorrhoids according to the Goligher’s classification, for which surgery has been generally indicated, at 28 days after treatment, the disappearance rate of prolapse was similar between OC-108 and surgery, 94% (75/80 patients) and 99% (84/85 patients), respectively. The 1-year recurrence rate was 16% (12/73 patients) in the OC-108 group, and this value was satisfactory because of its less invasive nature while it was more or less higher compared with 2% (2/81 patients) in the surgery group. The incidences of pain and bleeding were lower in the OC-108 group. OC-108 is a useful alternative treatment for Hemorrhoids.
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Sclerosing therapy of Internal Hemorrhoids with a novel sclerosing agent
International Journal of Colorectal Disease, 2006Co-Authors: M Takano, Hideo Takamura, Haruo Ieda, Hideo Ohba, Junichi Iwadare, K. Matsuo, Y Masuda, T. Kanai, Y Hattori, S KurataAbstract:Background and aims Patients with prolapsing Internal Hemorrhoids were treated with a novel sclerosing agent (OC-108), and the results were compared with surgery of ligation and excision. Patients and methods This study included 20 years or older patients with prolapsing Internal Hemorrhoids who visited ten medical institutions in Japan from October 2000 to October 2002. Investigation on surgery was also performed. Results Comparing OC-108 and surgery in patients with third- and fourth-degree Internal Hemorrhoids according to the Goligher’s classification, for which surgery has been generally indicated, at 28 days after treatment, the disappearance rate of prolapse was similar between OC-108 and surgery, 94% (75/80 patients) and 99% (84/85 patients), respectively. The 1-year recurrence rate was 16% (12/73 patients) in the OC-108 group, and this value was satisfactory because of its less invasive nature while it was more or less higher compared with 2% (2/81 patients) in the surgery group. The incidences of pain and bleeding were lower in the OC-108 group. Conclusions OC-108 is a useful alternative treatment for Hemorrhoids.
Rome Jutabha - One of the best experts on this subject based on the ideXlab platform.
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Randomized Prospective Study of Endoscopic Rubber Band Ligation Compared With Bipolar Coagulation for Chronically Bleeding Internal Hemorrhoids
The American journal of gastroenterology, 2009Co-Authors: Rome Jutabha, Dennis M. Jensen, Disaya ChavalitdhamrongAbstract:Randomized Prospective Study of Endoscopic Rubber Band Ligation Compared With Bipolar Coagulation for Chronically Bleeding Internal Hemorrhoids
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Endoscopy for Internal Hemorrhoids
Clinical Update, 2009Co-Authors: Rome JutabhaAbstract:Commentary: Rectal bleeding from Internal Hemorrhoids occurs commonly and is a frequent indication to visit a physician. Some patients may present with severe bleeding and anemia that require hospital admission and/or blood transfusion. Although medical therapy is usually effective for the majority of outpatients, some patients with frequent and/or severe bleeding may require therapy by endoscopy or surgery. In this Clinical Update, Dr Rome Jutabha reviews the indications and contraindications to endoscopic therapy of symptomatic Internal Hemorrhoids. In addition, Dr Jutabha discusses the relative risks and benefits of the various commercially available endoscopic treatments. – Richard C. K. Wong, MD, FASGE, Editor University Hospitals Case Medical Center, Cleveland, OH
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Current medical, anoscopic, endoscopic, and surgical treatments for bleeding Internal Hemorrhoids
Techniques in Gastrointestinal Endoscopy, 2001Co-Authors: Rome Jutabha, Chiaki Miura-jutabha, Dennis M. JensenAbstract:Internal Hemorrhoids are extremely common in adults and are the most frequent cause of self-limited hematochezia in ambulatory adults. Most patients with gastrointestinal bleeding from Internal Hemorrhoids have bright red blood per rectum that stops and is not associated with anemia. However, approximately 15% to 20% of patients with bleeding Internal Hemorrhoids have more severe bleeding that requires hospitalization and transfusion for severe anemia. In a CURE Hemostasis Research Group study of patients with severe hematochezia, Internal Hemorrhoids represented the second most common colorectal cause of severe hematochezia. Bleeding Internal Hemorrhoids are most effectively diagnosed by slotted anoscopy; however, in adults, other colonic lesions need to be excluded by colonoscopy. Endoscopic and anoscopic techniques for treatment of bleeding Internal Hemorrhoids include sclerotherapy, banding, direct current probe, infrared coagulator, bipolar probe, and heater probe. Endoscopic diagnosis, treatment techniques, results, and complications are presented in this report, and medical and surgical treatments are discussed.
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3638 Randomized, prospective trial of endoscopic rubber band ligation compared to bipolar coagulation for bleeding Internal Hemorrhoids
Gastrointestinal Endoscopy, 2000Co-Authors: Rome Jutabha, Dennis M. Jensen, Florence Lam, Mary Ellen Jensen, Gwen AlofaituliAbstract:Internal Hemorrhoids are the most common cause of recurrent hematochezia (BRB) in ambulatory adults.We compared the efficacy and safety of bipolar coagulation (BICAP) with endoscopic rubber band ligation (RBL) for hemostasis of bleeding Internal Hemorrhoids (IH). Methods: This was a randomized prospective trial of patients with IH bleeding, documented by anoscopy and colonoscopy, who continued to have BRB inspite of at least 60 days of medical therapy (bulk agents, suppositories, stool softeners). Exclusions were rectal fissures, AIDS, inflammatory disease, or incidental IH and another source of bleeding found. After grading of IH with a slotted anoscope, patients were randomized to anoscopic treatment with BICAP (16W, 1 secs pulses) or RBL (via videoendoscope) and treatments were applied above the dentate line on 3 IH segments/session. Endpoints were control of BRB, severe complication or refusal to continue the treatment, and reduction of all IH segments to grade ≤ 1 in ≥ 3 treatment sessions. Failures were crossed over to other therapies. Results: 37 patients with mean age of 51 and chronic IH symptoms for ≤ 9 yrs were treated, 18 with BICAP and 19 with RBL. See table for results. Significantly fewer treatment sessions with RBL were required for control of BRB. Conclusions: For patients with chronic Internal Hemorrhoids and recurrent hematochezia unresponsive to medical therapy: 1) bipolar coagulation and rubber band ligation were similar in efficacy and safety for hemostasis, 2) non-significantly more bipolar than RBL patients had treatment failures and were crossed-over to other treatments, and 3) RBL required significantly fewer sessions to control hematochezia and reduce the size of Internal Hemorrhoids than bipolar coagulation. Funded in part by NIH DK41301 (Human Studies Core), American Digestive Health Foundation Endoscopy Research Award, and NIH-GCRC M01-RR008658.
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Prospective randomized comparative study of bipolar electrocoagulation versus heater probe for treatment of chronically bleeding Internal Hemorrhoids
Gastrointestinal endoscopy, 1997Co-Authors: Dennis M. Jensen, Rome Jutabha, Mary Ellen Jensen, Gordon V. Ohning, Gustavo A. Machicado, S Cheng, Jeffrey Gornbein, Ken Hirabayashi, Gayle M. RandallAbstract:Abstract Background : Our purpose was to compare the efficacy, complications, failure rates, and crossovers of heater and bipolar probe treatments of chronically bleeding Internal Hemorrhoids. Methods : Eighty-one patients (31 female, 50 male) with mean age of 53 years had large (grade 2 to 3) Internal Hemorrhoids with bleeding for a mean of 12 years, had failed medical management, and were randomized in a prospective study of anoscopic treatments to heater versus bipolar probes. Failure was defined as a major complication or failure to reduce the size of all Internal Hemorrhoids with three or more treatments. Results : With similar background variables and no difference in treatment times, rectal bleeding and other symptoms were controlled in a shorter time with the heater probe than with the bipolar probe (77 versus 121 days). Five complications (fissures, bleeding, or rectal spasm) occurred with the bipolar probe, and two occurred with the heater probe. The heater probe caused more pain during treatments but had significantly fewer failures and crossovers. Conclusions : For patients who had failed medical management of chronically bleeding Internal Hemorrhoids, the techniques and complications of heater and bipolar probes were similar, but pain was more common, failures and crossovers were less frequent, and the time to symptom relief was shorter with the heater probe than with the bipolar probe. (Gastrointest Endosc 1997;46:435-43.)
Richard A Malthaner - One of the best experts on this subject based on the ideXlab platform.
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Stapled Hemorrhoidopexy Is Associated with a Higher Long-Term Recurrence Rate of Internal Hemorrhoids Compared with Conventional Excisional Hemorrhoid Surgery
Diseases of the Colon & Rectum, 2007Co-Authors: Shiva Jayaraman, Patrick H D Colquhoun, Richard A MalthanerAbstract:Purpose The purpose of this systematic review was to compare the long-term results of stapled hemorrhoidopexy with conventional excisional hemorrhoidectomy in patients with Internal Hemorrhoids. Methods A systematic review of all randomized, controlled trials comparing stapled hemorrhoidopexy and conventional hemorrhoidectomy with long-term results was performed by using the Cochrane methodology. The minimum follow-up was six months. Primary outcomes were hemorrhoid recurrence, hemorrhoid symptom recurrence, complications, and pain. Results Twelve trials were included. Follow-up varied from six months to four years. Conventional hemorrhoidectomy was more effective in preventing long-term recurrence of Hemorrhoids (odds ratio (OR), 3.85; 95 percent confidence interval (CI), 1.47–10.07; P
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stapled hemorrhoidopexy is associated with a higher long term recurrence rate of Internal Hemorrhoids compared with conventional excisional hemorrhoid surgery
Diseases of The Colon & Rectum, 2007Co-Authors: Shiva Jayaraman, Patrick H D Colquhoun, Richard A MalthanerAbstract:PURPOSE: The purpose of this systematic review was to compare the long-term results of stapled hemorrhoidopexy with conventional excisional hemorrhoidectomy in patients with Internal Hemorrhoids. METHODS: A systematic review of all randomized, controlled trials comparing stapled hemorrhoidopexy and conventional hemorrhoidectomy with long-term results was performed by using the Cochrane methodology. The minimum follow-up was six months. Primary outcomes were hemorrhoid recurrence, hemorrhoid symptom recurrence, complications, and pain. RESULTS: Twelve trials were included. Follow-up varied from six months to four years. Conventional hemorrhoidectomy was more effective in preventing long-term recurrence of Hemorrhoids (odds ratio (OR), 3.85; 95 percent confidence interval (CI), 1.47-10.07; P<0.006). Conventional hemorrhoidectomy also prevents Hemorrhoids in studies with follow-up of one year or more (OR, 3.6; 95 percent CI, 1.24-10.49; P<0.02). Conventional hemorrhoidectomy is superior in preventing the symptom of prolapse (OR, 2.96; 95 percent CI, 1.33-6.58; P< 0.008). Conventional hemorrhoidectomy also is more effective at preventing prolapse in studies with follow-up of one year or more (OR, 2.68; 95 percent CI, 0.98-7.34; P<0.05). Nonsignificant trends in favor of conventional hemorrhoidectomy were seen in the proportion of asymptomatic patients, bleeding, soiling/difficultly with hygiene/incontinence, the presence of perianal skin tags, and the need for further surgery. Nonsignificant trends in favor of stapled hemorrhoidopexy were seen in pain, pruritus ani, and symptoms of anal obstruction/stenosis. CONCLUSIONS: Conventional hemorrhoidectomy is superior to stapled hemorrhoidopexy for prevention of postoperative recurrence of Internal Hemorrhoids. Fewer patients who received conventional hemorrhoidectomy complained of hemorrhoidal prolapse in long-term follow-up compared with stapled hemorrhoidopexy.
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stapled hemorrhoidopexy is associated with a higher long term recurrence rate of Internal Hemorrhoids compared with conventional excisional hemorrhoid surgery
Diseases of The Colon & Rectum, 2007Co-Authors: Shiva Jayaraman, Patrick H D Colquhoun, Richard A MalthanerAbstract:PURPOSE: The purpose of this systematic review was to compare the long-term results of stapled hemorrhoidopexy with conventional excisional hemorrhoidectomy in patients with Internal Hemorrhoids. METHODS: A systematic review of all randomized, controlled trials comparing stapled hemorrhoidopexy and conventional hemorrhoidectomy with long-term results was performed by using the Cochrane methodology. The minimum follow-up was six months. Primary outcomes were hemorrhoid recurrence, hemorrhoid symptom recurrence, complications, and pain. RESULTS: Twelve trials were included. Follow-up varied from six months to four years. Conventional hemorrhoidectomy was more effective in preventing long-term recurrence of Hemorrhoids (odds ratio (OR), 3.85; 95 percent confidence interval (CI), 1.47-10.07; P<0.006). Conventional hemorrhoidectomy also prevents Hemorrhoids in studies with follow-up of one year or more (OR, 3.6; 95 percent CI, 1.24-10.49; P<0.02). Conventional hemorrhoidectomy is superior in preventing the symptom of prolapse (OR, 2.96; 95 percent CI, 1.33-6.58; P< 0.008). Conventional hemorrhoidectomy also is more effective at preventing prolapse in studies with follow-up of one year or more (OR, 2.68; 95 percent CI, 0.98-7.34; P<0.05). Nonsignificant trends in favor of conventional hemorrhoidectomy were seen in the proportion of asymptomatic patients, bleeding, soiling/difficultly with hygiene/incontinence, the presence of perianal skin tags, and the need for further surgery. Nonsignificant trends in favor of stapled hemorrhoidopexy were seen in pain, pruritus ani, and symptoms of anal obstruction/stenosis. CONCLUSIONS: Conventional hemorrhoidectomy is superior to stapled hemorrhoidopexy for prevention of postoperative recurrence of Internal Hemorrhoids. Fewer patients who received conventional hemorrhoidectomy complained of hemorrhoidal prolapse in long-term follow-up compared with stapled hemorrhoidopexy.