The prevalence of incontinence after excisional hemorrhoidectomy and stapled hemorrhoidopexy: A systematic review and meta-analysis

James Z Jin; Velia Men; Praharsh Bahl; Harshitha Penneru; Robin Yang; Niket Shah; Andrew G Hill

doi:10.1016/j.surg.2024.109139

The prevalence of incontinence after excisional hemorrhoidectomy and stapled hemorrhoidopexy: A systematic review and meta-analysis

Surgery. 2025 Jan 23:180:109139. doi: 10.1016/j.surg.2024.109139. Online ahead of print.

Authors

James Z Jin¹, Velia Men², Praharsh Bahl¹, Harshitha Penneru³, Robin Yang³, Niket Shah¹, Andrew G Hill¹

Affiliations

¹ South Auckland Clinical Campus, The University of Auckland, Auckland, New Zealand.
² Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand. Electronic address: [email protected].
³ Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand.

PMID: 39854786
DOI: 10.1016/j.surg.2024.109139

Abstract

Background: Excisional hemorrhoidectomy and stapled hemorrhoidopexy are 2 common procedures for treating symptomatic hemorrhoids. However, concerns persist regarding the risk of postoperative complications and their unclear prevalence in the literature. This systematic review aims to evaluate and compare the prevalence of incontinence after stapled hemorrhoidopexy and excisional hemorrhoidectomy.

Methods: A systematic search of Medline, EMBASE, and CENTRAL identified studies published in the past 25 years that reported incontinence after excisional treatments for hemorrhoids. Primary outcomes included early (<3 months) and late (≥3 months) fecal incontinence. Secondary outcomes included postoperative bleeding, urinary retention, and recurrence. Single-arm meta-analyses of proportions were performed using R with meta-regression.

Results: In total, 139 studies were included in the meta-analysis, including 68 randomized controlled trials with 8,445 participants and 71 observational studies with 22,687 participants. Early incontinence rates were 5.32% in randomized controlled trials (95% confidence interval, 2.74-8.51%) and 1.03% in nonrandomized controlled trials (95% confidence interval, 0.28-2.09%). Late incontinence rates were 2.48% in randomized controlled trials (95% confidence interval, 1.09-4.25%) and 1.44% in nonrandomized controlled trials (95% confidence interval, 0.71-2.37%). There was no significant difference in the risk of incontinence or other postoperative complications between stapled hemorrhoidopexy and excisional hemorrhoidectomy, both in randomized controlled trials and nonrandomized controlled trials.

Conclusion: Incontinence after stapled hemorrhoidopexy and excisional hemorrhoidectomy is uncommon, and there appears to be no significant difference in risk between the 2 procedures. However, considerable heterogeneity was observed, likely the result of differences in assessment and reporting methods across studies. Future research should standardize definitions and methods for assessing incontinence and include preoperative assessments to more accurately define the risks of complications associated with hemorrhoid surgery.