Chen Yang-Tao, Wang Zhao-Chu, Xie Ya-Meng, Wang Xun, Huang Juan, Wang Jing
Department of Anorectal Surgery, The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, 350004, China.
Department of Anorectal Surgery, The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, 350004, China.
Asian J Surg. 2024 Jul 15. doi: 10.1016/j.asjsur.2024.06.006.
Stapled hemorrhoidopexy has been used for years to treat hemorrhoids. Despite numerous systematic reviews and meta-analyses on the topic, inconsistent conclusions have left people uncertain about its effectiveness and raised doubts about the quality of these reviews.In order to provide reliable evidence for clinical practice, it is crucial to conduct an overview to assess the quality of MAs/SRs regarding the efficacy and complications of SH.A comprehensive search was performed across seven databases to identify MAs/SRs on the efficacy and complications of SH from inception to October 2023. The selected MAs/SRs were then assessed using three well-established tools: AMSTAR-2, PRISMA 2020and GRADE. These assessments provide a robust evaluation of the quality and reliability of the included MAs/SRs.We removed overlapping randomized controlled trials (RCTs) and conducted a new meta-analysis of the outcomes. The overview included 23 meta-analyses.In AMSTAR-2, three reviews were deemed moderate quality, nine reviews were classified as low quality, and eleven reviews were evaluated as critically low quality.In PRISMA 2020,certain deficiencies were exhibited, such as abstracts (0/23:0 %),final retrieval date (0/23:0 %), sensitivity analysis (6/23:26.09 %),publication bias assessment (11/23:47.83 %), the quality of evidence (2/23:8.70 %) and so on.In GRADE,twenty-six items were rated as moderate quality (27.96 %),forty-one items were rated as low quality (44.09 %) and twenty-six items were rated as critically low quality (27.96 %).SH has been found to be an effective intervention for reducing postoperative pain, shortening procedure time, and promoting wound healing. The re-analysis indicated that SH can reduce postoperative pain in hemorrhoid patients (odds ratio = 0.28, 95 % confidence interval [0.15,0.55], p = 0.0002; I2 = 74 %, p < 0.00001). But SH is associated with a higher risk of postoperative bleeding and recurrence of prolapse.Given that the reviews included in this overview were rated as low quality, caution should be exercised when interpreting the findings.
吻合器痔上黏膜环切术多年来一直用于治疗痔疮。尽管针对该主题进行了大量系统评价和荟萃分析，但结论不一致，人们对其有效性不确定，并对这些评价的质量产生怀疑。为了为临床实践提供可靠证据，进行一项概述以评估关于吻合器痔上黏膜环切术疗效和并发症的系统评价/荟萃分析的质量至关重要。对七个数据库进行全面检索，以识别从开始到2023年10月关于吻合器痔上黏膜环切术疗效和并发症的系统评价/荟萃分析。然后使用三种成熟的工具：AMSTAR-2、PRISMA 2020和GRADE对所选的系统评价/荟萃分析进行评估。这些评估对纳入的系统评价/荟萃分析的质量和可靠性提供了有力的评价。我们去除了重叠的随机对照试验，并对结果进行了新的荟萃分析。该概述包括23项荟萃分析。在AMSTAR-2中，三项评价被认为质量中等，九项评价被归类为低质量，十一项评价被评估为极低质量。在PRISMA 2020中，存在某些缺陷，如摘要（0/23：0%）、最终检索日期（0/23：0%）、敏感性分析（6/23：26.09%）、发表偏倚评估（11/23：47.83%）、证据质量（2/23：8.70%）等。在GRADE中，26项被评为中等质量（27.96%），41项被评为低质量（44.09%），26项被评为极低质量（27.96%）。已发现吻合器痔上黏膜环切术是减轻术后疼痛、缩短手术时间和促进伤口愈合的有效干预措施。重新分析表明，吻合器痔上黏膜环切术可减轻痔疮患者的术后疼痛（优势比=0.28，95%置信区间[0.15，0.55]，p=0.0002；I2=74%，p<0.00001）。但吻合器痔上黏膜环切术与术后出血和脱垂复发的较高风险相关。鉴于本概述中纳入的评价被评为低质量，在解释研究结果时应谨慎。
