|
Daily Medical Update
Hemorrhoids and fissures
Saturday, August 15, 2026
|
🔬 Practice-Changing Findings
Evidence from RCTs and meta-analyses published in the
last 12 months.
|
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP (2026) - Meta-Analysis
Key Findings
- Diode laser haemorrhoidoplasty reduced intraoperative blood loss versus conventional techniques (mean difference −20.19 mL; 95% CI −28.32 to −12.07; p < 0.001).
- Laser treatment also reduced postoperative bleeding (OR 0.32; 95% CI 0.11–0.93) and postoperative pain immediately and at one week.
📋 Practice Implication: For suitable symptomatic haemorrhoids, laser haemorrhoidoplasty may offer less perioperative morbidity and pain than conventional excision, although procedure selection should remain individualized.
|
International journal of colorectal disease (2026) - Meta-Analysis
Key Findings
- Metronidazole lowered postoperative pain scores on days 1, 2, 3, and 7 compared with placebo, including a day-7 mean difference of −1.72 (95% CI −2.27 to −1.18; p < 0.00001).
- Topical metronidazole produced lower day-3 pain scores than oral administration (difference 1.38; 95% CI 0.44–2.32; p = 0.004).
📋 Practice Implication: Metronidazole is a plausible adjunct to multimodal analgesia after excisional haemorrhoidectomy, with topical delivery showing the strongest later postoperative pain signal in this review.
|
Updates in surgery (2025) - Meta-Analysis
Key Findings
- Operative treatment lowered recurrence compared with conservative management (RR 0.49; 95% CI 0.26–0.91; p < 0.05).
- Bleeding risk did not differ significantly between operative and nonoperative groups (RR 0.96; 95% CI 0.27–3.44; p = 0.95).
📋 Practice Implication: When treating a thrombosed external haemorrhoid, clinicians can frame surgery as a recurrence-reducing option without a demonstrated bleeding disadvantage, while still weighing patient preference and procedural burden.
|
World journal of surgery (2026) - Meta-Analysis
Key Findings
- Routine prophylactic antibiotics did not significantly reduce surgical-site infections in elective anorectal surgery.
- Other postoperative complication rates were also not significantly reduced with prophylactic antibiotics.
📋 Practice Implication: Routine antibiotic prophylaxis may be avoidable for many elective anorectal procedures, supporting procedure- and patient-specific prescribing and antimicrobial stewardship.
|
International journal of colorectal disease (2026) - Meta-Analysis
Key Findings
- Stapled haemorrhoidopexy had higher overall long-term recurrence than conventional haemorrhoidectomy (RR 1.56; 95% CI 1.00–2.44; I² = 48%).
- Prolapse-related recurrence was more frequent after stapled haemorrhoidopexy (RR 3.28; 95% CI 1.49–7.25), while reintervention, persistent pain, functional impairment, and quality of life did not differ significantly.
📋 Practice Implication: Stapled haemorrhoidopexy may preserve early recovery advantages but should be presented as less durable anatomically than conventional haemorrhoidectomy, particularly for prolapse control.
|
|
💡
Summary
The validated first-pass pool contains four candidates with clinical significance at least 7, so the fifth finding uses the next-highest candidate (significance 6). The research pool was sparse, and search terms may need to be broadened; the studies nevertheless provide practical evidence on operative choice, postoperative analgesia, antibiotic stewardship, and long-term durability.
|
|