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- Title
The role of the Rafaelo procedure in the management of hemorrhoidal disease: a systematic review and meta-analysis.
- Authors
Christodoulou, Prokopis; Baloyiannis, Ioannis; Perivoliotis, Konstantinos; Symeonidis, Dimitrios; Tzovaras, George
- Abstract
Background: The aim of this study was to summarize the current evidence regarding the role of the Rafaelo procedure in the management of hemorrhoidal disease (HD). Methods: This study was based on the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was performed (Medline, Scopus, CENTRAL, and Web of Science) from inception to 25/09/2022. Grey literature databases were also reviewed. The primary endpoint was the pooled complications rate of the Rafaelo procedure in patients with HD. Secondary endpoints included short- (bleeding, pain, thrombosis, necrosis, urinary retention, fever, oedema, anal fissure, and readmission) and long-term (stenosis, meteorism, constipation, anal tags, anal hyposensibility, reoperation, and recurrence) postoperative complication rates. Both prospective and retrospective studies were considered. Quality evaluation was performed via the ROBINS-I tool. Certainty of Evidence was based on the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Results: Overall, 6 non-randomized studies and 327 patients were included. The overall complication rate was 17.6% (95% CI 8.8–26.3%). Short-term complications were bleeding (7.5%, 95% CI 2.5–12.5%), thrombosis (2.2%, 95% CI 0.4–4.8%), and pain (1.6%, 95% CI 0.2–3.3%). Reoperation and recurrence rates were 1.8% (95% CI 0.3–3.4%) and 4.8% (95% CI 1.2–8.4%), respectively. A significant improvement in the presenting symptoms was noted. Method approval and patient satisfaction rates were 89.1% (95% CI 81.7–96.6%) and 95% (95% CI 89.8–100%), correspondingly. Overall CoE was "Very Low". Conclusions: Further randomized controlled trials are required to delineate the exact role of the Rafaelo procedure in HD.
- Subjects
DISEASE management; PATIENT satisfaction; RANDOMIZED controlled trials; GREY literature; RETENTION of urine
- Publication
Techniques in Coloproctology, 2023, Vol 27, Issue 2, p103
- ISSN
1123-6337
- Publication type
Article
- DOI
10.1007/s10151-022-02730-w