AB179. SOH25_AB_145. Metronidazole is an effective method of analgesia following haemorrhoidectomy: a systematic review and meta-analysis
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AB179. SOH25_AB_145. Metronidazole is an effective method of analgesia following haemorrhoidectomy: a systematic review and meta-analysis

Aaron O. Mahony, Carolyn Cullinane, Benjamin Mac Curtain, Colin Peirce, Eoghan Condon, John Calvin Coffey, Christina Fleming

Department of Surgery, University Hospital Limerick, Limerick, Ireland


Background: Haemorrhoids are one of the most frequently encountered benign anorectal conditions that negatively impact patients’ quality of life. Excisional haemorrhoidectomy (closed or open) is a surgical procedure reserved for the treatment of third- and fourth-degree haemorrhoids with considerable post-procedure pain reported. This study aims to clarify the association between post-operative metronidazole use (both oral and topical) and post haemorrhoidectomy pain scores through systematic review and meta-analysis of randomised controlled trials (RCTs).

Methods: This study was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Prospective registration was performed on PROSPERO (CRD42024580928). A systematic review was performed for RCTs reporting post-haemorrhoidectomy pain scores between patients who received metronidazole and patients who received placebo. Meta-analysis was performed using RevMan (version 7.12).

Results: Fifteen RCTs, including 1,147 participants, were eligible for inclusion. Metronidazole administration was associated with significantly lower post-operative visual analogue scores (VAS) on day 1 (−1.18, P<1.00e−05), day 2 (−1.15, P=0.003), day 3 (−0.86, P<1.00e−05) and day 7 with a mean pain score difference of −1.72 (95% confidence interval: −2.27 to −1.18) (P<1.00e−05). There was no significant difference in VAS scores 3 days post-haemorrhoidectomy between the groups that received oral and topical metronidazole.

Conclusions: This review synthesises the best available evidence to support the use of metronidazole to reduce pain after excisional haemorrhoidectomy. While both oral and topical forms appear to be beneficial, there was no statistically significant difference between either route of administration.

Keywords: Analgesia; haemorrhoidectomy; metronidazole; pain; visual analogue scale (VAS)


Acknowledgments

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Footnote

Funding: None.

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.


doi: 10.21037/map-25-ab179
Cite this abstract as: Mahony AO, Cullinane C, Mac Curtain B, Peirce C, Condon E, Coffey JC, Fleming C. AB179. SOH25_AB_145. Metronidazole is an effective method of analgesia following haemorrhoidectomy: a systematic review and meta-analysis. Mesentery Peritoneum 2025;9:AB179.

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