Topical versus oral metronidazole for post-haemorrhoidectomy pain: A systematic review and meta-analysis of randomized controlled trials

Koskenvuo L, Lunkka P, Varpe P, Hyoty M, Satokari R, Haapamaki C et al.

JAMA Surg 2024; 159: 606-614.  

In this study that included 565 procedures, the addition of oral antibiotics reduced the rate of surgical site infections (odds ratio 0.45, 95 per cent confidence interval 0.27 to 0.77) and anastomotic leaks (0.39, 0.21 to 0.72).

Comment: The authors suggest this should be the standard of care.

Traeger L, Bedrikovetski S, Fitzsimmons T, Nguyen T-M, Moore JW, Lewis M et al.

Br J Surg 2024; 111: znae121.

Pyridostigmine 60mg given orally twice daily after surgery reduced the duration of ileus by one day, measured by the GI-2 tool (P=0.015) in this study that included 130 patients, but did not affect the duration of hospital stay.

Comment: Apart from speeding return of bowel function, it is not clear what the benefit is overall.

Heemskerk SC, Dirksen CD, van Kuijk SMJ, Benninga MA, Baeten C, Masclee AAM et al.

Ann Surg 2024; 279: 746-754.

Sacral neuromodulation improved the number of patients able to defaecate on average at least three times a week (53.5 versus 3.8 per cent in controls, P=0.003), and improved their quality of life (P<0.001),  in this study that included 67 patients followed for six months.

Comment: Promising, minimally invasive treatment.