EP-270 A meta-analysis of the randomized controlled trials exploring the effectiveness of oral versus topical use of metronidazole following excisional haemorrhoidectomy

Abstract

Abstract Objective Metronidazole has been proven an effective proctological analgesic and antimicrobial agent in patients undergoing excisional haemorrhoidectomy. The aim of this article is to evaluate the efficacy of topical versus oral administration of metronidazole to in controlling the post-operative pain following excisional haemorrhoidectomy. Method A comprehensive systematic search was undertaken with the help of local librarian and relevant published randomized controlled trials (RCT) were shortlisted according to the inclusion criteria. Summated outcomes of the poste-operative pain on day one and day seven were analyzed using the principles of meta-analysis on RevMan 5 statistical software. Result Two RCTs on 286 patients undergoing excisional haemorrhoidectomy were included in this review. There were 143 patients in topical metronidazole group and same number of patients were in oral metronidazole group. the antibiotics group (AG) and 877 patients in the no-antibiotics group (NAG). In the random effects model analysis, day 1 [standardized mean difference -0.06, 95% CI (-0.30–0.17), z = 0.55, p = 0.59] and day 7 [standardized mean difference 0.09, 95% CI (-1.29–1.47), z = 0.12, p = 0.90] post-operative pain score was statistically similar in both groups. There was significant heterogeneity [Tau2 = 0.96, chi2 = 32.49, df = 1; p = 0.00001, I2= 97%] between included trials. Conclusion Both topical and oral administration of metronidazole as post-haemorrhoidectomy proctological analgesic is an effective modality. However, this evidence is based upon the findings of two RCTs on 286 patients and should be taken cautiously. A major, high quality RCT is mandatory to validate these findings.