An explanation of PROSPECT methodology and Working Group processes can be found at the following link: PROSPECT methodology primer
For the haemorrhoidectomy review, the Subgroup members were:
Dr Tarik Sammour1
Dr Ahmed W H Barazanchi2
Professor Andrew G Hill3,4 (former PROSPECT Working Group Member)
Haemorrhoidectomy literature search: review update
All included studies were assessed for quality of reporting of methodology and results, as explained below. The study quality assessments are summarised here: Methodological quality summary and LoE
Additional study quality assessment: including an assessment of how closely the study report meets the requirements of the CONSORT statement
No meta-analyses were performed due to a limited number of studies of homogeneous design that reported similar outcome measures. Therefore, the procedure-specific evidence was only assessed qualitatively
Transferable evidence from procedures other than excisional haemorrhoidectomy was not used in the current review, but was part of earlier PROSPECT methodology used in the last review (Joshi 2010)
Information on clinical practice was taken into account to ensure that the recommendations had clinical validity
The recommendations were formulated by the PROSPECT Working Group, using the Delphi method to collate rounds of individual comments on the evidence and draft recommendations, followed by round-table discussion, and then further Delphi rounds, to achieve final consensus
Recommendations for optimal pain relief are graded A–D according to the overall level of evidence, as determined by the quality of studies included, consistency of evidence and source of evidence: Relationship between quality and source of evidence, levels of evidence and grades of recommendation
Major limitations were the variability in the methodological quality of the randomized trials and that quantitative analyses could not be performed as a result of heterogeneity in study design and outcome measures.
The recommendations for individual techniques are based on specific interventional studies, while no firm evidence is available on combination of techniques. Further research is needed in the area of multimodal analgesia to support its use.
The AGREE II instrument (Brouwers 2010) is used internationally to assess the methodological rigour and transparency of practice guidelines. As far as possible, the methodology of the PROSPECT Haemorrhoidectomy review meets the requirements of ‘Domain 3: Rigour of development’ of the AGREE II instrument: