Seven trials (five RCTs and two controlled trials) were included in the review (712 participants). The Jadad score of trials ranged from 0 to 3. The SEQES score of trials ranged from 29 to 40, which indicated that the quality of trials ranged from moderate to high.
Compared with non surgical interventions, surgical interventions were associated with a significant improvement at six months for self-reported functional status (WMD -0.35, 95% CI -0.47 to -0.22; four RCTs) and self-reported symptom severity (WMD -0.43, 95% CI -0.57 to -0.29; four RCTs).
Compared with non surgical interventions, surgical interventions were associated with a significant improvement at 12 months for self-reported functional status (WMD -0.35, 95% CI -0.55 to -0.15; two RCTs) and self-reported symptom severity (WMD -0.37, 95% CI -0.56 to -0.19; two RCTs). There were no significant differences for both outcomes between the treatment groups at three months.
Compared with non surgical interventions, surgical interventions were significantly associated with an increased rate of complication (RR 2.03, 95% CI 1.28 to 3.22; six RCTs). The most commonly reported complications in the surgical group were skin irritation and wound haematoma.
Significant heterogeneity (Ι²>80%) was only observed on the outcomes at three months.