Residual skin tags following procedure for prolapse and hemorrhoids should be differentiated from recurrence GAO Xian-hua*, FU Chuan-gang, NABIEU Paul Fallah-wandalachi. *Department of Colorectal Surgery of Changhai Hospital, the Second Military Medical University, Shanghai 200433, China Corresponding author: FU Chuan-gang, E-mail: fugang416@126.com. Abstract Objective To explore the definition of recurrence after PPH. Methods Related Chinese and English literature admitted between January 2001 and October 2008 was collected with multi-methods. Meta-analysis was used to compare the incidence of recurrence and residual skin tag of PPH vs. CH. Results In China, 13.94% of hemorrhoids had residual skin tag after PPH. The mean recurrence rate after PPH was 3.23%, ranging from 0.40% to 26.44%. The Meta-analysis of PPH vs. CH of Chinese studies showed that PPH had a significantly lower recurrence rate (13 studies, OR 0.27, 95%CI (0.17，0.42), P<0.00001), and a higher incidence of skin tag with no significance (6 studies, OR 3.42, 95%CI (0.49，24.04), P=0.22). The Meta-analysis of PPH vs. CH of English studies showed that PPH had a significantly higher recurrence rate (17 studies, 636 patients in PPH group vs. 625 patients in CH group; OR 2.96, 95%CI (1.57, 5.56); P=0.0008) and a significantly higher incidence of residual skin tag (8 studies, 297 patients in PPH group vs. 289 patients in CH group; OR 1.88, 95%CI (1.15, 3.05); P=0.01). However, the recurrence of prolapse was stated to be ascertained by anorectal examination in only 6 studies. The Meta-analysis of the 6 studies showed that PPH was not associated with a higher recurrence (6studies, 230 patients in PPH group vs. 220 patients in CH group; OR 1.87, 95%CI (0.70, 5.00); P=0.22). Conclusion PPH is not associated with a higher recurrence rate but a higher incidence of skin tag compared with CH. The reported high recurrence rates are probably caused by the improper inclusion of residual skin tag into recurrence. Anorectal examination should be performed by surgeons to differentiate residual skin tag from recurrence.