A prospective and comparative study between stapled hemorrhoidopexy and hemorrhoidal artery ligation with mucopexy

Béliard, Anne-Sophie; Labbé, F.; Faucal, D. de; Fabreguette, J.-M.; Pouderoux, Philippe; Borie, F.

doi:10.1016/j.jviscsurg.2014.03.009

Cited by 18 publications

(6 citation statements)

References 28 publications

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“…However, these signi cant bleeding episodes may even be recurrent and cause distress to both the patient and the surgeon [31] Here only a small percentage (2.63%) of re-bleeding patients needed a second procedure or operation to arrest the bleeding; i.e., two cases, one per group were re-admitted. These results are comparable to studies on postoperative bleeding in LHP in other centres [1,5,11,33].…”

Section: Discussionsupporting

confidence: 89%

Comparison of Post-operative Bleeding Incidence in Laser Hemorrhoidoplasty with and without Hemorrhoidal Artery Ligation: A Double-Blinded Randomized Controlled Trial

Lim

Rajandram

Roslani

2022

Preprint

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Purpose: To investigate the effectiveness of hemorrhoidal artery ligation supplementation in reducing the incidence of post laser hemorrhoidoplasty bleeding.Method: This was a double-blind, randomized controlled trial comparing post-operative bleeding incidence in patients undergoing laser hemorrhoidoplasty (LHP) only versus LHP with hemorrhoidal artery ligation (HAL). Outcome measures included post-operative bleeding and its severity (i.e. verbal rating scale and Clavien-Dindo classification), presence of perianal swelling and pain score (visual analog score) at 1-day, 1-week and 6-weeks post-operatively. Statistical tests were performed and a value of P<0.05 was considered significant. Results: Seventy-six patients were randomized. There was no difference in median operating time. The bleeding incidence was highest at 1-week post-operatively (17.1%), and decreased to 1.3% at 6-weeks. There was no significant difference in bleeding incidence between both groups at any of the measured timepoints (P>0.05). Severity of bleeding and incidence of post-operative perianal swelling were similar in both groups (P>0.05). There was no difference in median pain scores. Conclusion: Supplementation of HAL to LHP does not reduce the post-operative bleeding incidence. LHP is sufficient as a stand-alone procedure for treating haemorrhoids.Trial Registration:National Registration Number is NMRR-15-1112-24065 (IIR). The trial start date was 1st January 2015 with the ClinicalTrials.gov identifier and registration number as NCT04667169.

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Section: Discussionsupporting

confidence: 89%

Comparison of Post-operative Bleeding Incidence in Laser Hemorrhoidoplasty with and without Hemorrhoidal Artery Ligation: A Double-Blinded Randomized Controlled Trial

Lim

Rajandram

Roslani

2022

Preprint

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“…However, these significant bleeding episodes may even be recurrent and cause distress to both the patient and the surgeon [ 31 ] Here only a small percentage (2.63%) of re-bleeding patients needed a second procedure or operation to arrest the bleeding; i.e., two cases, one per group were re-admitted. These results are comparable to studies on post-operative bleeding in LHP in other centres [ 1 , 5 , 11 , 33 ].…”

Section: Discussionsupporting

confidence: 88%

Comparison of post-operative bleeding incidence in laser hemorrhoidoplasty with and without hemorrhoidal artery ligation: a double-blinded randomized controlled trial

2022

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Introduction The effectiveness of hemorrhoidal artery ligation supplementation in reducing the incidence of post laser hemorrhoidoplasty bleeding has not been investigated. Methods This was a double-blind, randomized controlled trial comparing post-operative bleeding incidence in patients undergoing laser hemorrhoidoplasty (LHP) only versus LHP with hemorrhoidal artery ligation (HAL). Outcome measures included post-operative bleeding and its severity (i.e. verbal rating scale and Clavien-Dindo classification), presence of perianal swelling and pain score (visual analog score) at 1-day, 1-week and 6-weeks post-operatively. Statistical tests were performed and a value of P < 0.05 was considered significant. Results Seventy-six patients were randomized. There was no difference in median operating time. The bleeding incidence was highest at 1-week post-operatively (17.1%), and decreased to 1.3% at 6-weeks. There was no significant difference in bleeding incidence between both groups at any of the measured timepoints (P > 0.05). Severity of bleeding and incidence of post-operative perianal swelling were similar in both groups (P > 0.05). There was no difference in median pain scores. Conclusion Supplementation of HAL to LHP does not reduce the post-operative bleeding incidence. LHP is sufficient as a stand-alone procedure for treating haemorrhoids. Trial registration: National Registration Number is NMRR-15-1112-24065 (IIR). The trial start date was 1st January 2015 with the ClinicalTrials.gov identifier and registration number as NCT04667169.

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“…In DGH, shorter work resumption and higher patient satisfaction, but not significantly. Similar recurrence rates needing additional surgery (4.2 vs. 4.2%, p = 0.55) at 1-year follow-up Béliard et al [ 23 ] Total: 54 (grade 2) PPH In DGHL group, shorter disability for work (4.4 ± 6.6 vs. 18.6 ± 13.7, p < 0.001), significantly more improved prolapse, similar improvement of bleeding, significant improvement of tenesmus at 3 months, similar incontinence score, lower pain level at 1 month, significantly higher patient satisfaction, higher recurrence rate, similar reoperation rate PPH procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy); HL hemorrhoidal artery ligation (without Doppler guidance); DGHL Doppler-guided hemorrhoidal artery ligation; MMH Milligan–Morgan hemorrhoidectomy; QoL quality of life …”

Section: Discussionmentioning

confidence: 73%

“…In four studies, THD was compared to hemorrhoidectomy (in 2 with the Milligan–Morgan procedure [ 19 , 20 ], in 1 with the Ferguson procedure [ 17 , 18 ], and 1 with hemorrhoidectomy using LigaSure™ [ 16 ]. In four other studies [ 11 , 13 , 15 , 23 ], THD was compared to stapled hemorrhoidopexy.…”

Section: Discussionmentioning

confidence: 99%

Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: a single-center study on 1000 consecutive cases and a review of the literature

et al. 2017

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BackgroundThe transanal hemorrhoidal dearterialization (THD) Doppler procedure is a minimally invasive technique to treat symptomatic hemorrhoids. The aim of the study was to assess the clinical efficacy and the satisfaction of patients in a large series treated with THD and to review the relevant literature.MethodsIn this retrospective, single-institution, study consecutive patients with grade 2, 3, or 4 hemorrhoidal disease were treated with the THD Doppler procedure. Dearterialization was performed in all cases and mucopexy in case of prolapse. The dearterialization procedure evolved from “proximal artery ligation” to “distal Doppler-guided dearterialization.” Follow-up was scheduled at 15 days, 1, 3, 12 months, and once a year thereafter. Complications were recorded. Clinical efficacy was assessed comparing both frequency of symptoms and disease grading (Goligher’s classification) at baseline versus last follow-up. Uni-/multivariate analysis evaluated factors affecting the outcome.ResultsThere were 1000 patients (619 men; mean age: 48.6 years, range 19–88 years). Acute postoperative bleeding was observed in 14 patients (1.4%), pain/tenesmus in 31 patients (3.1%), and urinary retention in 23 patients (2.3%). At mean follow-up duration of 44 ± 29 months, the symptomatic recurrence rate was 9.5% (95 patients; bleeding in 12 (1.2%), prolapse in 46 (4.6%), and bleeding and prolapse in 37 (3.7%) patients). The recurrence rate was 8.5, 8.7, and 18.1% in patients with grade 2, 3, and 4 hemorrhoids, respectively. Seventy out of 95 patients with recurrence needed surgery (reoperation rate: 7.0%). At final follow-up and taking into account the reoperations, 95.7% of patients had no hemorrhoidal disease on examination. Younger age, grade 4 disease, and high artery ligation affected the outcome negatively.ConclusionsOur results show that the THD Doppler procedure is safe and effective in patients with hemorrhoidal disease and associated with low morbidity and recurrence rates and a high rate percentage of treatment success.

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A prospective and comparative study between stapled hemorrhoidopexy and hemorrhoidal artery ligation with mucopexy

Abstract: THDm was safe and effective. Short-term outcomes after THDm were better than after Longo but long-term results seemed to be similar.

Cited by 18 publications

References 28 publications

Comparison of Post-operative Bleeding Incidence in Laser Hemorrhoidoplasty with and without Hemorrhoidal Artery Ligation: A Double-Blinded Randomized Controlled Trial

Comparison of Post-operative Bleeding Incidence in Laser Hemorrhoidoplasty with and without Hemorrhoidal Artery Ligation: A Double-Blinded Randomized Controlled Trial

Comparison of post-operative bleeding incidence in laser hemorrhoidoplasty with and without hemorrhoidal artery ligation: a double-blinded randomized controlled trial

Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: a single-center study on 1000 consecutive cases and a review of the literature

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