Excisional Hemorrhoidectomy Versus Dearterialization With Mucopexy for the Treatment of Grade 3 Hemorrhoidal Disease: the EMODART3 Multicenter Study

Abstract

BACKGROUND: In the last decades, several surgical approaches have been proposed to treat hemorrhoids. OBJECTIVE: This multicenter study aims to compare transanal hemorrhoidal artery ligation and conventional excisional hemorrhoidectomy for grade III hemorrhoidal disease. DESIGN: Multicenter retrospective study. SETTINGS: Any center belonging to the Italian Society of Colorectal Surgery in which at least 30 surgical procedures per year for hemorrhoidal disease were performed was able to join the study. PATIENTS: Clinical data from patients with Goligher’s grade III hemorrhoidal disease who underwent excisional hemorrhoidectomy or hemorrhoidal artery ligation were retrospectively analyzed after a 24-months follow-up period. MAIN OUTCOME MEASURES: The primary aims were to evaluate the adoption of 2 different surgical techniques and to compare them in terms of symptoms, postoperative adverse events and recurrences at 24-months follow-up. RESULTS: Data from 1681 patients were analyzed. The 2 groups resulted to be comparable in terms of postoperative clinical score by multiple regression analysis and matched case-control analysis. Patients submitted to excisional hemorrhoidectomy had a significantly higher risk of postoperative complication (adjusted odds ratio=1.58; p = 0.006). A secondary analysis highlighted that excisional hemorrhoidectomy performed with new devices and hemorrhoidal artery ligation reported significant lower risk for complications then excisional hemorrhoidectomy performed with traditional monopolar diathermy. At the 24-month follow-up assessment, recurrence was significantly higher in hemorrhoidal artery ligation group (adjusted odds ratio=0.50; p = 0.001). A secondary analysis did not show a higher risk of recurrences based on the type of device. LIMITATIONS: The retrospective design and to the self-reported nature of data from different centers. CONCLUSION: Hemorrhoidal artery ligation is an effective option for grade III hemorrhoidal disease; however it is burdened by high risk of recurrences. Excisional hemorrhoidectomy performed with newer devices is competitive in terms of post-operative complications.

Results of sclerotherapy and mucopexy with haemorrhoidal dearterialization in II and III degree haemorrhoids. A 4 years' single centre experience

“…A recent multicentre study reported benefits from Doppler-guided MHD using a THD device with a 9.5% recurrence and 7% reoperation rate ( 29 , 31 , 32 ). Giuliani et al reported that MHD is a safe and efficient technique, especially for third-degree HD ( 33 ).…”