Hemorrhoidal dearterialization with mucopexy versus hemorrhoidectomy: 3-year follow-up assessment of a randomized controlled trial

Abstract

Background A randomized controlled trial showed that patients with grade III or IV internal hemorrhoids had similar symptomatic relief of symptoms up to 3 months following dearterialization with mucopexy or hemorrhoidectomy albeit with less postoperative pain after the former. This study aimed to compare hemorrhoidal recurrence and chronic complications at 3-year follow-up.MethodsThis study was carried out on 40 patients with grade III or IV internal hemorrhoids previously enrolled to a randomized trial comparing dearterialization to hemorrhoidectomy. Recurrence was defined as internal hemorrhoids diagnosed on proctoscopy. Chronic complications were nonresolving adverse events related to surgery. Outcome measures included patient-reported outcomes and quality of life measured by brief pain inventory (BPI), SF-12, and fecal incontinence surveys.ResultsAt median follow-up of 36 (27–43) months, 13 patients (32.5 %) were lost to follow-up. Patient-reported outcomes suggested no difference between dearterialization and hemorrhoidectomy in persistent symptoms, occurring in 1 (8.3 %) vs. 2 (13.3 %) patients (p = 0.681) and in symptom recurrence, occurring in 6 (50 %) vs. 4 (26.7 %) patients (p = 0.212). On proctoscopy, recurrence was seen in 2 (13.3 %) vs. 1 (6.7 %) patients (p = 0.411), all with index grade IV disease. One patient in each arm required reoperation (p = 0.869). Chronic complications were not seen in the dearterialization arm while they occurred in 2 (13.3 %) hemorrhoidectomy patients (p = 0.189) and included unhealed wound (n = 1), anal fissure (n = 1) and fecal incontinence (n = 1). There was a trend toward more patient reported than actual recurrence on proctoscopy (10 vs. 3, p = 0.259). There was no difference in BPI, SF-12, and fecal incontinence quality of life scores.ConclusionsRecurrence rates did not differ significantly at 3-year follow-up and occurred in patients with index grade IV hemorrhoids. Chronic complications occurred only after hemorrhoidectomy.

Embolization of the superior rectal arteries for chronic bleeding due to haemorrhoidal disease

“…Because our approach is not far from DG‐HAL, the fact that we find positive clinical results is encouraging . Furthermore, previous studies of embolization to treat acute bleeding have demonstrated efficacy and an absence of ischaemic complications for the use of this technique to treat life‐threatening rectal bleeding of various origins , as confirmed by the preliminary experience of our group with haemorrhoidal bleeding .…”

Laser hemorrhoidoplasty versus Milligan-Morgan hemorrhoidectomy - short term outcome

“…According to literature sources 25 infection occurs in 5%-15% of patients, and relapse in 5%-30% 16,17,24,25,26 . Not a single case of urinary retention and no need to set a urinary catheter were registered in comparison to some literature data showing 0%-16% of cases with urinary retention and catheterization 21,27 . Average hospitalizations was 2.1 days in case of the MM method and 1 day after the LHP.…”

The HubBLe Trial: haemorrhoidal artery ligation (HAL) versus rubber band ligation (RBL) for symptomatic second- and third-degree haemorrhoids: a multicentre randomised controlled trial and health-economic evaluation

“…We chose to assess recurrence at 12 months because published data suggest that most HAL and RBL recurrences occur within 1 year. 26 Several studies have shown that using HAL for higher-grade haemorrhoids or significant prolapse adversely affects the recurrence rate; 19,37,41,66,67 they also conclude that HAL is perhaps most effective for grade II and early grade III disease. We therefore limited our trial to this most clinically relevant patient population.…”

“…The substantial data concerning effectiveness include four systematic reviews, 5,19-21 11 randomised controlled trials (RCTs), [22][23][24][25][26][27][28][29][30][31][32] seven non-randomised trials [33][34][35][36][37][38][39] and > 60 case series. An overview has been carried out by the National Institute for Health and Clinical Excellence (NICE), which concludes that current evidence shows it to be a safe alternative to OH or SH; 40 this is summarised below.…”