Transanal Hemorrhoidal Dearterialization With Doppler Arterial Identification Versus Classic Hemorrhoidectomy: A Retrospective Analysis of 270 Patients

Consalvo, Vincenzo; D'Auria, Francesca; Salsano, Vincenzo

doi:10.3393/ac.2017.09.04

“…On the other hand, after 1-3 years of follow-up, the recurrence rate of THD is higher than that of CH [9,10]; however, when mucopexy is added to THD, the recurrence rates are comparable. Their levels of postoperative pain and rate of complications have also been reported as similar [11,12].…”

Section: Discussionmentioning

confidence: 90%

Linear Pinched Hemorrhoidectomy: A Retrospective Observational Study (An Innovative, Simplified Hemorrhoidectomy)

Kurihara

¹

,

Yoshino

²

,

Sakai

³

et al. 2021

J Anus Rectum Colon

1

0

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Objectives: There was an urgent need to create a simple, reliable hemorrhoidectomy procedure for high-risk cases in our university hospital. We performed linear pinched hemorrhoidectomy (LPH) and evaluated its effectiveness compared to conventional hemorrhoidectomy (CH). Methods: We included 215 Goligher grade 3 and 4 hemorrhoid cases in this study. Of these cases, 167 were in the CH group, and 48 patients were in the LPH group. We retrospectively compared the lengths of hospital stay, operative times, blood loss, and complications. Results: The age tended to be higher in the LPH group (mean: CH 60 years, LPH 68 years). In the univariate analysis, LPH had more resections, shorter operative times, and less blood loss. LPH had shorter operative times in the multivariate analysis, less blood loss, and more anticoagulant use. There were no significant differences between the two groups in terms of complications. Five and two patients in the CH and LPH groups, respectively, had postoperative hemorrhage requiring hemostasis. Only the CH group had three and four cases of anal stenosis and wound edema, respectively. Conclusions: We studied simplified hemorrhoidectomy using an ultrasonic scalpel and cylindrical proctoscope in a university hospital. We found that it a useful procedure with few complications and was easy for residents to learn. We believe that advances in surgical devices will make it possible to perform safer and simpler hemorrhoidectomy in the future.

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“…19 Other studies showed similar results, with significantly lower pain scores after HAL than hemorrhoidectomy. 12,17 In particular, Popov et al 18 reported similar pain scores on day 2 (5.07 in the hemorrhoidectomy group vs 2.98 in the HAL group); according to a meta-analysis performed by Xu et al, 33 there was no significant difference among trials regarding postoperative pain.…”

Section: Discussionmentioning

confidence: 97%

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

Giuliani,

Romano,

Necozione

et al. 2023

Diseases of the Colon &Amp; Rectum

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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.

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“…12 However, whether 1 of these 2 techniques is superior to the other in the long term remains unclear. [13][14][15][16] The aim of this study was to analyze the long-term results of the THDLIGA-RCT in terms of recurrence of hemorrhoid symptoms, long-term surgery-related complications, functional outcomes, and QoL.…”

mentioning

confidence: 99%

“…12 However, whether 1 of these 2 techniques is superior to the other in the long term remains unclear. 13–16…”

mentioning

confidence: 99%

Transanal Hemorrhoidal Dearterialization With Mucopexy Versus Vessel-Sealing Device Hemorrhoidectomy for Grade III to IV Hemorrhoids: Long-term Outcomes From the THDLIGA Randomized Controlled Trial

Trenti

¹

,

Biondo

²

,

Espín‐Basany

³

et al. 2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Both transanal hemorrhoidal dearterialization and vessel-sealing device hemorrhoidectomy are safe for grade III to IV hemorrhoid treatment. Whether one of them is superior regarding long-term results remains unclear. OBJECTIVE: To compare long-term results after transanal hemorrhoidal dearterialization and vessel-sealing device hemorrhoidectomy. DESIGN: Multicenter randomized controlled trial. SETTINGS: This study was conducted at 6 centers. PATIENTS: Patients ≥18 years of age with grade III to IV hemorrhoids were included in the study. INTERVENTIONS: Patients were randomly assigned to transanal hemorrhoidal dearterialization (n = 39) or vessel-sealing device hemorrhoidectomy (n = 41). MAIN OUTCOME MEASURES: The primary outcome was hemorrhoid symptom recurrence assessed by a specific questionnaire 2 years postoperatively. Secondary outcomes included long-term complications, reoperations, fecal continence, and patient satisfaction and quality of life. RESULTS: Five of the 80 patients included in the study were lost to follow-up. Thirty-six patients randomly assigned to transanal hemorrhoidal dearterialization and 39 patients randomly assigned to vessel-sealing device hemorrhoidectomy were included in the long-term analysis. The differences between mean baseline and mean 2-year score in the 2 groups were similar (–11.0, SD 3.8 vs –12.5, SD 3.6; p = 0.080). Three patients in the transanal hemorrhoidal dearterialization group underwent supplementary procedures for hemorrhoid symptoms, compared with none in the vessel-sealing device hemorrhoidectomy group (p = 0.106). Four patients in the vessel-sealing hemorrhoidectomy group and none in the transanal hemorrhoidal dearterialization group experienced chronic opened wound (p = 0.116). LIMITATIONS: Lack of stratification for hemorrhoid grade and power calculation based on the main outcome trial but not on the end point of this long-term study. CONCLUSIONS: Transanal hemorrhoidal dearterialization with mucopexy is associated with hemorrhoid symptom recurrence similar to vessel-sealing device hemorrhoidectomy at 2 years. See Video Abstract at http://links.lww.com/DCR/B933. REGISTRATION: Clinicaltrials.gov; ID: NCT02654249. DESARTERIALIZACIÓN HEMORROIDAL TRANSANAL CON MUCOPEXIA VERSUS HEMORROIDECTOMÍA CON DISPOSITIVO DE SELLADO DE VASOS PARA HEMORROIDES DE GRADO III-IV: RESULTADOS A LARGO PLAZO DEL ENSAYO CLÍNICO ALEATORIZADO THDLIGA-RCT ANTECEDENTES: Tanto la desarterialización hemorroidal transanal como la hemorroidectomía con dispositivo de sellado de vasos son seguras y bien toleradas para el tratamiento de las hemorroides de grado III-IV. La primera se asocia con una necesidad más breve de analgesia posoperatoria que la hemorroidectomía con dispositivo de sellado de vasos. No está claro si uno de ellos es superior con respecto a los resultados a largo plazo. OBJETIVO: El objetivo fue comparar los resultados a largo plazo después de la desarterialización hemorroidal transanal y la hemorroidectomía con dispositivo de sellado de vasos. DISEÑO: Se realizó un ensayo clínico aleatorizado multicéntrico. AJUSTE: Este estudio se realizó en 6 centros. PACIENTES: Se incluyeron en el estudio pacientes de ≥18 años con hemorroides de grado III-IV. INTERVENCIONES: Los pacientes fueron asignados al azar a desarterialización hemorroidal transanal (n = 39) o hemorroidectomía con dispositivo de sellado de vasos (n = 41). PRINCIPALES MEDIDAS DE RESULTADO: El resultado primario fue la recurrencia de los síntomas de hemorroides evaluada mediante un cuestionario específico 2 años después de la operación. Los resultados secundarios incluyeron complicaciones a largo plazo, reoperaciones, continencia fecal, satisfacción del paciente y calidad de vida. RESULTADOS: Cinco de los 80 pacientes incluidos en el estudio se perdieron durante el seguimiento. En el análisis a largo plazo se incluyeron 36 pacientes aleatorizados a desarterialización hemorroidal transanal y 39 aleatorizados a hemorroidectomía con dispositivo de sellado de vasos. Las diferencias entre la puntuación inicial media y la puntuación media a los 2 años en los dos grupos fueron similares (-11,0, DE 3,8 frente a -12,5, DE 3,6; p = 0,080). Tres pacientes en el grupo de desarterialización hemorroidal transanal se sometieron a procedimientos complementarios por síntomas de hemorroides, en comparación con ninguno en el grupo de hemorroidectomía con dispositivo de sellado de vasos (p = 0,106). Cuatro pacientes en el grupo de hemorroidectomía con sellado de vasos y ninguno en el grupo de desarterialización hemorroidal transanal experimentaron herida abierta crónica (p = 0,116). No se encontraron diferencias en cuanto a continencia fecal (p = 0,657), satisfacción del paciente (p = 0,483) y calidad de vida. LIMITACIONES: No hay estratificación para el grado de hemorroides ni el cálculo del poder basado en el resultado principal del ensayo, pero no en el criterio de valoración de este estudio a largo plazo. CONCLUSIONES: La desarterialización hemorroidal transanal con mucopexia se asocia con una recurrencia de síntomas de hemorroides similar a la hemorroidectomía con dispositivo de sellado de vasos a los dos años. See Video Abstract at http://links.lww.com/DCR/B933. (Traducción— Dr. Francisco M. Abarca-Rendon) REGISTRO DE PRUEBA: Clinicaltrials.gov (NCT02654249).

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Transanal Hemorrhoidal Dearterialization With Doppler Arterial Identification Versus Classic Hemorrhoidectomy: A Retrospective Analysis of 270 Patients

Cited by 7 publications

References 16 publications

Linear Pinched Hemorrhoidectomy: A Retrospective Observational Study (An Innovative, Simplified Hemorrhoidectomy)

Linear Pinched Hemorrhoidectomy: A Retrospective Observational Study (An Innovative, Simplified Hemorrhoidectomy)

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

Transanal Hemorrhoidal Dearterialization With Mucopexy Versus Vessel-Sealing Device Hemorrhoidectomy for Grade III to IV Hemorrhoids: Long-term Outcomes From the THDLIGA Randomized Controlled Trial

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