2014

A Prospective, Randomized Trial Comparing the Short- and Long-term Results of Doppler-Guided Transanal Hemorrhoid Dearterialization With Mucopexy Versus Excision Hemorrhoidectomy for Grade III Hemorrhoids

De Nardi P., Capretti G., Corsaro A., Staudacher C.
Diseases of the Colon & Rectum: March 2014 - Volume 57 - Issue 3 - p 348-353

BACKGROUND
Few randomized trials have compared the results of Doppler-guided transanal hemorrhoid dearterialization with mucopexy and excisional open hemorrhoidectomy. Few studies have reported long-term results.

OBJECTIVE
The aim of this study is to evaluate the results of Doppler-guided transanal hemorrhoid dearterialization with mucopexy compared with excisional open hemorrhoidectomy in patients with grade III hemorrhoids.

DESIGN
This is a prospective randomized study registered at clinicaltrials.gov (NCT01263431). A power analysis assessed the study’s sample size. Patients were randomly assigned to undergo either hemorrhoidectomy or Doppler-guided hemorrhoid dearterialization plus mucopexy. The χ2 test, Mann-Whitney U test, Student t test, and a regression model were used, as appropriate.

SETTINGS
This study was conducted at the Department of Surgery, San Raffaele Scientific Institute, Milan, Italy. PATIENTS Fifty consecutive patients were treated for grade III hemorrhoids from July to November 2010.

MAIN OUTCOME MEASURES
The primary outcome was postoperative pain. The secondary outcomes included postoperative morbidity, the resumption of social and/or working activity, patient satisfaction, and the relapse of symptoms at 1 and 24 months.

RESULTS
No major complications occurred in either group. The median visual analog scale scores for pain in the hemorrhoidectomy and Doppler-guided dearterialization plus mucopexy groups on days 1, 7, 14, and 30 were 7 vs 5.5, 3 vs 2.5, 1 vs 0, and 0 vs 0 (p> 0.05). The median work resumption day was the 22nd in the hemorrhoidectomy group and the 10th in the Doppler-guided dearterialization plus mucopexy group (p = 0.09). Patient satisfaction at 1 and 24 postoperative months, with the use of a 4-point scale, was 3 vs 4 and 4 vs 4 (p > 0.05). During the follow-up, 2 patients in the dearterialization group required ambulatory treatment, and 1 patient in each group required further surgery for symptom relapse.

LIMITATIONS
Nonvalidated questionnaires were used in the follow-up. Cost analysis was not performed.

CONCLUSION
Compared with hemorrhoidectomy, dearterialization with mucopexy resulted in similar postoperative pain and morbidity, and a similar long-term cure rate.

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