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He J, Zhou MD, Wu WJ, Liu ZY, Wang D, Yang GG, Yang QY, Shen Z. The comparison of an accessible C-shaped partial stapled hemorrhoidopexy (C-PSH) versus circular stapled hemorrhoidopexy (CSH) in patients with grade IV hemorrhoids: a retrospective cohort study. BMC Gastroenterol 2023; 23:443. [PMID: 38104065 PMCID: PMC10725019 DOI: 10.1186/s12876-023-03062-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 11/24/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVES The objectives of this study were to present an accessible C-shaped partial stapled hemorrhoidopexy (C-PSH) in the treatment of grade IV hemorrhoids and to assess long-term outcomes of this technique compared with circular stapled hemorrhoidopexy (CSH). METHODS Conventional CSH kits combined with an intestinal spatula were used for performing C-PSH. A total of 256 patients with grade IV hemorrhoids referred to Hangzhou Third People's Hospital between January 2016 and June 2017 were obtained: 122 (47.7%) with C-PSH, and 134 (52.3%) with CSH. After propensity score matching, 222 patients (111 in C-PSH group and 111 in CSH group) were ultimately analyzed. The primary outcome was the five-year recurrence rate of hemorrhoids. Secondary outcomes included intraoperative outcomes, postoperative outcomes and complications. RESULTS The operative time in the C-PSH group was slightly longer than that in the CSH group (p < 0.01). The vertical length of rectal mucosa specimen in the C-PSH group was shorter than that in the CSH group (p < 0.01). Compared with the CSH group, fecal urgency incidence and numeric rating scale (NRS) score at first defecation were lower in the C-PSH group (p < 0.05). Major complication rate in the CSH group was higher than that in the C-PSH group (p = 0.03). Five-year recurrence rate between the C-PSH group and CSH group was comparable (p > 0.05). Multivariate Cox regression analysis revealed that constipation was an independent prognostic factor for hemorrhoidal recurrence. CONCLUSIONS The accessible C-PSH seems to be a safe and effective technique in managing grade IV hemorrhoids. It has advantages in alleviating postoperative pain at first defecation, fecal urgency and major complications compared with CSH. It could be an alternative technique in the treatment of grade IV hemorrhoids.
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Affiliation(s)
- Jun He
- Department of Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China
| | - Meng-Dan Zhou
- Department of Nursing, Hangzhou First People's Hospital, Hangzhou, 310006, Zhejiang, People's Republic of China
| | - Wen-Jing Wu
- Department of Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China
| | - Zhi-Yong Liu
- Department of Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China
| | - Dong Wang
- Department of Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China
| | - Guan-Gen Yang
- Department of Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China
| | - Qin-Yan Yang
- Department of Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China.
| | - Zhong Shen
- Department of Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China.
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Miyamoto H. Minimally Invasive Treatment for Advanced Hemorrhoids. J Anus Rectum Colon 2023; 7:8-16. [PMID: 36743466 PMCID: PMC9876604 DOI: 10.23922/jarc.2022-068] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/24/2022] [Indexed: 01/25/2023] Open
Abstract
Hemorrhoids, the most common anorectal disease, give rise to symptoms such as bleeding, prolapse, and pruritus. The treatment for advanced hemorrhoids (Grade III or IV) is gradually shifting toward minimally invasive procedures. These procedures focus on reduction of blood flow in hemorrhoids. Conventional hemorrhoidectomy (CH), also known as Milligan-Morgan or Ferguson hemorrhoidectomy, is considered as the standard treatment for Grade III and IV hemorrhoids because it achieves the lowest recurrence rate. Over the years, alternative minimally invasive techniques such as stapled hemorrhoidopexy and transanal hemorrhoidal dearterialization (THD) have been developed. A new, effective sclerosant, aluminum potassium sulfate and tannic acid (ALTA), has been developed in Japan and has been used for all grades of hemorrhoids; however, its effectiveness declines over time. Other minimally invasive, nonsurgical procedures, including rubber band ligation, endoscopic injection sclerotherapy, and infrared coagulation, have also been performed for Grade III hemorrhoids. Those minimally invasive treatments improve bleeding and prolapse and are highly recommended for patients who are unfit for CH. THD with mucopexy or ALTA sclerotherapy has also been performed for Grade IV hemorrhoids. However, the recurrence rate after ALTA sclerotherapy for Grade IV hemorrhoids was higher than that for Grade III lesions in our case study. In conclusion, minimally invasive treatments are a valid alternative for patients with advanced hemorrhoids after clear explanation of recurrence rates and possible complications.
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Zhang C, Zhang W, Xu J. Comparison of the outcomes of hemorrhoidectomy and PPH in the treatment of grades III and IV hemorrhoids. Medicine (Baltimore) 2022; 101:e29100. [PMID: 35356944 PMCID: PMC10684234 DOI: 10.1097/md.0000000000029100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 02/28/2022] [Indexed: 11/27/2022] Open
Abstract
ABSTRACT To investigate the clinical effect and outcome of traditional hemorrhoidectomy and procedures for prolapse and hemorrhoid (PPH) for the treatment of grades III and IV hemorrhoids.We retrospectively reviewed 1003 grades III and IV hemorrhoid patients who presented to our hospital. A total of 585 patients underwent PPH, and 418 patients underwent hemorrhoidectomy. The outcomes were 1-year recurrence, postoperative complications, surgery-related complications, and indicators.No significant difference between the 2 treatment groups regarding patient demographics. All patients underwent more than 12months of postoperative follow-up. No significant difference between the 2 treatment groups in 1-year recurrence. PPH can markedly improve anal pain, postoperative bleeding, difficult urination, and postoperative resting anal pressure. The operative blood loss, operative time, wound healing time, and wound infection rates were decreased significantly in the PPH group compared with the traditional hemorrhoidectomy group.Our data suggest that PPH is useful and safe for grades III and IV hemorrhoids. It can reduce postoperative and surgery-related complications. However, this was a single-hospital retrospective study. Therefore, well-designed, multicenter, randomized controlled trials are needed to evaluate the value of PPH for grades III and IV hemorrhoids.
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Affiliation(s)
- Chaojie Zhang
Department of General Surgery, Wuxi Clinical Medical School of Anhui Medical University, 904th Hospital of PLA (Wuxi Taihu Hospital, Wuxi, China.
| | - Weiping Zhang
Department of General Surgery, Wuxi Clinical Medical School of Anhui Medical University, 904th Hospital of PLA (Wuxi Taihu Hospital, Wuxi, China.
| | - Jian Xu
Department of General Surgery, Wuxi Clinical Medical School of Anhui Medical University, 904th Hospital of PLA (Wuxi Taihu Hospital, Wuxi, China.
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Boukris Toledano A, Blanchard P, Zaleski A, Benfredj P, Fathallah N, Sultan S, Pommaret E, de Parades V. Lessons from the first 70 patients operated by doppler-guided haemorrhoidal artery ligation with mucopexy in a French team specialising in surgical proctology. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1016/j.jcol.2017.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Doppler-guided haemorrhoidal artery ligation with mucopexy is a minimal-invasive surgical technique. It is both effective and less painful than conventional haemorrhoidectomy.
Methods We gathered records on all patients operated on between November 2012 and June 2014. Pre- and postoperative scores were calculated during consultation and then by phone. Unsuccessful surgical treatment was defined by persistent haemorrhoid symptoms within three months following the procedure and relapse defined by recurrent symptoms after the third postoperative month.
Results During the period analysed, 70 patients underwent consecutive surgical procedures for haemorrhoid prolapse (52%), bleeding (29%), or both (17%). Hospitalisation was outpatient or overnight for 87% of patients. There were no complications in 92.7% of cases. The average period away from work was 11 days (± 6.5). The time between the procedure and last postoperative consultation, followed by telephone contact, was respectively 2.7 months (± 5.8) and 16.5 months (± 4.9). At the time of the postoperative telephone call, the Thaha et al. score decreased by 5.6 (p < 0.001), while the quality of life score decreased by 2 (p < 0.001). The Wexner score remained the same or improved for all patients except one. Treatment was unsuccessful for 6/67 patients (9%) and 10/61 patients (16.4%) experienced a subsequent recurrence in haemorrhoid symptoms. Only those over 51 years old were statistically associated with more frequent recurrences (p = 0.044).
Conclusion Doppler-guided haemorrhoidal artery ligation with mucopexy is an effective technique in the medium-term. Good tolerance in makes this treatment an attractive alternative to conventional haemorrhoidectomy.
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Affiliation(s)
- Alexia Boukris Toledano
- Institut Léopold Bellan, Groupe hospitalier Paris Saint-Joseph, Department of Medical and Surgical Proctology, Paris, France
| | - Pierre Blanchard
- Institut Gustave Roussy, Epidemiology and Biostatistics, Villejuif, France
| | | | - Paul Benfredj
- Institut Léopold Bellan, Groupe hospitalier Paris Saint-Joseph, Department of Medical and Surgical Proctology, Paris, France
- Clinique du Louvre, Paris, France
| | - Nadia Fathallah
- Institut Léopold Bellan, Groupe hospitalier Paris Saint-Joseph, Department of Medical and Surgical Proctology, Paris, France
| | - Samy Sultan
- Institut Léopold Bellan, Groupe hospitalier Paris Saint-Joseph, Department of Medical and Surgical Proctology, Paris, France
| | - Elise Pommaret
- Institut Léopold Bellan, Groupe hospitalier Paris Saint-Joseph, Department of Medical and Surgical Proctology, Paris, France
| | - Vincent de Parades
- Institut Léopold Bellan, Groupe hospitalier Paris Saint-Joseph, Department of Medical and Surgical Proctology, Paris, France
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Gallo G, Martellucci J, Sturiale A, Clerico G, Milito G, Marino F, Cocorullo G, Giordano P, Mistrangelo M, Trompetto M. Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of hemorrhoidal disease. Tech Coloproctol 2020; 24:145-164. [PMID: 31993837 PMCID: PMC7005095 DOI: 10.1007/s10151-020-02149-1] [Citation(s) in RCA: 140] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/06/2020] [Indexed: 02/07/2023]
Abstract
Hemorrhoidal disease (HD) is the most common proctological disease in the Western countries. However, its real prevalence is underestimated due to the frequent self-medication.The aim of this consensus statement is to provide evidence-based data to allow an individualized and appropriate management and treatment of HD. The strategy used to search for evidence was based on application of electronic sources such as MEDLINE, PubMed, Cochrane Review Library, CINAHL, and EMBASE.These guidelines are inclusive and not prescriptive.The recommendations were defined and graded based on the current levels of evidence and in accordance with the criteria adopted by American College of Chest Physicians. The recommendations were graded A, B, and C.
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Affiliation(s)
- G Gallo
- Department of Surgical and Medical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy
| | - J Martellucci
- Department of General, Emergency and Minimally Invasive Surgery, Careggi University Hospital, Florence, Italy
| | - A Sturiale
- Proctological and Perineal Surgical Unit, Cisanello University Hospital, Pisa, Italy
| | - G Clerico
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy
| | - G Milito
- Department of General Surgery, Tor Vergata University, Rome, Italy
| | - F Marino
- Operative Unit of General Surgery, IRCCS de Bellis, Castellana Grotte, Bari, Italy
| | - G Cocorullo
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - P Giordano
- Department of Colorectal Surgery, Whipps Cross University Hospital, Barts Health, London, UK
| | - M Mistrangelo
- Department of General and Minimally Invasive Surgery, University of Turin, Turin, Italy
| | - M Trompetto
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy.
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Brown CJ, Hochman D, Raval MJ, Moloo H, Phang PT, Bouchard A, Williams L, Drolet S, Boushey R. A multi-centre randomized controlled trial of open vs closed management of the rectal defect after transanal endoscopic microsurgery. Colorectal Dis 2019; 21:1025-1031. [PMID: 31081281 DOI: 10.1111/codi.14689] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/12/2019] [Indexed: 01/17/2023]
Abstract
AIM Transanal endoscopic microsurgery (TEM) is a technically challenging strategy that allows expanded indications for local excision of rectal lesions. Transluminal suturing is difficult, so open management of the resultant defect is appealing. Expert opinion suggests there is more pain when the defect is left open. The aim of this study was to determine if closure of the defect created during full thickness excision of rectal lesions with TEM leads to less postoperative pain compared to leaving the defect open. METHOD At the time of surgery, patients undergoing a full thickness TEM were randomized to sutured (TEM-S) or open (TEM-O) management of the rectal defect. At five Canadian academic colorectal surgery centres, experienced TEM surgeons enrolled patients ≥ 18 years treated by full thickness TEM. The primary outcome was postoperative pain measured by the visual analogue scale. Secondary outcomes included postoperative pain medication use and 30-day postoperative complications, including bleeding, infection and hospital readmission. RESULTS Between March 2012 and October 2013, 50 patients were enrolled and randomized to sutured (TEM-S, n = 28) or open (TEM-O, n = 22) management of the rectal defect. There was no difference between the two study groups in postoperative pain on postoperative day 1 (2.8 vs 2.6, P = 0.76), day 3 (2.8 vs 2.1, P = 0.23) and day 7 (2.8 vs 1.7, P = 0.10). CONCLUSION In this multicentre randomized controlled trial, there was no difference in postoperative pain between sutured or open defect management in patients having a full thickness excision with TEM.
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Affiliation(s)
- C J Brown
- Department of Surgery, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - D Hochman
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - M J Raval
- Department of Surgery, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - H Moloo
- Department of Surgery, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - P T Phang
- Department of Surgery, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - A Bouchard
- Department of Surgery, CHU de Québec - Université Laval, Quebec City, Quebec, Canada
| | - L Williams
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - S Drolet
- Department of Surgery, CHU de Québec - Université Laval, Quebec City, Quebec, Canada
| | - R Boushey
- Department of Surgery, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Cuong LM, Ha TT, Anh NN, Thanh NT, Kien VD, Lam ND. Comparison of Doppler-Guided Transanal Hemorrhoidal Dearterialization for Grade III and IV Hemorrhoids in Vietnam. Adv Ther 2019; 36:1388-1397. [PMID: 30972656 DOI: 10.1007/s12325-019-00948-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION This study aimed to assess the short- and long-term outcomes of Doppler-guided transanal hemorrhoidal dearterialization (THD) for grade III and IV hemorrhoidal disease in Vietnam. METHODS In a prospective observational design, patients treated for grade III and IV hemorrhoidal disease with the THD method at the National Hospital of Traditional Medicine (Hanoi, Vietnam) were included between June 2012 and December 2013. Patients were evaluated postoperatively at the time they were discharged from the hospital (short-term outcome) and 6 months after surgery (long-term outcome). RESULTS A total of 128 patients were enrolled in the study, 94 were classified with grade III disease and 34 with grade IV. Grade IV hemorrhoidal patients reported on average 18.2 years of disease symptom duration, while grade III hemorrhoidal patients reported 11.2 years. All patients with grade III and grade IV hemorrhoidal disease had good outcomes at discharge day and reported to return to work in a median of 6 days after THD. At long-term follow-up, the results were good for 80.9% of patients from grade III hemorrhoidal disease and 61.8% of patients from grade IV hemorrhoidal disease. Patient satisfaction with the procedure and outcomes was 93.6% for grade III and 85.3% for grade IV hemorrhoidal patients. CONCLUSIONS The THD technique was shown to be safe for both grade III and IV hemorrhoidal patients. The THD technique showed better results with grade III hemorrhoidal patients as compared to grade IV hemorrhoidal patients.
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Xu L, Chen H, Gu Y. Stapled Hemorrhoidectomy Versus Transanal Hemorrhoidal Dearterialization in the Treatment of Hemorrhoids: An Updated Meta-Analysis. Surg Laparosc Endosc Percutan Tech 2019; 29:75-81. [DOI: 10.1097/sle.0000000000000612] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Emile SH, Elfeki H, Sakr A, Shalaby M. Transanal hemorrhoidal dearterialization (THD) versus stapled hemorrhoidopexy (SH) in treatment of internal hemorrhoids: a systematic review and meta-analysis of randomized clinical trials. Int J Colorectal Dis 2019; 34:1-11. [PMID: 30421308 DOI: 10.1007/s00384-018-3187-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although conventional hemorrhoidectomy proved effective in treatment of hemorrhoidal disease, postoperative pain remains a vexing problem. Alternatives to conventional hemorrhoidectomy as transanal hemorrhoidal dearterialization (THD) and stapled hemorrhoidopexy (SH) were described. The present meta-analysis aimed to review the randomized trials that compared THD and SH to determine which technique is superior in terms of recurrence of hemorrhoids, complications, and postoperative pain. METHODS Electronic databases were searched for randomized trials that compared THD and SH for internal hemorrhoids. The PRISMA guidelines were followed when reporting this meta-analysis. The primary endpoint of the analysis was persistence or recurrence of hemorrhoidal disease. Secondary endpoints were postoperative pain, complications, readmission, return to work, and patients' satisfaction. RESULTS Six randomized trials including 554 patients (THD = 280; SH = 274) were included. The mean postoperative pain score of THD was significantly lower than SH (2.9 ± 1.5 versus 3.3 ± 1.6). 13.2% of patients experienced persistent or recurrent hemorrhoids after THD versus 6.9% after SH (OR = 1.93, 95%CI = 1.07-3.51, p = 0.029). Complications were recorded in 17.1% of patients who underwent THD and 23.3% of patients who underwent SH (OR = 0.68, 95%CI 0.43-1.05, p = 0.08). The average duration to return to work after THD was 7.3 ± 5.2 versus 7.7 ± 4.8 days after SH (p = 0.34). Grade IV hemorrhoids was significantly associated with persistence or recurrence of hemorrhoidal disease after both procedures. CONCLUSION THD had significantly higher persistence/recurrence rate compared to SH whereas complication and readmission rates, hospital stay, return to work, and patients' satisfaction were similar in both groups.
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Affiliation(s)
- Sameh Hany Emile
- Department of General surgery, colorectal surgery unit, Mansoura Faculty of medicine, Mansoura University Hospitals, Elgomhuoria Street, Mansoura, Egypt.
| | - Hossam Elfeki
- Department of General surgery, colorectal surgery unit, Mansoura Faculty of medicine, Mansoura University Hospitals, Elgomhuoria Street, Mansoura, Egypt
- Department of surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Ahmad Sakr
- Department of General surgery, colorectal surgery unit, Mansoura Faculty of medicine, Mansoura University Hospitals, Elgomhuoria Street, Mansoura, Egypt
- Colorectal surgery department, Yonsei University College of Medicine, Seoul, South Korea
| | - Mostafa Shalaby
- Department of General surgery, colorectal surgery unit, Mansoura Faculty of medicine, Mansoura University Hospitals, Elgomhuoria Street, Mansoura, Egypt
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Song Y, Chen H, Yang F, Zeng Y, He Y, Huang H. Transanal hemorrhoidal dearterialization versus stapled hemorrhoidectomy in the treatment of hemorrhoids: A PRISMA-compliant updated meta-analysis of randomized control trials. Medicine (Baltimore) 2018; 97:e11502. [PMID: 30024532 PMCID: PMC6086545 DOI: 10.1097/md.0000000000011502] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The aim of this study was to compare the outcomes of transanal hemorrhoidal dearterialization (THD) and stapled hemorrhoidectomy (SH) in the treatment of hemorrhoids by a meta-analysis. METHODS Randomized control trials (RCTs) comparing SH with THD were searched for in databases, including MEDLINE, PubMed, Web of science, Embase, and the Cochrane Library database. Data were independently extracted from each study, and a meta-analysis was performed using RevMan5.2 software. RESULTS Eight RCTs, including 977 patients, were included in this meta-analysis. No statistically significant differences were noted between THD and SH in terms of total complications (OR, 0.93; 95% CI, 0.69, 1.25), but a significant differences were noted in terms of bleeding (OR, 1.85; 95% CI, 1.10, 3.10). The total recurrence rate was higher in THD than in SH on short-term follow-up; however, the recurrence rate was equal in both the THD and SH groups on long-term follow-up. The present study showed that no significant difference between SH and THD in terms of postoperative pain (OR, 0.43; 95% CI, -0.43, 1.29), operative time (OR, -3.12; 95% CI, -7.01, 0.77), hospital time (OR, -0.00; 95% CI, -0.21, 0.20), time before returning to work (OR,-0.50; 95%CI, -4.42,3.43), and reoperation rate (OR, 1.81; 95% CI, 0.93, 3.54). CONCLUSION Our meta-analysis indicated that THD and SH are equally effective techniques for the treatment of hemorrhoids. However, future studies addressing cost-effectiveness, satisfaction rate, and recurrence rate over a long follow-up period are needed to validate these results.
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Affiliation(s)
- Yan Song
- Department of Colonproctology Surgery, the Second Affiliated Hospital
- Hunan Provincial Key Laboratory for Diagnostic and Therapeutic Research in Chinese Medicine, Hunan University of Chinese Medical, Changsha, Hunan Province, P.R. China
| | - Honglei Chen
- Department of Gastrointestinal Endoscopy, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University
| | - Fang Yang
- Department of Colonproctology Surgery, the Second Affiliated Hospital
| | - Yuheng Zeng
- Department of Colonproctology Surgery, the Second Affiliated Hospital
| | - Yongheng He
- Department of Colonproctology Surgery, the Second Affiliated Hospital
| | - Huiyong Huang
- Hunan Provincial Key Laboratory for Diagnostic and Therapeutic Research in Chinese Medicine, Hunan University of Chinese Medical, Changsha, Hunan Province, P.R. China
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Giarratano G, Toscana E, Toscana C, Petrella G, Shalaby M, Sileri P. Transanal Hemorrhoidal Dearterialization Versus Stapled Hemorrhoidopexy: Long-Term Follow-up of a Prospective Randomized Study. Surg Innov 2018; 25:236-241. [DOI: 10.1177/1553350618761757] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Aim. This study aims to compare the early and late outcomes of transanal hemorrhoidal dearterialization (THD) versus stapled hemorrhoidopexy (SH) for the treatment of hemorrhoidal disease. Methods. From January 2013 to December 2014, 100 patients—50 patients on each arm—were randomly allocated to THD or SH groups. The inclusion criteria were grade III and IV hemorrhoids diagnosed by clinical examination and proctoscopy. The primary outcome was to compare the recurrence rate with a minimum follow-up of 2 years, and the secondary outcome was to compare complications rate, time to return to work postsurgery, procedure length, and patient’s satisfaction between the 2 techniques. Results. The mean follow-up period was 33.7 ± 7.6. The recurrence rate was 4% in the SH group and 16% in the THD group ( P = .04). There was no difference in the intraoperative and postoperative complications rate; the pain score was significantly higher in the THD group. The mean operative time was significantly shorter in the SH group compared with the THD group. Patients in the THD group returned to work or routine activities significantly later compared with patients in the SH group. The overall satisfaction rate was also higher in the SH group. Conclusion. Both procedures are simple and easy to perform for the treatment of grade III and IV hemorrhoids. SH showed better results in terms of lower rate of recurrence, lower postoperative pain, quicker return to work, and higher patient satisfaction.
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Leung LH. Reply to the letter to the editor regarding: A prospective randomized trial evaluating the outcomes of transanal hemorrhoidal dearterialization versus tissue-selecting technique. Tech Coloproctol 2018; 22:149-150. [PMID: 29435793 DOI: 10.1007/s10151-018-1752-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 01/18/2018] [Indexed: 11/25/2022]
Affiliation(s)
- L H Leung
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong, Hong Kong.
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Brown S, Tiernan J, Biggs K, Hind D, Shephard N, Bradburn M, Wailoo A, Alshreef A, Swaby L, Watson A, Radley S, Jones O, Skaife P, Agarwal A, Giordano P, Lamah M, Cartmell M, Davies J, Faiz O, Nugent K, Clarke A, MacDonald A, Conaghan P, Ziprin P, Makhija R. 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. Health Technol Assess 2018; 20:1-150. [PMID: 27921992 DOI: 10.3310/hta20880] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Optimal surgical intervention for low-grade haemorrhoids is unknown. Rubber band ligation (RBL) is probably the most common intervention. Haemorrhoidal artery ligation (HAL) is a novel alternative that may be more efficacious. OBJECTIVE The comparison of HAL with RBL for the treatment of grade II/III haemorrhoids. DESIGN A multicentre, parallel-group randomised controlled trial. PERSPECTIVE UK NHS and Personal Social Services. SETTING 17 NHS Trusts. PARTICIPANTS Patients aged ≥ 18 years presenting with grade II/III (second- and third-degree) haemorrhoids, including those who have undergone previous RBL. INTERVENTIONS HAL with Doppler probe compared with RBL. OUTCOMES Primary outcome - recurrence at 1 year post procedure; secondary outcomes - recurrence at 6 weeks; haemorrhoid severity score; European Quality of Life-5 Dimensions, 5-level version (EQ-5D-5L); Vaizey incontinence score; pain assessment; complications; and cost-effectiveness. RESULTS A total of 370 participants entered the trial. At 1 year post procedure, 30% of the HAL group had evidence of recurrence compared with 49% after RBL [adjusted odds ratio (OR) = 2.23, 95% confidence interval (CI) 1.42 to 3.51; p = 0.0005]. The main reason for the difference was the number of extra procedures required to achieve improvement/cure. If a single HAL is compared with multiple RBLs then only 37.5% recurred in the RBL arm (adjusted OR 1.35, 95% CI 0.85 to 2.15; p = 0.20). Persistence of significant symptoms at 6 weeks was lower in both arms than at 1 year (9% HAL and 29% RBL), suggesting significant deterioration in both groups over the year. Symptom score, EQ-5D-5L and Vaizey score improved in both groups compared with baseline, but there was no difference between interventions. Pain was less severe and of shorter duration in the RBL group; most of the HAL group who had pain had mild to moderate pain, resolving by 3 weeks. Complications were low frequency and not significantly different between groups. It appeared that HAL was not cost-effective compared with RBL. In the base-case analysis, the difference in mean total costs was £1027 higher for HAL. Quality-adjusted life-years (QALYs) were higher for HAL; however, the difference was very small (0.01) resulting in an incremental cost-effectiveness ratio of £104,427 per additional QALY. CONCLUSIONS At 1 year, although HAL resulted in fewer recurrences, recurrence was similar to repeat RBL. Symptom scores, complications, EQ-5D-5L and continence score were no different, and patients had more pain in the early postoperative period after HAL. HAL is more expensive and unlikely to be cost-effective in terms of incremental cost per QALY. LIMITATIONS Blinding of participants and site staff was not possible. FUTURE WORK The incidence of recurrence may continue to increase with time. Further follow-up would add to the evidence regarding long-term clinical effectiveness and cost-effectiveness. The polysymptomatic nature of haemorrhoidal disease requires a validated scoring system, and the data from this trial will allow further assessment of validity of such a system. These data add to the literature regarding treatment of grade II/III haemorrhoids. The results dovetail with results from the eTHoS study [Watson AJM, Hudson J, Wood J, Kilonzo M, Brown SR, McDonald A, et al. Comparison of stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease (eTHoS): a pragmatic, multicentre, randomised controlled trial. Lancet 2016, in press.] comparing stapled haemorrhoidectomy with excisional haemorrhoidectomy. Combined results will allow expansion of analysis, allowing surgeons to tailor their treatment options to individual patients. TRIAL REGISTRATION Current Controlled Trials ISRCTN41394716. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 88. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Steven Brown
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jim Tiernan
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Katie Biggs
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Daniel Hind
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Neil Shephard
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Mike Bradburn
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Allan Wailoo
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Abualbishr Alshreef
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Lizzie Swaby
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Simon Radley
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Oliver Jones
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Paul Skaife
- Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Anil Agarwal
- North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
| | | | - Marc Lamah
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | - Justin Davies
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Omar Faiz
- North West London Hospitals NHS Trust, London, UK
| | - Karen Nugent
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | | | | | - Paul Ziprin
- Imperial College Healthcare NHS Trust, London, UK
| | - Rohit Makhija
- Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, UK
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Short-term outcomes of transanal haemorrhoidal dearterialization versus tissue-selecting technique. Tech Coloproctol 2018; 22:147. [PMID: 29340833 DOI: 10.1007/s10151-018-1749-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 01/05/2018] [Indexed: 10/18/2022]
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Ul Ain Q, Bashir Y, Eguare E. Evaluation of the effectiveness and patients' contentment with transanal haemorrhoidal artery dearterialisation and mucopexy (THD) for treatment of haemorrhoidal disease: a 6-year study. Ir J Med Sci 2017; 187:647-655. [PMID: 29214383 DOI: 10.1007/s11845-017-1715-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/10/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION With high incidence of haemorrhoidal disease and significant complication rates of traditional haemorrhoidectomy procedures, transanal haemorrhoidal artery ligation and mucopexy (THD) emerges as a minimally invasive procedure with superior results. However, it is crucial that effectiveness of results and patient satisfaction be gauged based on post-operative experience, symptomology and recurrence. AIM Our aim is to provide a long-term analysis of efficacy and patient's satisfaction for the procedure, for the largest patient population, in correlation to presenting symptoms and degree of haemorrhoids. METHOD A prospective study was conducted for all the patients (324) that underwent THD between 2011 and 2016 in Naas General Hospital. The assessment was done for postoperative complications, symptoms pre- and postoperatively and patients' satisfaction rating. Clinical follow-up was done after 6 weeks and long-term follow-up by standardized questionnaire filled by telephonic clinic. RESULTS Of the 324 patients who underwent surgery, 256 (79.0%) participated in the study. There were 119 (46.5%) males and 137 (53.5%) females. The average age of patients was 48.40 years (17-82). Two hundred and fifteen (84.0%) patients had no recurrence. Forty-one (16.0%) had recurrence requiring further treatment. There was statistically significant higher recurrence in patients with grade 3 and 4 haemorrhoids and per-rectal bleeding (p < 0.05) while there was no statistically significant recurrence for age, gender, sedentary lifestyle and constipation/pruritus. Two hundred and twenty-four (87.5%) patients were completely satisfied from the procedure and highly recommend the procedure. CONCLUSION THD is a comparably pain-free procedure with improved results that prides in higher long-term satisfaction, minimal recurrence and fewer complications, in comparison to other surgical modalities.
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Affiliation(s)
- Qurat Ul Ain
- General Surgery Department, Naas General Hospital, Naas, Co. Kildare, Ireland.
| | - Yasir Bashir
- General Surgery Department, Naas General Hospital, Naas, Co. Kildare, Ireland
| | - Emmanuel Eguare
- General Surgery Department, Naas General Hospital, Naas, Co. Kildare, Ireland
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Ratto C, Campennì P, Papeo F, Donisi L, Litta F, Parello A. Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: a single-center study on 1000 consecutive cases and a review of the literature. Tech Coloproctol 2017; 21:953-962. [PMID: 29170839 PMCID: PMC5830492 DOI: 10.1007/s10151-017-1726-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 09/19/2017] [Indexed: 01/12/2023]
Abstract
Background The 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. Methods In 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. Results There 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. Conclusions Our 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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Affiliation(s)
- Carlo Ratto
- Proctology Unit, University Hospital "A. Gemelli", Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy.
| | - Paola Campennì
- Proctology Unit, University Hospital "A. Gemelli", Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Francesco Papeo
- Proctology Unit, University Hospital "A. Gemelli", Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Lorenza Donisi
- Proctology Unit, University Hospital "A. Gemelli", Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Francesco Litta
- Proctology Unit, University Hospital "A. Gemelli", Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Angelo Parello
- Proctology Unit, University Hospital "A. Gemelli", Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
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Leung ALH, Cheung TPP, Tung K, Tsang YP, Cheung H, Lau CW, Tang CN. A prospective randomized controlled trial evaluating the short-term outcomes of transanal hemorrhoidal dearterialization versus tissue-selecting technique. Tech Coloproctol 2017; 21:737-743. [DOI: 10.1007/s10151-017-1669-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 06/19/2017] [Indexed: 12/22/2022]
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20
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Leardi S, Pessia B, Mascio M, Piccione F, Schietroma M, Pietroletti R. Doppler-Guided Transanal Hemorrhoidal Dearterialization (DG-THD) Versus Stapled Hemorrhoidopexy (SH) in the Treatment of Third-Degree Hemorrhoids: Clinical Results at Short and Long-Term Follow-Up. J Gastrointest Surg 2016; 20:1886-1890. [PMID: 27601250 DOI: 10.1007/s11605-016-3220-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 07/20/2016] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The stapled hemorrhoidopexy (SH) and the Doppler-guided transanal hemorrhoidal dearterialization (DG-THD) are minimally invasive procedures for the surgical treatment of hemorrhoids. This study aims to verify the efficacy of the DG-THD versus the SH in the treatment of third-degree hemorrhoids. METHOD One hundred consecutive patients were causally allocated to either procedure, obtaining two groups of 50 pts. A clinical examination was performed at 3, 7, 15, and 30 days after the operation. Quality of life, anal symptoms, recurrence of hemorrhoids, and reoperation were assessed by means of a questionnaire and of a clinical examination at long-term follow-up (7.0 year average). RESULTS At short-term follow-up, the median postoperative pain score was significantly lower in DG-THD group compared to SH group, (V.A.S 2 vs 6; t = 2.65, p < 0.01). The morbidity rate and the return to normal life and work were similar after the two procedures. At long-term follow-up, the incidence of piles was not statistically different between the two groups (DG-THD 10.0 %; SH 14.0 %). No differences were reported by patients in terms of satisfaction for surgery. CONCLUSION SH and DG-THD procedures do not show significantly different results with regard to the patients outcome. However, considering the lower p. o. pain, the DG-THD might be proposed as the first line treatment in third-degree hemorrhoids.
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Affiliation(s)
- S Leardi
- Surgery Unit-Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy.
- Dipartimento Scienze Cliniche Applicate e Biotecnologie, Ospedale Civile San Salvatore, Università degli Studi di L'Aquila, Edificio Delta 6, 67100, L'Aquila, Italy.
| | - B Pessia
- Surgery Unit-Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - M Mascio
- Surgery Unit-Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - F Piccione
- Surgery Unit-Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - M Schietroma
- Surgery Unit-Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - R Pietroletti
- Department of Life, Health and Environmental Sciences MeSVA, University of L'Aquila, L'Aquila, Italy
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21
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Bjelanovic Z, Draskovic M, Veljovic M, Lekovic I, Karanikolas M, Stamenkovic D. Transanal hemorrhoid dearterialization is a safe and effective outpatient procedure for the treatment of hemorrhoidal disease. Cir Esp 2016; 94:588-594. [PMID: 27771095 DOI: 10.1016/j.ciresp.2016.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/30/2016] [Accepted: 07/09/2016] [Indexed: 12/15/2022]
Abstract
INTRODUCTION This prospective, observational study evaluated transanal dearterialization (THD) efficacy and safety in grade 2-4 hemorrhoids (HD). METHODS THD was performed under sedation-locoregional anesthesia in 402 outpatients. Patients had follow-up evaluation 3 days, 2 weeks, 1, 6 and 12 months postoperatively. Postoperative complications and recurrence of symptoms at 12 months were analyzed. The relationship between the learning curve and the number of postoperative complications was studied. RESULTS Mean patient age was 46.4 (range 20-85) years. A total of 268 patients (66.6%) were male. Sixteen patients (4.0%) had grade 2 HD, 210 (52.2%) had grade 3 and 176 (43.8%) had grade 4 HD. Surgery lasted 23 (17-34) min. A total of 67 patients had complications: bleeding in 10 patients (2.5%), hemorrhoidal thromboses in 10 (2.5%), perianal fistulas in 5 (1.2%), fissures in 14 (3.5%), urinary retention in 3 (0.8%), residual prolapse in 19 (4.7%), severe anal pain in 3 (0.8%), and perianal abscess in 3 patients (0.8%). Recurrent HD occurred in 6.3% (1/16) of grade 2 HD patients, 5.8% (12/210) of grade 3 patients and 9.7% (17/176) of grade 4 patients. Twelve months after THD, bleeding was controlled in 363 patients (90.5%), prolapse was controlled in 391 (97.3%) and pain markedly improved in 390 patients (97%). CONCLUSION THD appears safe and effective for grade 2-4 HD, and the number of complications decreased with increasing surgeon experience. THD advantages include mild pain, fast recovery, early return to daily activities and low incidence of complications.
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Affiliation(s)
- Zoran Bjelanovic
- Clinic for Vascular and Endovascular Surgery, Military Medical Academy, Belgrado, Serbia.
| | - Miroljub Draskovic
- Clinic for Vascular and Endovascular Surgery, Military Medical Academy, Belgrado, Serbia
| | - Milic Veljovic
- Clinic for Anesthesiology and Intensive Care, Military Medical Academy, Belgrado, Serbia
| | - Ivan Lekovic
- Clinic for Vascular and Endovascular Surgery, Military Medical Academy, Belgrado, Serbia
| | - Menelaos Karanikolas
- Department of Anesthesiology, Washington University School of Medicine, San Luis, Misuri, Estados Unidos
| | - Dusica Stamenkovic
- Clinic for Anesthesiology and Intensive Care, Military Medical Academy, Belgrado, Serbia
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Miyamoto H, Hada T, Ishiyama G, Ono Y, Watanabe H. Aluminum potassium sulfate and tannic acid sclerotherapy for Goligher Grades II and III hemorrhoids: Results from a multicenter study. World J Hepatol 2016; 8:844-849. [PMID: 27458504 PMCID: PMC4945504 DOI: 10.4254/wjh.v8.i20.844] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/30/2016] [Accepted: 06/16/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To show that aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy has a high success rate for Grade II and III hemorrhoids.
METHODS: This study was based on the clinical data of 604 patients with hemorrhoids who underwent ALTA sclerotherapy between January 2009 and February 2015. The objective of this study was to assess the efficacy of this treatment for Grades II and III hemorrhoids. Preoperative and postoperative symptoms, complications and success rate were all assessed retrospectively. Follow-up consisted of a simple questionnaire, physical examination and an anoscopy. Patients were followed-up at one day, one week, two weeks, one month, one year, two years, three years, four years and five years after the ALTA sclerotherapy.
RESULTS: One hundred and sixty-nine patients were diagnosed with Grade II hemorrhoids and 435 patients were diagnosed with Grade III hemorrhoids. The one year, three year and five year cumulative success rates of ALTA sclerotherapy for Grades II and III hemorrhoids were 95.9% and 93.1%; 89.3% and 83.7%; and 89.3% and 78.2%, respectively. No significant differences were observed in the cumulative success rates after ALTA sclerotherapy between Grades II and III hemorrhoids (P = 0.09). There were forty-seven post-operative complications (low grade fever; anal pain; urinary retention; rectal ulcer; and others). No serious or life-threatening complications occurred and all cases improved through conservative treatment. At univariate analysis there were no predictive factors of failure.
CONCLUSION: ALTA sclerotherapy has had a high success rate for Grade II and III hemorrhoids during five years of post-operative treatment. However, additional studies are needed to evaluate the efficacy of this ALTA sclerotherapy in the management of hemorrhoidal disease.
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Transanal hemorrhoidal dearterialization (THD): a safe procedure for the anticoagulated patient? Tech Coloproctol 2016; 20:461-6. [PMID: 27170327 PMCID: PMC4920854 DOI: 10.1007/s10151-016-1481-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 04/28/2016] [Indexed: 01/01/2023]
Abstract
Background Approximately one in five persons living in the USA is maintained on oral anticoagulation. It has typically been recommended that anticoagulation be withheld prior to hemorrhoidal procedures. Transanal hemorrhoidal dearterialization (THD) is a minimally invasive treatment for symptomatic hemorrhoids, and outcomes with patients on anticoagulation who have undergone this procedure have not been previously reported. Here, we report our preliminary results of patients who underwent THD while on anticoagulation. Methods During a 53-month period (February 2009–July 2015), patients with symptomatic hemorrhoids refractory to medical management who underwent surgical treatment with THD were retrospectively reviewed. The subset of patients who underwent THD while anticoagulated was compared to a cohort of patient who were not taking anticoagulation and who otherwise demonstrated normal coagulation profiles and who did not have a known predisposition to bleeding or inherited coagulopathy. The primary study endpoint was to assess postoperative bleeding in patients who were maintained on anticoagulation before and after surgery. Results During the 53-month study period, 106 patients underwent the THD procedure for symptomatic hemorrhoids. Of these, seventy patients underwent THD without anticoagulation therapy, while 36 patients underwent THD while taking one or more oral anticoagulants. The postoperative morbidity between the two cohorts was similar, and specifically there was no statistical difference in the rate of postoperative hemorrhage (19.4 vs. 15.7 %; odds ratio 1.295, 95 % CI 0.455–3.688, p = 0.785). No patient, in either cohort, required re-intervention for any reason during the study period. Patients who underwent THD while on anticoagulation were less likely to have recurrent hemorrhoidal disease during the study’s 6-month median follow-up period (2.8 vs. 7.1 %, p = 0.049). Conclusions These preliminary data reveal that THD can be performed on anticoagulated patients without cessation of oral agents without increasing morbidity from postoperative bleeding.
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Figueiredo MN, Campos FG. Doppler-guided hemorrhoidal dearterialization/transanal hemorrhoidal dearterialization: Technical evolution and outcomes after 20 years. World J Gastrointest Surg 2016; 8:232-237. [PMID: 27022450 PMCID: PMC4807324 DOI: 10.4240/wjgs.v8.i3.232] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 12/19/2015] [Accepted: 01/22/2016] [Indexed: 02/06/2023] Open
Abstract
In the setting of Hemorrhoidal Disease treatment, the option of conventional hemorrhoidectomy is highly effective, but it is still associated with postoperative pain and discomfort. For this reason, technical alternatives have been developed in order to reduce complications and to provide better postoperative recovery. To accomplish this aim, non-excisional techniques such as stapled hemorrhoidectomy and Doppler-guided hemorrhoidal ligation have been introduced into clinical practice with high expectations. The aim of this article is to revise the literature about transanal hemorrhoidal dearterialization technique in the treatment of hemorrhoidal disease, looking into its evolution, results and possible benefits over other modalities of surgical treatment. The literature review showed that Doppler-guided hemorrhoidal dearterialization is a safe and effective method to treat grades II to IV hemorrhoidal disease. Outcomes in patients presenting prolapse are satisfactory and the association of anopexy is an important aspect of this operation. Anal physiology disturbances are rarely observed and mainly transitory. This technique is an excellent option for every patient, especially in those with previous anal surgeries and in patients with previous alterations of fecal continence, when an additional procedure might represent a risk of definitive incontinence.
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Trompetto M, Clerico G, Cocorullo GF, Giordano P, Marino F, Martellucci J, Milito G, Mistrangelo M, Ratto C. Evaluation and management of hemorrhoids: Italian society of colorectal surgery (SICCR) consensus statement. Tech Coloproctol 2015; 19:567-575. [PMID: 26403234 DOI: 10.1007/s10151-015-1371-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 09/05/2015] [Indexed: 02/07/2023]
Abstract
Hemorrhoids are one of the most common medical and surgical diseases and the main reason for a visit to a coloproctologist. This consensus statement was drawn up by the Italian society of colorectal surgery in order to provide practice parameters for an accurate assessment of the disease and consequent appropriate treatment. The authors made a careful search in the main databases (MEDLINE, PubMed, Embase and Cochrane), and all results were classified on the basis of the grade of recommendation (A-C) of the American College of Chest Physicians.
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Affiliation(s)
- M Trompetto
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy.
| | - G Clerico
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
| | - G F Cocorullo
- Unit of Emergency and General Surgery, Department of Surgical Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - P Giordano
- Department of Colorectal Surgery, Barts Health, London, UK
| | - F Marino
- Department of General Surgery, "A. Perrino" Hospital, Brindisi, Italy
| | - J Martellucci
- General, Emergency and Minimally Invasive Surgery, Careggi University Hospital, Florence, Italy
| | - G Milito
- Department of General Surgery, Tor Vergata University, Rome, Italy
| | - M Mistrangelo
- Department of General and Minimally Invasive Surgery, University of Turin, Turin, Italy
| | - C Ratto
- Proctology Unit, University Hospital "A Gemelli", Catholic University, Rome, Italy
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Simillis C, Thoukididou SN, Slesser AAP, Rasheed S, Tan E, Tekkis PP. Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids. Br J Surg 2015; 102:1603-18. [PMID: 26420725 DOI: 10.1002/bjs.9913] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/08/2015] [Accepted: 07/08/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND The aim was to compare the clinical outcomes and effectiveness of surgical treatments for haemorrhoids. METHODS Randomized clinical trials were identified by means of a systematic review. A Bayesian network meta-analysis was performed using the Markov chain Monte Carlo method in WinBUGS. RESULTS Ninety-eight trials were included with 7827 participants and 11 surgical treatments for grade III and IV haemorrhoids. Open, closed and radiofrequency haemorrhoidectomies resulted in significantly more postoperative complications than transanal haemorrhoidal dearterialization (THD), LigaSure™ and Harmonic® haemorrhoidectomies. THD had significantly less postoperative bleeding than open and stapled procedures, and resulted in significantly fewer emergency reoperations than open, closed, stapled and LigaSure™ haemorrhoidectomies. Open and closed haemorrhoidectomies resulted in more pain on postoperative day 1 than stapled, THD, LigaSure™ and Harmonic® procedures. After stapled, LigaSure™ and Harmonic® haemorrhoidectomies patients resumed normal daily activities earlier than after open and closed procedures. THD provided the earliest time to first bowel movement. The stapled and THD groups had significantly higher haemorrhoid recurrence rates than the open, closed and LigaSure™ groups. Recurrence of haemorrhoidal symptoms was more common after stapled haemorrhoidectomy than after open and LigaSure™ operations. No significant difference was identified between treatments for anal stenosis, incontinence and perianal skin tags. CONCLUSION Open and closed haemorrhoidectomies resulted in more postoperative complications and slower recovery, but fewer haemorrhoid recurrences. THD and stapled haemorrhoidectomies were associated with decreased postoperative pain and faster recovery, but higher recurrence rates. The advantages and disadvantages of each surgical treatment should be discussed with the patient before surgery to allow an informed decision to be made.
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Affiliation(s)
- C Simillis
- Department of Colorectal Surgery, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
| | - S N Thoukididou
- Department of Colorectal Surgery, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
| | - A A P Slesser
- Department of Colorectal Surgery, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
| | - S Rasheed
- Department of Colorectal Surgery, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
| | - E Tan
- Department of Colorectal Surgery, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
| | - P P Tekkis
- Department of Colorectal Surgery, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK
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Treatment of Internal Hemorrhoids by Endoscopic Sclerotherapy with Aluminum Potassium Sulfate and Tannic Acid. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2015; 2015:517690. [PMID: 26246785 PMCID: PMC4515268 DOI: 10.1155/2015/517690] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 06/27/2015] [Accepted: 07/01/2015] [Indexed: 12/16/2022]
Abstract
Objective. A new sclerosing agent for hemorrhoids, aluminum potassium sulfate and tannic acid (ALTA), is attracting attention as a curative treatment for internal hemorrhoids without resection. The outcome and safety of ALTA sclerotherapy using an endoscope were investigated in the present study. Materials and Methods. Subjects comprised 83 internal hemorrhoid patients (61 males and 22 females). An endoscope was inserted and retroflexed in the rectum, and a 1st-step injection was applied to the upper parts of the hemorrhoids. The retroflexed scope was returned to the normal position, and 2nd–4th-step injections were applied to the middle and lower parts of the hemorrhoids under direct vision. The effects of endoscopic ALTA sclerotherapy were determined by evaluating the condition of the hemorrhoids using an anoscope and interviewing the patient 28 days after the treatment. Results. A cure, improvement, and failure were observed in 54 (65.1%), 27 (32.5%), and 2 (2.4%) patients, respectively, treated with ALTA. Complications developed in 4 patients (mild fever in 3 and hematuria in 1). Recurrence occurred in 9.6%. Conclusions. The results of the present study suggest that endoscopic ALTA has the potential to become a useful and minimally invasive approach for ALTA sclerotherapy.
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Ambulatory haemorrhoidal surgery: systematic literature review and qualitative analysis. Int J Colorectal Dis 2015; 30:437-45. [PMID: 25427629 DOI: 10.1007/s00384-014-2073-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE The aims of this study are to review the advantages and drawbacks of the ambulatory management of patients scheduled for haemorrhoidal surgery and to highlight the reasons for unplanned hospital admission and suggest preventive strategies. METHODS We conducted a systematic review of the literature from January 1999 to January 2013 using MEDLINE and EMBASE databases. Manuscripts were specifically analysed for failure and side effects of haemorrhoidal surgery in ambulatory settings. RESULTS Fifty relevant studies (6082 patients) were retrieved from the literature review. The rate of ambulatory management failure ranged between 0 and 61%. The main reasons for failure were urinary retention, postoperative haemorrhage and unsatisfactory pain control. Spinal anaesthesia was associated with the highest rates of urinary retention. Doppler-guided haemorrhoidal artery ligation has less frequent side effects susceptible to impair ambulatory management than haemorrhoidectomy and stapled haemorrhoidopexy. However, the fact that haemorrhoidopexy is less painful than haemorrhoidectomy may allow ambulatory management. CONCLUSION Day-case haemorrhoidal surgery can be performed whatever the surgical procedure. Postoperative pain deserves special prevention measures after haemorrhoidectomy, especially by using perineal block or infiltrations. Urinary retention is a common issue that can be responsible for failure; it requires a preventive strategy including short duration spinal anaesthesia. Doppler-guided haemorrhoidal artery ligation is easy to perform in outpatients but deserves more complete evaluation in this setting.
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Noguerales F, Díaz R, Salim B, Piniella F, Landaluce A, Garcea A, de Mata López Pérez J. Tratamiento de la enfermedad hemorroidal mediante desarterialización y hemorroidopexia. Experiencia de varias unidades especializadas☆. Cir Esp 2015; 93:236-40. [DOI: 10.1016/j.ciresp.2014.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 03/28/2014] [Accepted: 04/11/2014] [Indexed: 01/19/2023]
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LaBella GD, Main WPL, Hussain LR. Evaluation of transanal hemorrhoidal dearterialization: a single surgeon experience. Tech Coloproctol 2015; 19:153-7. [PMID: 25637412 PMCID: PMC4369582 DOI: 10.1007/s10151-015-1269-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 12/20/2014] [Indexed: 02/08/2023]
Abstract
Background
There is an increasing, though still limited, amount of evidence describing the use of the transanal hemorrhoidal dearterialization (THD) device for the treatment of hemorrhoidal disease. This study assesses postoperative outcomes from a single surgeon experience with the THD device. Methods From January 2009 to December 2011, 108 THD procedures were performed. With Doppler guidance, the THD device makes possible precise ligation of the branches of the superior hemorrhoidal artery. Patients were seen postoperatively at 3 weeks and 6 months. They underwent physical examination to determine whether there was recurrence of hemorrhoidal prolapse. They were asked to describe any bleeding, to rate pain using the visual analog scale, and to rate their level of satisfaction on a scale of 1–5 (with 5 = highly satisfied). A phone interview was used for follow-up at 1 year to determine the rate of recurrent prolapse. Results Of the 108 patients who underwent THD, two were lost to follow-up and excluded. All of the remaining 106 patients completed follow-up at 3 weeks and 6 months. At 3 weeks, 92 % of patients had no pain and 88 % were highly satisfied with the procedure at 3 weeks. This increased to 92 % satisfaction at 1 year. Prolapse recurrence was 7.5 % at 6 months and 10.3 % at 1 year. Bleeding was the most common complication, but did not require re-intervention or transfusion. Conclusions THD is a same-day procedure for the treatment of hemorrhoidal disease that is safe and effective, and offers the potential for immediate return to normal activity.
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Affiliation(s)
- G D LaBella
- Division of Colon and Rectal Surgery and Trauma Surgery, Department of Surgery, Bethesda North and Good Samaritan TriHealth Hospital, Cincinnati, OH, USA,
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Ratto C, Parello A, Veronese E, Cudazzo E, D'Agostino E, Pagano C, Cavazzoni E, Brugnano L, Litta F. Doppler-guided transanal haemorrhoidal dearterialization for haemorrhoids: results from a multicentre trial. Colorectal Dis 2015; 17:O10-9. [PMID: 25213152 DOI: 10.1111/codi.12779] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 08/20/2014] [Indexed: 12/11/2022]
Abstract
AIM This multicentre study, based on the largest patient population ever published, aims to evaluate the efficacy of Doppler-guided transanal haemorrhoidal dearterialization (THD Doppler) in the treatment of symptomatic haemorrhoids and to identify the factors predicting failure for an effective mid-term outcome. METHOD Eight hundred and three patients affected by Grade II (137, 17.1%), III (548, 68.2%) and IV (118, 14.7%) symptomatic haemorrhoidal disease underwent THD Doppler, with a rectal mucopexy in patients with haemorrhoidal prolapse. The disease was assessed through a specifically designed symptom questionnaire and scoring system. A uni- and multivariate analyses of the potential predictive factors for failure were performed. RESULTS The morbidity rate was 18.0%, represented mainly by pain or tenesmus (106 patients, 13.0%). Acute bleeding requiring surgical haemostasis occurred in seven patients (0.9%). No serious or life-threatening complications occurred. After a mean follow-up period of 11.1 ± 9.2 months, the overall success rate was 90.7% (728 patients), with a recurrence of haemorrhoidal prolapse, bleeding, and both symptoms in 51 (6.3%), 19 (2.4%) and 5 (0.6%) patients, respectively. Sixteen out of 47 patients undergoing re-operation had a conventional haemorrhoidectomy. All the symptoms were significantly improved in each domain of the score (P < 0.0001). At multivariate analysis the absence of morbidity and performance of a distal Doppler-guided dearterialization were associated with a better outcome. CONCLUSION THD Doppler is a safe and effective therapy for haemorrhoidal disease. If this technique is to be employed, an accurate distal Doppler-guided dearterialization and a tailored mucopexy are mandatory to contain and reduce the symptoms.
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Affiliation(s)
- C Ratto
- Proctology Unit, Department of Surgical Sciences, Catholic University, Rome, Italy
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Ratto C, de Parades V. Doppler-guided ligation of hemorrhoidal arteries with mucopexy: A technique for the future. J Visc Surg 2014; 152:S15-21. [PMID: 25262549 DOI: 10.1016/j.jviscsurg.2014.08.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE The transanal hemorrhoidal de-arterialization (THD) procedure is an effective treatment of hemorrhoidal disease. The ligation of hemorrhoidal arteries ("de-arterialization") can provide a significant reduction of arterial blood flow to the hemorrhoidal tissues. Plication of redundant rectal mucosa/submucosa ("mucopexy") can reposition prolapsing tissue to its original anatomical site. In this paper the surgical technique using a specific device (THD(®) Doppler) and peri-operative patient management are illustrated. METHODS After appropriate clinical assessment, patients undergo the THD procedure under general or spinal anesthesia, in either the dorsal lithotomy or prone jackknife position. A specifically designed device is used. In all patients, THD is performed, consisting of selective ligation of hemorrhoidal arteries identified by Doppler and marked with a mucosal stitch overlying the artery. In patients with hemorrhoidal or mucosal prolapse, a mucopexy is also performed using continuous suture(s) that include the redundant prolapsing mucosa and submucosa. RESULTS In long-term follow-up, THD results in resolution of symptoms in the majority of patients. The most common complication is transient but sometimes-painful tenesmus. Rectal bleeding occurs in only a very limited number of patients. There is little or no risk of fecal incontinence or chronic pain. Ano-rectal manometry and endo-anal ultrasound show no evidence of injury to physiologic sphincteric function. CONCLUSIONS THD is a safe procedure and is, at present, one of the most effective treatments of hemorrhoidal disease.
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Affiliation(s)
- C Ratto
- Proctology Unit, Catholic University, 8, Largo A. Gemelli, 00168 Rome, Italy.
| | - V de Parades
- Service de Proctologie Médico-Chirurgicale, Groupe hospitalier Paris Saint-Joseph, Institut Léopold-Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
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Tsang YP, Fok KLB, Cheung YSH, Li KWM, Tang CN. Comparison of transanal haemorrhoidal dearterialisation and stapled haemorrhoidopexy in management of haemorrhoidal disease: a retrospective study and literature review. Tech Coloproctol 2014; 18:1017-22. [PMID: 24906978 DOI: 10.1007/s10151-014-1170-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 05/10/2014] [Indexed: 01/23/2023]
Abstract
BACKGROUND The aim of this study was to evaluate and compare transanal haemorrhoidal dearterialisation (THD) and stapled haemorrhoidopexy [also called procedure for prolapsed haemorrhoids (PPH)] in the management of haemorrhoidal disease, in terms of short-term outcomes and efficacy. METHODS Patients presenting with symptomatic haemorrhoids were treated with THD. Patient demographics, pre-operative data, post-operative pain scores, complications, recurrence, and patient satisfaction scores were evaluated and recorded. Patients with acute thrombosed haemorrhoids, external haemorrhoids only, or other concomitant anal diseases were excluded. These data were compared with the historical data of PPH. RESULTS Forty consecutive patients underwent THD from February 2012 to July 2013 and were compared to 37 patients who underwent PPH taken from a medical records database. There were no significant differences in terms of demographic data, type of anaesthesia, operative time, and blood loss. Length of hospital stay, time to first post-operative bowel movement, and complications were similar between the two groups. The median pain score after THD and PPH was 1.71 and 5.00, respectively, on a scale of 0-10 (10 = worst possible pain) (p = 0.000). There was a significant improvement in bleeding and prolapse scores after THD. THD patients had an earlier return to normal daily activities (3.13 vs. 6.78 days, p = 0.001) when compared with the PPH group. Upon follow-up, patients in both groups had similar satisfaction scores, and complication and recurrence rates. CONCLUSIONS Both THD and PPH appear to be safe procedures for haemorrhoidal disease, and they appear to have similar short-term outcomes. In particular, THD seems to be associated with a lower pain score than PPH, an earlier return to normal daily activities, and similar rates of complication and recurrence.
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Affiliation(s)
- Y P Tsang
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hongkong, SAR, China,
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Tsunoda A, Kiyasu Y, Fujii W, Kano N. Comparison of the early results of transanal hemorrhoidal dearterialization and hemorrhoidectomy using an ultrasonic scalpel. Surg Today 2014; 45:175-80. [DOI: 10.1007/s00595-014-0885-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 03/03/2014] [Indexed: 01/12/2023]
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Miyamoto H, Asanoma M, Miyamoto H, Takasu C, Masamune K, Shimada M. Visualization and hypervascularization of the haemorrhoidal plexus in vivo using power Doppler imaging transanal ultrasonography and three-dimensional power Doppler angiography. Colorectal Dis 2013; 15:e686-91. [PMID: 24034699 DOI: 10.1111/codi.12406] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 05/07/2013] [Indexed: 01/13/2023]
Abstract
AIM The purpose of this study was to demonstrate the distribution of haemorrhoidal arteries and the relationship between vascularity and growth of haemorrhoids. METHOD One-hundred and three patients with haemorrhoids were studied. Using power Doppler imaging (PDI) transanal ultrasound and three-dimensional power Doppler angiography (3D-PDA), the course of the arteries supplying the haemorrhoids was identified. Measurement of the PDI area was made using the cursor to outline the power Doppler signal of the haemorrhoid, approximately 1 cm above the dentate line. RESULTS The haemorrhoidal arteries were seen as branches of the superior rectal artery and were detected in 75.7, 71.8, 68.0 and 62.1% of the 11, 7, 3 and 1 o'clock positions in the lithotomy position. The median number of haemorrhoidal arteries significantly increased from three to six with progression of the Goligher classification from Grade 1 to Grade 4 (P < 0.0001). The PDI areas in Grades 1, 2, 3 and 4 were 0.04 ± 0.03, 0.18 ± 0.07, 0.38 ± 0.18 and 0.96 ± 0.32 cm(2) (P < 0.05). CONCLUSION The distribution of haemorrhoidal arteries varies widely in both number and position. Using PDI transanal ultrasonography and 3D-PDA it was possible to visualize the haemorrhoid plexus and the course of the haemorrhoidal artery in vivo.
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Affiliation(s)
- H Miyamoto
- Department of Surgery and Proctologic Surgery, Miyamoto Hospital, Anan, Japan; Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan
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Altomare DF, Giuratrabocchetta S. Conservative and surgical treatment of haemorrhoids. Nat Rev Gastroenterol Hepatol 2013; 10:513-21. [PMID: 23752820 DOI: 10.1038/nrgastro.2013.91] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The management of haemorrhoids has evolved rapidly during the past few decades. Several new treatments have been proposed with the aim of reducing patients' postoperative pain, time to return to normal life, risk of early and late complications, and recurrence rate. Although conservative treatment based on dietary and lifestyle changes can help the majority of patients, and rubber band ligation and phlebotonic drugs can effectively treat grade I and II haemorrhoids, surgery is required for the most advanced stages. Milligan-Morgan haemorrhoidectomy is considered to be the gold-standard approach for grade IV haemorrhoids. An increasing number of minimally invasive treatment options, including mucopexy with or without mucosal resection and haemorrhoid artery ligation, have now been proposed for the management of grade III haemorrhoids. These approaches aim to correct the underlying pathophysiological mechanisms involved in the aetiology of haemorrhoids. An increased risk of recurrence is the price to pay for these minimally invasive and less painful treatments, but the sparing of the sensitive anoderm and a rapid return to normal life without pain are greatly appreciated by patients. An algorithm for the management of haemorrhoids using evidence-based medicine is also presented here.
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Affiliation(s)
- Donato F Altomare
- Department of Emergency and Organ Transplantation, Policlinico Universitario Bari, Piazza G. Cesare, 11-70124 Bari, Italy
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Pucher PH, Sodergren MH, Lord AC, Darzi A, Ziprin P. Clinical outcome following Doppler-guided haemorrhoidal artery ligation: a systematic review. Colorectal Dis 2013; 15:e284-94. [PMID: 23489678 DOI: 10.1111/codi.12205] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 01/13/2013] [Indexed: 12/26/2022]
Abstract
AIM Doppler-guided haemorrhoidal artery ligation (DGHL) has experienced wider uptake and has recently received National Institute for Health and Clinical Excellence (NICE) approval in the UK. A systematic review of the literature was conducted to assess its safety and efficacy. METHOD This review was conducted in keeping with PRISMA guidelines. MEDLINE, EMBASE, Google Scholar and Cochrane Library databases were searched. Studies describing DGHL as a primary procedure and reporting clinical outcome were considered. Primary end-points were recurrence and postoperative pain. Secondary end-points included operation time, complications and reintervention rates. Studies were scored for quality with either Jadad score or NICE scoring guidelines. RESULTS Twenty-eight studies including 2904 patients were included in the final analysis. They were of poor overall quality. Recurrence ranged between 3% and 60% (pooled recurrence rate 17.5%), with the highest rates for grade IV haemorrhoids. Postoperative analgesia was required in 0-38% of patients. Overall postoperative complication rates were low, with an overall bleeding rate of 5% and an overall reintervention rate of 6.4%. The operation time ranged from 19 to 35 min. CONCLUSION DGHL is safe and efficacious with a low level of postoperative pain. It can be safely considered for primary treatment of grade II and III haemorrhoids.
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Affiliation(s)
- P H Pucher
- Department of Surgery and Cancer, Imperial College London, London, UK
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Lucarelli R, Picchio M, Caporossi M, De Angelis F, Di Filippo A, Stipa F, Spaziani E. Transanal haemorrhoidal dearterialisation with mucopexy versus stapler haemorrhoidopexy: a randomised trial with long-term follow-up. Ann R Coll Surg Engl 2013; 95:246-51. [PMID: 23676807 PMCID: PMC4132497 DOI: 10.1308/003588413x13511609958136] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2012] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The present study aimed to compare the long-term results of transanal haemorrhoidal dearterialisation (THD) with mucopexy and stapler haemorrhoidopexy (SH) in treatment of grade III and IV haemorrhoids. METHODS One hundred and twenty-four patients with grade III and IV haemorrhoids were randomised to receive THD with mucopexy (n=63) or SH (n=61). A telephone interview with a structured questionnaire was performed at a median follow-up of 42 months. The primary outcome was the occurrence of recurrent prolapse. Patients, investigators and those assessing the outcomes were blinded to group assignment. RESULTS Recurrence was present in 21 patients (16.9%). It occurred in 16 (25.4%) in the THD group and 5 (8.2%) in the SH group (p=0.021). A second surgical procedure was performed in eight patients (6.4%). Reoperation was open haemorrhoidectomy in seven cases and SH in one case. Five patients out of six in the THD group and both patients in the SH group requiring repeat surgery presented with grade IV haemorrhoids. No significant difference was found between the two groups with respect to symptom control. Patient satisfaction for the procedure was 73.0% after THD and 85.2% after SH (p=0.705). Postoperative pain, return to normal activities and complications were similar. CONCLUSIONS The recurrence rate after THD with mucopexy is significantly higher than after SH at long-term follow-up although results are similar with respect to symptom control and patient satisfaction. A definite risk of repeat surgery is present when both procedures are performed, especially for grade IV haemorrhoids.
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Affiliation(s)
| | - M Picchio
- Hospital ‘Paolo Colombo’, Rome,Italy
| | | | | | | | - F Stipa
- Hospital ‘San Giovanni-Addolorata’, Rome,Italy
| | - E Spaziani
- University of Rome ‘La Sapienza’, Latina,Italy
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Sobrado-Junior CW, Hora JAB. Transanal desarterialization guided by Doppler associated to anorectal repair in hemorrhoids: THD technic. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2013; 25:293-7. [PMID: 23411932 DOI: 10.1590/s0102-67202012000400016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 08/13/2012] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Surgical treatment for hemorrhoids should be indicated individually and is based on the predominant symptom (bleeding or prolapse), severity of disease and the presence or absence of external component (plicoma). Surgeons must choose among varied techniques the one suitable for each case. TECHNIC The THD procedure consists of Doppler guided high ligation, selective to up six submucosal arterial branches that supply the hemorrhoids, leading to its desarterialization associated with prolapse repair (anorectal repair or lifting). It uses special equipment and kit. CONCLUSION THD technique has shown good initial results. Because surgical technique respects the anatomy, it acts directly on the pathophysiology of the disease and corrects its principal consequences; it looks quite promising. Its initial application may be in patients with hemorrhoids grade II, which have surgical indication, grades III and IV, the latter being associated with resection of plicomas.
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Miyamoto H, Asanoma M, Miyamoto H, Takasu C, Shimada M. Three-dimensional power Doppler transanal ultrasonography, to monitor haemorrhoidal blood flow after Doppler-guided ALTA sclerosing therapy. Colorectal Dis 2013; 15:e84-8. [PMID: 22966905 DOI: 10.1111/codi.12024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM The study aimed to use power Doppler imaging (PDI) transanal ultrasonography to produce three-dimensional power Doppler angiography images of haemorrhoidal tissue and to monitor the effects of Doppler-guided aluminium potassium sulfate and tannic acid (DGALTA) sclerotherapy. METHOD Ninety-six haemorrhoids in 43 patients were examined using PDI transanal ultrasonography, and DGALTA sclerotherapy was performed from April 2011 to April 2012. DGALTA sclerotherapy was conducted using a four-step injection process with pulse wave Doppler ultrasound under perianal local anaesthesia. RESULTS A three-dimensional power Doppler angiography image of the blood flow in haemorrhoidal tissue was produced using PDI transanal ultrasonography. The cross-sectional area of blood flow in the haemorrhoidal tissue (PDI area) significantly decreased after DGALTA sclerotherapy. The PDI areas in the preoperative state and 1 and 3 months after treatment were 0.35±0.27, 0.03±0.05 and 0.04±0.05 cm(2) (P<0.0001). CONCLUSION A three-dimensional power Doppler angiography image of the haemorrhoidal tissue was technically possible and showed blood flow in the haemorrhoidal tissue to be significantly decreased after DGALTA sclerotherapy.
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Affiliation(s)
- H Miyamoto
- Department of Proctologic Surgery, Miyamoto Hospital, Tokushima, Japan.
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Zampieri N, Castellani R, Andreoli R, Geccherle A. Long-term results and quality of life in patients treated with hemorrhoidectomy using two different techniques: Ligasure versus transanal hemorrhoidal dearterialization. Am J Surg 2013; 204:684-8. [PMID: 23140829 DOI: 10.1016/j.amjsurg.2012.01.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 01/17/2012] [Accepted: 01/17/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hemorrhoids are the most frequent anal pathology. We evaluated the results of 2 techniques at 1 year after surgery. METHODS The clinical charts and data of patients who underwent hemorrhoidectomy between January 2008 and June 2010 were considered and analyzed. Patients underwent surgery with 2 techniques: transanal hemorrhoidal dearterialization (THD) hemorrhoidectomy or LigaSure-vessel sealing system (Valleylab, Boulder, CO). Patients were chosen randomly to receive one technique or the other. The primary objectives were quality of life, quality of defecation, and regression of symptoms. RESULTS Forty-six patients treated with THD and 68 patients treated with Ligasure were enrolled in the study. No significant differences were observed in the rate of postoperative surgical complications or readmissions. Short- and medium-term (1-6 mo) results showed that THD patients had a higher rate of pain resolution compared with Ligasure patients (P < .05). Functionally, all patients treated with Ligasure showed more postoperative constipation despite administration of laxatives than patients treated with THD. CONCLUSIONS THD is an effective technique and is associated with the best short-term clinical and surgical outcomes if compared with Ligasure.
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Affiliation(s)
- Nicola Zampieri
- Multispecialistic Rectal-Perineal Disease Centre, Sacro Cuore, Don Calabria Hospital, Negrar, Verona, Italy.
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Ratto C, Donisi L, Parello A, Litta F, Zaccone G, De Simone V. 'Distal Doppler-guided dearterialization' is highly effective in treating haemorrhoids by transanal haemorrhoidal dearterialization. Colorectal Dis 2012; 14:e786-9. [PMID: 22731786 DOI: 10.1111/j.1463-1318.2012.03146.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIM Transanal haemorrhoidal dearterialization (THD® Doppler) is a surgical procedure involving Doppler-guided ligation of haemorrhoidal arteries to reduce arterial flow. With proximal Doppler-guided dearterialization, arterial ligation is achieved by introducing the proctoscope completely into the anal canal and lower rectum. In the present study, distal Doppler-guided dearterialization (DDD) is performed in the distal 2 cm of the lower rectum. Immediate and short-term results were evaluated. METHOD One hundred patients with bleeding haemorrhoids, with or without muco-haemorrhoidal prolapse, underwent THD® Doppler procedure, using DDD of the haemorrhoidal arteries 2 cm above the anorectal junction. Mucopexy was performed in patients with haemorrhoidal prolapse. RESULTS The operation time was 20 ± 7 min for dearterialization alone (10 patients), and 30 ± 10 min when mucopexy was added (90 patients). Morbidity included: transient haemorrhoidal thrombosis (two patients); urinary retention (five patients); submucosal abscess (one patient). No patient complained of faecal incontinence. At a median follow-up of 7.3 (3-17) months, all patients reported an improvement in symptoms. No patients reported bleeding. CONCLUSION DDD of the haemorrhoidal arteries could be a simplified and more effective method of applying THD.
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Affiliation(s)
- C Ratto
- Department of Surgical Sciences, Catholic University, Rome, Italy.
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43
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Tiernan J, Hind D, Watson A, Wailoo AJ, Bradburn M, Shephard N, Biggs K, Brown S. The HubBLe trial: haemorrhoidal artery ligation (HAL) versus rubber band ligation (RBL) for haemorrhoids. BMC Gastroenterol 2012; 12:153. [PMID: 23098097 PMCID: PMC3503770 DOI: 10.1186/1471-230x-12-153] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 10/17/2012] [Indexed: 12/11/2022] Open
Abstract
Background Haemorrhoids (piles) are a very common condition seen in surgical clinics. After exclusion of more sinister causes of haemorrhoidal symptoms (rectal bleeding, perianal irritation and prolapse), the best option for treatment depends upon persistence and severity of the symptoms. Minor symptoms often respond to conservative treatment such as dietary fibre and reassurance. For more severe symptoms treatment such as rubber band ligation may be therapeutic and is a very commonly performed procedure in the surgical outpatient setting. Surgery is usually reserved for those who have more severe symptoms, as well as those who do not respond to non-operative therapy; surgical techniques include haemorrhoidectomy and haemorrhoidopexy. More recently, haemorrhoidal artery ligation has been introduced as a minimally invasive, non destructive surgical option. There are substantial data in the literature concerning efficacy and safety of 'rubber band ligation including multiple comparisons with other interventions, though there are no studies comparing it to haemorrhoidal artery ligation. A recent overview has been carried out by the National Institute for Health and Clinical Excellence which concludes that current evidence shows haemorrhoidal artery ligation to be a safe alternative to haemorrhoidectomy and haemorrhoidopexy though it also highlights the lack of good quality data as evidence for the advantages of the technique. Methods/design The aim of this study is to establish the clinical effectiveness and cost effectiveness of haemorrhoidal artery ligation compared with conventional rubber band ligation in the treatment of people with symptomatic second or third degree (Grade II or Grade III) haemorrhoids. Design: A multi-centre, parallel group randomised controlled trial. Outcomes: The primary outcome is patient-reported symptom recurrence twelve months following the intervention. Secondary outcome measures relate to symptoms, complications, health resource use, health related quality of life and cost effectiveness following the intervention. Participants: 350 patients with grade II or grade III haemorrhoids will be recruited in surgical departments in up to 14 NHS hospitals. Randomisation: A multi-centre, parallel group randomised controlled trial. Block randomisation by centre will be used, with 175 participants randomised to each group. Discussion The results of the research will help inform future practice for the treatment of grade II and III haemorrhoids. Trial Registration ISRCTN41394716
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Affiliation(s)
- Jim Tiernan
- CRUK Clinical Research Fellow, St James' University Hospital, Leeds, UK
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Gomez-Rosado JC, Sanchez-Ramirez M, Capitan-Morales LC, Valdes-Hernandez J, Reyes-Diaz ML, Cintas-Catena J, Guerrero-Garcia JM, Galan-Alvarez J, Oliva-Mompean F. Resultados a un año tras desarterialización hemorroidal guiada por doppler. Cir Esp 2012; 90:513-7. [DOI: 10.1016/j.ciresp.2012.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 02/13/2012] [Accepted: 03/01/2012] [Indexed: 11/29/2022]
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Affiliation(s)
- N P Ross
- Department of Surgery, Raigmore Hospital, Inverness, UK
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46
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Infantino A, Altomare DF, Bottini C, Bonanno M, Mancini S, Yalti T, Giamundo P, Hoch J, El Gaddal A, Pagano C. Prospective randomized multicentre study comparing stapler haemorrhoidopexy with Doppler-guided transanal haemorrhoid dearterialization for third-degree haemorrhoids. Colorectal Dis 2012; 14:205-11. [PMID: 21689317 DOI: 10.1111/j.1463-1318.2011.02628.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIM Doppler-guided transanal haemorrhoid dearterialization (THD) and stapler haemorrhoidopexy (SH) have been demonstrated to be less painful than the Milligan-Morgan procedure. The aim of this study was to compare the effectiveness of THD vs SH in the treatment of third-degree haemorrhoids in an equivalent trial. METHOD One hundred and sixty-nine patients with third-degree haemorrhoids were randomized online to receive THD (n = 85) or SH (n = 84) in 10 Colorectal Units in which the staff were well trained in both techniques. The mean follow-up period was 17 (range 15-20) months. RESULTS Early minor postoperative complications occurred in 30.6% of patients in the THD group and in 32.1% of patients in the SH group. Milder spontaneous pain and pain on defecation were reported in the THD group in the first postoperative week, but this was not statistically significant. Late complications were significantly higher (P = 0.028) in the SH group. Residual haemorrhoids persisted in 12 patients in the THD group and in six patients in the SH group (P = 0.14). Six patients in the SH group and 10 in the THD group underwent further treatment of haemorrhoids (P = 0.34). No differences were found in postoperative incontinence. The obstructed defecation score (ODS) was significantly higher in the SH group (P < 0.02). Improvement in quality of life was similar in both groups. Postoperative in-hospital stay was 1.14 days in the THD group and 1.31 days in the SH group (P = 0.03). CONCLUSION Both THD and SH techniques are effective for the treatment of third-degree haemorrhoids in the medium term. THD has a better cost-effective ratio and lower (not significant) pain compared with SH. Postoperative pain and recurrence did not differ significantly between the two groups.
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Affiliation(s)
- A Infantino
- Department of Surgery, S. Maria dei Battuti Hospital, S. Vito al Tagliamento, PN, Italy.
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Ratto C, Parello A, Donisi L, Litta F, Zaccone G, Doglietto GB. Assessment of haemorrhoidal artery network using colour duplex imaging and clinical implications. Br J Surg 2012; 99:112-118. [PMID: 22021046 PMCID: PMC3266492 DOI: 10.1002/bjs.7700] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Dearterialization should reduce arterial overflow to haemorrhoids. The purpose of this study was to assess the topography of haemorrhoidal arteries. METHODS Fifty patients with haemorrhoidal disease were studied. Using endorectal ultrasonography, six sectors were identified within the lower rectal circumference. Starting from the highest level (6 cm above the anorectal junction), the same procedure was repeated every 1 cm until the lowest level was reached (1 cm above the anorectal junction). Colour duplex imaging examinations identified haemorrhoidal arteries related to the rectal wall layers, and the arterial depth was calculated. RESULTS Haemorrhoidal arteries were detected in 64·3, 66·0, 66·0, 98·3, 99·3 and 99·7 per cent of the sectors 6, 5, 4, 3, 2 and 1 cm above the anorectal junction respectively (P < 0·001). Most of the haemorrhoidal arteries were external to the rectal wall at 6 and 5 cm (97·9 and 90·9 per cent), intramuscular at 4 cm (55·0 per cent), and within the submucosa at 3, 2 and 1 cm above the anorectal junction (67·1, 96·6 and 100 per cent) (P < 0·001). The mean arterial depth decreased significantly from 8·3 mm at 6 cm to 1·9 mm at 1 cm above the anorectal junction (P < 0·001). CONCLUSION This study demonstrated that the vast majority of haemorrhoidal arteries lie within the rectal submucosa at the lowest 2 cm above the anorectal junction. This should therefore be the best site for performing haemorrhoidal dearterialization.
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Affiliation(s)
- C Ratto
- Department of Surgical Sciences, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy.
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Pescatori M. Hemorrhoids. PREVENTION AND TREATMENT OF COMPLICATIONS IN PROCTOLOGICAL SURGERY 2012:15-56. [DOI: 10.1007/978-88-470-2077-1_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Song SG, Kim SH. Optimal treatment of symptomatic hemorrhoids. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2011; 27:277-81. [PMID: 22259741 PMCID: PMC3259422 DOI: 10.3393/jksc.2011.27.6.277] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 09/02/2011] [Indexed: 12/11/2022]
Abstract
Hemorrhoids are the most common anorectal complaint, and approximately 10 to 20 percent of patients with symptomatic hemorrhoids require surgery. Symptoms of hemorrhoids, such as painless rectal bleeding, tissue protrusion and mucous discharge, vary. The traditional therapeutic strategies of medicine include surgical, as well as non-surgical, treatment. To alleviate symptoms caused by hemorrhoids, oral treatments, such as fiber, suppositories and Sitz baths have been applied to patients. Other non-surgical treatments, such as infrared photocoagulation, injection sclerotherapy and rubber band ligation have been used to fixate the hemorrhoid's cushion. If non-surgical treatment has no effect, surgical treatments, such as a hemorrhoidectomy, procedure for prolapsed hemorrhoids, and transanal hemorrhoidal dearterialization are used.
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Affiliation(s)
- Seok-Gyu Song
- Department of Coloproctology, Seoul Song Do Colorectal Hospital, Seoul, Korea
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A systematic review comparing transanal haemorrhoidal de-arterialisation to stapled haemorrhoidopexy in the management of haemorrhoidal disease. Tech Coloproctol 2011; 16:1-8. [PMID: 22183450 DOI: 10.1007/s10151-011-0796-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Accepted: 11/23/2011] [Indexed: 01/14/2023]
Abstract
BACKGROUND The aim of this study was to systematically analyse the clinical trials on the effectiveness of transanal haemorrhoidal de-arterialisation (THD) and stapled haemorrhoidopexy (SH) in the management of haemorrhoidal disease (HD). METHODS Clinical trials on the effectiveness of THD and SH in the management of HD were analysed systematically using RevMan(®), and combined outcomes were expressed as risk ratio (RR) and mean difference (MD). RESULTS Three randomised, controlled trials encompassing 150 patients were analysed systematically. There were 80 THD patients and 70 SH patients. There was no significant heterogeneity (P = 0.40) among included trials. Therefore, in the fixed effects model, THD and SH were statistically equivalent in terms of treatment success rate (P = 0.19), operation time (P = 0.55), postoperative complications (P = 0.11) and recurrence (P = 0.46) of HD. THD was associated with significantly less postoperative pain (MD, -2.00; 95% CI, -2.06, -1.94; z = 63.59; P < 0.00001) compared to SH. CONCLUSIONS Both THD and SH are equally effective and can be attempted for the management of HD. However, THD is associated with significantly lesser postoperative pain and therefore may be considered a preferred procedure. This conclusion is based only on treating 150 patients by THD or SH in three moderate-quality randomised trials. A major, multicenter, randomised trial is required to validate this conclusion and investigate other variables like hospital stay, cost-effectiveness and health-related quality of life measurement.
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