Abstract
Background
The aim of the present study was to compare short- and medium-term results of transanal Doppler-guided hemorrhoidal dearterialization with mucopexy (DM) versus hemorrhoidectomy using an ultrasonic scalpel (US) for third-degree hemorrhoids.
Methods
Forty-four patients were randomly assigned to undergo either DM or US. The patients were followed up at 1, 2, 3 months at our clinic, and by telephone interview when the study was completed in May 2017. The primary endpoint was postoperative pain with quality of life, length of stay, return to normal activities, and incontinence among secondary endpoints.
Results
Postoperative pain was less intense in the DM group than in the US group during week 1 (p < 0.05), but no difference was seen after 2 weeks. More DM patients returned to normal daily activities within 3 days (p < 0.05). There were no between-group differences in quality of life. One patient in each group developed postoperative hemorrhage requiring readmission. No differences were found between the groups in postoperative incontinence, obstructed defecation scores, or SF-36. During a median 33-month follow-up (range 12–46 months), two patients in the DM group and one patient in the US group underwent further surgery for residual hemorrhoid related problems. Two patients in the DM group required further rubber band ligation.
Conclusions
Medium-term results demonstrated that DM and US have similar effects on quality of life in the treatment of third-degree hemorrhoids. However, DM was associated with less early postoperative pain than US and a faster return to normal activities.
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References
Jayaraman S, Colquhoun PH, Malthaner RA (2006) Stapled versus conventional surgery for hemorrhoids. Cochrane Database Syst Rev 18(4):CD005393
Tjandra JJ, Chan MK (2007) Systematic review on the procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy). Dis Colon Rectum 50:878–892
Pescatori M, Gagliardi G (2008) Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures. Tech Coloproctol 12:7–19
Morinaga K, Hasuda K, Ikeda T (1995) A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter. Am J Gastroenterol 90:610–613
Sohn N, Aronoff JS, Cohen FS, Weinstein MA (2001) Transanal hemorrhoidal dearterialization is an alternative to operative hemorrhoidectomy. Am J Surg 182:515–519
Felice G, Privitera A, Ellul E, Klaumann M (2005) Doppler-guided hemorrhoidal artery ligation: an alternative to hemorrhoidectomy. Dis Colon Rectum 48:2090–2093
Greenberg R, Karin E, Avital S, Skornick Y, Werbin N (2006) First 100 cases with Doppler-guided hemorrhoidal artery ligation. Dis Colon Rectum 49:485–489
Faucheron JL, Gangner Y (2008) Doppler-guided hemorrhoidal artery ligation for the treatment of symptomatic hemorrhoids: early and three-year follow-up results in 100 consecutive patients. Dis Colon Rectum 51:945–949
Dal Monte PP, Tagariello C, Sarago M, Giordano P, Shafi A, Cudazzo E et al (2007) Transanal haemorrhoidal dearterialisation: nonexcisional surgery for the treatment of haemorrhoidal disease. Tech Coloproctol 11:333–338
Ratto C, Donisi L, Parello A, Litta F, Doglietto GB (2010) Evaluation of transanal hemorrhoidal dearterialization as a minimally invasive therapeutic approach to hemorrhoids. Dis Colon Rectum 53:803–811
Infantino A, Altomare DF, Bottini C, Bonanno M, Mancini S, THD group of the SICCR (Italian Society of Colorectal Surgery) et al (2012) Prospective randomized multicentre study comparing stapler haemorrhoidopexy with Doppler-guided transanal haemorrhoid dearterialization for third-degree haemorrhoids. Colorectal Dis 14:205–211
Giordano P, Nastro P, Davies A, Gravante G (2011) Prospective evaluation of stapled haemorrhoidopexy versus transanal haemorrhoidal dearterialisation for stage II and III haemorrhoids: three-year outcomes. Tech Coloproctol 15:67–73
Armstrong DN, Ambroze WL, Schertzer ME, Orangio GR (2001) Harmonic Scalpel vs. electrocautery hemorrhoidectomy: a prospective evaluation. Dis Colon Rectum 44:558–564
Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG et al (1999) Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum 42:1525–1532
Tsunoda A, Sada H, Sugimoto T, Kano N, Kawana M, Sasaki T et al (2011) Randomized controlled trial of bipolar diathermy vs ultrasonic scalpel for closed hemorrhoidectomy. World J Gastrointest Surg 3:147–152
Altomare DF, Spazzafumo L, Rinaldi M, Dodi G, Ghiselli R, Piloni V (2008) Set-up and statistical validation of a new scoring system for obstructed defaecation syndrome. Colorectal Dis 10:84–88
Fukuhara S, Bito S, Green J, Hsiao A, Kurokawa K (1998) Translation, adaptation, and validation of the SF-36 Health Survey for use in Japan. J Clin Epidemiol 51:1037–1044
Tsunoda A, Kiyasu Y, Fujii W, Kano N (2015) Comparison of the early results of transanal hemorrhoidal dearterialization and hemorrhoidectomy using an ultrasonic scalpel. Surg Today 45:175–180
Scheyer M, Antonietti E, Rollinger G, Mall H, Arnold S (2006) Doppler-guided hemorrhoidal artery ligation. Am J Surg 191:89–93
Elmér SE, Nygren JO, Lenander CE (2013) A randomized trial of transanal hemorrhoidal dearterialization with anopexy compared with open hemorrhoidectomy in the treatment of hemorrhoids. Dis Colon Rectum 56:484–490
Denoya PI, Fakhoury M, Chang K, Fakhoury J, Bergamaschi R (2013) Dearterialization with mucopexy versus haemorrhoidectomy for grade III or IV haemorrhoids: short-term results of a double-blind randomized controlled trial. Colorectal Dis 15:1281–1288
De Nardi P, Capretti G, Corsaro A, Staudacher C (2014) A prospective, randomized trial comparing the short- and long-term results of doppler-guided transanal hemorrhoid dearterialization with mucopexy versus excision hemorrhoidectomy for grade III hemorrhoids. Dis Colon Rectum 57:348–353
Lestar B, Penninckx F, Kerremans R (1989) The composition of anal basal pressure. An in vivo and in vitro study in man. Int J Colorectal Dis 4:118–122
Talha S, Burke JP, Waldron D, Coffey JC, Condon E (2013) Early quality of life outcomes following Doppler guided transanal haemorrhoidal dearterialisation: a prospective observational study. Acta Gastroenterol Belg 76:231–234
Pucher PH, Sodergren MH, Lord AC, Darzi A, Ziprin P (2013) Clinical outcome following Doppler-guided haemorrhoidal artery ligation: a systematic review. Colorectal Dis 15:e284–e294
Ratto C, Parello A, Veronese E, Cudazzo E, D’Agostino E, Pagano C et al (2015) Doppler-guided transanal haemorrhoidal dearterialization for haemorrhoids: results from a multicentre trial. Colorectal Dis 17:O10–O19
Acknowledgements
The authors would like to thank Dr. Yuko Tsunoda for the statistical analyses.
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This study was approved by the Ethical Committee of Kameda Medical Center.
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Informed consent was obtained from all individual participants included in the study.
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Tsunoda, A., Takahashi, T. & Kusanagi, H. A prospective randomized trial of transanal hemorrhoidal dearterialization with mucopexy versus ultrasonic scalpel hemorrhoidectomy for grade III hemorrhoids. Tech Coloproctol 21, 657–665 (2017). https://doi.org/10.1007/s10151-017-1673-1
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DOI: https://doi.org/10.1007/s10151-017-1673-1