Abstract
Background
Several studies comparing Doppler-guided hemorrhoidal artery ligation (DG HAL) with or without mucopexy with hemorrhoidopexy and hemorrhoidectomy techniques show no difference in short-term efficacy. The aim of this study was to evaluate efficacy of DG HAL with mucopexy (DG HAL+m) in the long term (beyond 5 years) for patients with hemorrhoidal disease.
Methods
A retrospective observational study was conducted on patients with symptomatic hemorrhoidal disease of any stage treated with DG HAL m at our outpatient colorectal surgery unit in April 2009–April 2013. Patients were followed clinically for 1 month and with a questionnaire until 5 years after surgery or until they underwent a second surgery for recurrent hemorrhoids.
Results
Of 150 patients who underwent DG HALm during the study period 50 (33.3%) were lost to follow-up. A total of 100 patients (47 women, 53 men) were analysed. The average age was 50 (± 12) years. Twenty-six patients (17.3%) had had one or more prior procedures. The mean length of hospital stay was 2.2 days (median = 2 days; range = 1–8 days). No major complications were described. There were no deaths. At 5 years the mean bleeding, local discomfort and pain scores were significantly improved. Thirty-six patients (35.6%) had a recurrence during the follow-up period, and 20 (19.8%) of them underwent reoperation. The mean time between the operation and the second procedure was 36 months (median 27.4 months). The majority (61.4%) of patients were satisfied with the procedure.
Conclusions
Despite the low invasiveness of DG HALm the low morbidity associated with the procedure and the satisfactory functional outcomes, the long-term recurrence rate can be very high. However, only about half of the patients who experienced a recurrence needed a second operation.
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References
Loder PB, Kamm MA, Nicholls RJ, Phillips RKS (1994) Haemorrhoids: pathology, pathophysiology and aetiology. Br J Surg 81:946–954
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
Béliard A, Labbé F, de Faucal D, Fabreguette JM, Pouderoux P, Borie F (2014) A prospective and comparative study between stapled hemorrhoidopexy and hemorrhoidal artery ligation with mucopexy. J Visc Surg 151:261–267
Thaha MA, Campbell KL, Kazmi SA, Irvine LA, Khalil A, Binnie NR, Hendry WS, Walker Staines HJ, Steele RJ (2009) Prospective randomised multi-centre trial comparing the clinical efficacy, safety and patient acceptability of circular stapled anopexy with closed diathermy haemorrhoidectomy. Gut 58:668–678
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
Denoya P, Tam J, Bergamaschi R (2014) Hemorrhoidal dearterialization with mucopexy versus hemorrhoidectomy: 3-year follow-up assessment of a randomized controlled trial. Tech Coloproctol 18:1081–1085
Zampieri N, Castellani R, Andreoli R, Geccherle A (2012) Long-term results and quality of life in patients treated with hemorrhoidectomy using two different techniques: ligasure versus transanal hemorrhoidal dearterialization. AJS 204:684–688
Abudeeb H, Ugwu A, Darabnia J et al (2017) THD and mucopexy: efficacy and controversy. Ann Med Surg 21:89–92
Trenti L, Biondo S, Galvez A, Bravo A, Cabrera J, Kreisler E (2017) Distal Doppler-guided transanal hemorrhoidal dearterialization with mucopexy versus conventional hemorrhoidectomy for grade III and IV hemorrhoids: postoperative morbidity and long-term outcomes. Tech Coloproctol 21:337–344
Lehur PA, Didnée AS, Faucheron JL et al (2016) Cost-effectiveness of new surgical treatments for hemorrhoidal disease a multicentre randomized controlled trial comparing transanal doppler-guided hemorrhoidal artery ligation with mucopexy and circular stapled hemorrhoidopexy. Ann Surg 264:710–716
Figueiredo MN, Campos FG (2016) Doppler-guided hemorrhoidal dearterialization/transanal hemorrhoidal dearterialization: technical evolution and outcomes after 20 years. World J Gastrointest Surg 8:232–237
Faucheron JL, Poncet G, Voirin D, Badic B, Gangner Y (2011) Doppler-guided hemorrhoidal artery ligation and rectoanal repair (HAL-RAR) for the treatment of grade IV hemorrhoids: long-term results in 100 consecutive patients. Dis Colon Rectum 54:226–231
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
Giordano P, Tomasi I, Pascariello A, Mills E, Elahi S (2014) Transanal dearterialization with targeted mucopexy is effective for advanced haemorrhoids”. Colorectal Dis 16:373–376
Tiernan JP, Hind D, Brown SR (2013) Evaluating the efficacy of treatments for haemorrhoids: time for a standardized definition of recurrence? Colorectal Dis 15:1449–1450
Ul Ain Q, Bashir Y, Eguare E (2018) 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 187:647–655
Ratto C, Campennì P, Papeo F, Donisi L, Litta F, Parello A (2017) Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: a single-center study on 1000 consecutive cases and a review of the literature. Tech Coloproctol 21:953–962
Dal Monte PP, Tagariello C, Giordano P et al (2007) Transanal haemorrhoidal dearterialisation: nonexcisional surgery for the treatment of haemorrhoidal disease. Tech Coloproctol 11:333–339
Ratto C, De Parades V (2015) Ligatures artérielles hémorroïdaires sous contrôle Doppler avec mucopexie: une technique d’ avenir [Doppler-guided ligation of hemorrhoidal arteries with mucopexy]. J Visc Surg 152:S15–S21
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Frederic Borie is THD workshop instructor, the other authors declare that they have no conflict of interest.
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This study was reviewed and approved by the Committee on Ethics of the institution in June 2009.
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Ferrandis, C., De Faucal, D., Fabreguette, JM. et al. Efficacy of Doppler-guided hemorrhoidal artery ligation with mucopexy, in the short and long terms for patients with hemorrhoidal disease. Tech Coloproctol 24, 165–171 (2020). https://doi.org/10.1007/s10151-019-02136-1
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DOI: https://doi.org/10.1007/s10151-019-02136-1