Techniques in Coloproctology

, Volume 20, Issue 6, pp 353–359 | Cite as

Transanal anopexy with HemorPex System (HPS) is effective in treating grade II and III hemorrhoids: medium-term follow-up

Original Article
First Online:
Received:
Accepted:

Abstract

Background

Hemorrhoidal disease is a common proctologic disorder. The HemorPex System® (HPS) (Angiologica, S. Martino Siccomario PV, Italy) is an innovative surgical technique based on muco-hemorrhoidopexy without Doppler guidance. The aim of this study was to evaluate the efficacy of HPS in on the treatment of grade II and III hemorrhoids.

Methods

One hundred patients with grade II and III hemorrhoidal disease were included in the study and operated on using HPS without Doppler guidance. The procedure consists of a mucopexy carried out by means of a dedicated rotating anoscope in the 6 relatively constant positions of the terminal branches of the superior hemorrhoidal artery. A direct follow-up was carried out on 100 patients for up to 3 months. A late analysis (>12 months postoperatively) was conducted by telephone interview. At follow-up the following parameters were considered: pain, bleeding, prolapse, difficulties with hygiene and patient satisfaction with treatment.

Results

Operative time was 16 ± 5 min. Three-month follow-up showed significant improvement of symptoms: pain was present in 10 (10 %) patients versus 45 (45 %) preoperatively; bleeding in 13 (13 %) of patients versus 57 (57 %) preoperatively; prolapse in 13 (13 %) of patients versus 45 (45 %) preoperatively and difficulties with hygiene in 1 (1 %) versus 24 (24 %) preoperatively (all p < 0.05). At longer follow-up which was available in 67 patients, 5 patients (7.5 %) had recurrence and were reoperated on at 8, 10, 24, 26 and 36 months, respectively after the first procedure. As regards patient satisfaction, complete satisfaction was reported by 95/100 patients (95 %) at 3 months, 62/67 (92.5 %) at 12 months and 8/56 (85.7 %) at 24 months; partial satisfaction was reported by 3/100 patients (3 %) with intermittent bleeding at 3 months, 3/67 (4.4 %) patients at 12 months and 6/56 (10.7 %) patients at 24 months, all with either intermittent bleeding or prolapse. Dissatisfaction with the procedure was reported by in 1/100 (1 %) patient at 3 months, 2/67 (2.9 %) at 12 months and 2/56 (3.6 %) at 24 months including patients who underwent reintervention.

Conclusions

HPS can be used in the treatment of grade II and III hemorrhoidal disease. Our results show that this simple technique may be an effective but due to the important limitations of this study (loss to follow-up, non-comparative study) further studies are required.

Keywords

Hemorrhoids HemorPex System (HPS) Muco-hemorrhoidopexy Doppler 
This is a preview of subscription content, log in to check access.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Johanson JF, Sonneberg A (1990) The prevalence of hemorrhoids and chronic constipation: an epidemiologic study. Gastroenterology 98:380–386PubMedGoogle Scholar
  2. 2.
    Meurette G, Lehur PA (2014) The future of hemorrhoidal surgery: towards an ‘a la carte’ choice of minimally invasive techniques. J Visc Surg 151:255–256CrossRefPubMedGoogle Scholar
  3. 3.
    Aigner F, Bodner G, Gruber H et al (2006) The vascular nature of hemorrhoids. J Gastrointest Surg 10:1044–1050CrossRefPubMedGoogle Scholar
  4. 4.
    Aigner F, Gruber H, Conrad F (2009) Revised morphology and hemodynamics of anorectal vascular plexus: impact on the course of hemorrhoidal disease. Int J Colorectal Dis 24:105–113CrossRefPubMedGoogle Scholar
  5. 5.
    Lunniss PJ, Phillips RK (1992) Anatomy and function of the anal longitudinal muscle. Br J Surg 79:882–884CrossRefPubMedGoogle Scholar
  6. 6.
    Gaj F, Trecca A (2005) Hemorrhoids and rectal internal mucosal prolapse: one or two conditions? A national survey. Tech Coloproctol 9:163–165CrossRefPubMedGoogle Scholar
  7. 7.
    Shao WJ, Li GC, Xhang ZH, Yang BL, Sun GD, Chen YQ (2008) Systematic review and meta-analysis of randomized controlled trials comparing stapled hemorrhoidopexy with conventional hemorrhoidectomy. Br J Surg 95:147–160CrossRefPubMedGoogle Scholar
  8. 8.
    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 flow meter. Am J Gastroenterol 90:610–613PubMedGoogle Scholar
  9. 9.
    Giordano P, Overton J, Maddedu F, Zaman S, Gravante G (2009) Transanal hemorrhoidal dearterialization: a systematic review. Dis Colon Rectum 52:1665–1671CrossRefPubMedGoogle Scholar
  10. 10.
    Dal Monte PP, Tagariello C, Sarago M et al (2007) Transanal hemorrhoidal dearterialization: nonexcisional surgery for the treatment of hemorrhoidal disease. Tech Coloproctol 11:333–338CrossRefPubMedGoogle Scholar
  11. 11.
    Pol RA, van der Zwet WC, Kaijser M, Schattenkerk ME, Eddes EH (2011) Comparison of Doppler-guided hemorrhoidal artery ligation without mucopexy and rubber band ligation for hemorrhoids. Arab J Gastroenterol 12:189–193CrossRefPubMedGoogle Scholar
  12. 12.
    Schuurman JP, Go PM, Bleys RL (2009) Anatomical branches of the superior rectal artery in the distal rectum. Colorectal Dis 11:967–971CrossRefPubMedGoogle Scholar
  13. 13.
    Avital S, Inbar R, Karin E, Greednberg R (2012) Is Doppler ultrasonography essential for hemorrhoidal artery ligation? Tech Coloproctol 16:291–294CrossRefPubMedGoogle Scholar
  14. 14.
    Iachino C, Guerrero Y, Sias F et al (2009) Hemorpex system: a new procedure for the treatment of hemorrhoids. Cir Esp 86:105–109CrossRefPubMedGoogle Scholar
  15. 15.
    Tagliabue M, Cusumano C, Kechoud ES et al (2015) Hemorrhoidopexy with the HemorPex system. Tech Coloproctol 19:255–257CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Boccasanta P, Capretti PG, Venturi M et al (2002) Randomized controlled trial between stapled circumferential mucosectomy and conventional circular hemorrhoidectomy in advanced hemorrhoids with external mucosal prolapse. Am J Surg 182:64–68CrossRefGoogle Scholar
  17. 17.
    Infantino A, Altomare DF, Bottini C et al (2012) Prospective randomized multicenter study comparing stapler hemorrhoidopexy (SH) with Doppler-guided transanal, hemorrhoid dearterialization (THD) for III degree hemorrhoids. Colorectal Dis 14:205–211CrossRefPubMedGoogle Scholar
  18. 18.
    Beliard A, Labbe F, de Faucal D, Fabreguette JM, Pouderoux P, Borie F (2014) A prospective and comparative study between stapled hemorrhoidopexy and hemorrhoid artery ligation with mucopexy. J Visc Surg 151:257–262CrossRefPubMedGoogle Scholar
  19. 19.
    Ratto C, Parello A, Donisi L, Litta F, Doglietto GB (2011) Anorectal physiology is not changed following transanal haemorrhoidal dearterialization for haemorrhoidal disease: clinical, manometric and endosonographic features. Colorectal Dis 13:e243–e245CrossRefPubMedGoogle Scholar
  20. 20.
    Ratto C, Parello A (2011) To improve the “target” of transanal hemorrhoidal dearterialization. Tech Coloproctol 15:357CrossRefPubMedGoogle Scholar
  21. 21.
    Sajid MS, Parampulli U, Whitehouse P et al (2012) A systematic review comparing transanal haemorrhoidal dearterialization to stapled haemorrhoidopexy in the management of haemorrhoidal disease. Coloproctology 16:1–8CrossRefGoogle Scholar
  22. 22.
    Lucarelli P, Picchio M, Caporossi M (2013) Transanal haemorrhoidal dearterialization with mucopexy versus stapler haemorrhoidopexy: a randomized trial with long-term follow-up. Ann R Coll Surg Engl 95:246–251CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Ratto C (2012) Assessment of hemorrhoidal artery network using colour Duplex imaging and clinical implications. Br J Surg 99:112–118CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Gupta PJ, Kalaskar S, Taori S, Heda PS (2011) Doppler-guided hemorrhoidal artery ligation does not offer any advantage over suture ligation of grade 3 symptomatic hemorrhoids. Tech Coloproctol 15:439–444CrossRefPubMedGoogle Scholar
  25. 25.
    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 18:1081–1085CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Giordano P, Tomasi I, Pascariello A, Mills E, Elahi S (2014) Transanal dearterialization with targeted mucopexy is effective for advanced haemorrhoids. Colorectal Dis 16:373–376CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Tiernan J, Hind D, Watson A et al (2012) The HubBLe trial: haemorrhoidal artery ligation (HAL) versus rubber band ligation (RBL) for haemorrhoids. BMC Gastroenterol 12:153CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Bernal Sprekelsen JC, Morera Ocón F, Landete Molina FJ, López García J (2010) Outpatient treatment for haemorrhoids with Hemorpex. An innovative method? Cir Esp 87:266–267CrossRefPubMedGoogle Scholar
  29. 29.
    Bruch HP, Roblick UJ (2001) Pathophysiology of hemorrhoids. Chirurg 72:656–659CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia Srl 2016

Authors and Affiliations

  1. 1.Department of General Surgery“Spirito Santo” General HospitalPescaraItaly
  2. 2.Department of Experimental and Clinical Science“G. D’Annunzio” UniversityChietiItaly

Personalised recommendations