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Ligation anopexy versus hemorrhoidectomy in the treatment of second- and third-degree hemorrhoids

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Abstract

Background

The aim of the study was to compare ligation anopexy (LA) and conventional hemorrhoidectomy (CH) in treatment of second- and third-degree hemorrhoids.

Methods

A prospective controlled randomized clinical trial included 100 patients who underwent CH (CH group) and 100 patients who underwent LA (LA group). A detailed history was taken from all the patients. The effectiveness, safety, postoperative complications, operative time, length of hospital stay, time until first bowel movement, time until return to work, and postoperative pain score were assessed.

Results

There was no significant difference between groups regarding age, sex, and preoperative symptoms. The LA group had significantly shorter operative times, earlier first bowel movement, and an earlier return to work/activities. The postoperative pain score in the LA group was significantly lower than that in the CH group on days 1, 3, 7, and 14 after surgery. There was no significant difference between groups as regards postoperative complications.

Conclusions

LA is safe, and as effective as CH in the treatment of grade II and grade III hemorrhoids, with shorter operative times, earlier mobilization, and lower postoperative pain scores.

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References

  1. Aigner F, Bodner G, Gruber H et al (2006) The vascular nature of hemorrhoids. J Gastrointest Surg 10:1044–1050

    Article  PubMed  Google Scholar 

  2. Jóhannsson HO, Påhlman L, Graf W (2006) Randomized clinical trial of the effects on anal function of Milligan–Morgan versus Ferguson haemorrhoidectomy. Br J Surg 93:1208–1214

    Article  PubMed  Google Scholar 

  3. Pescatori M, Aigner F (2007) Stapled transanal rectal mucosectomy ten years after. Tech Coloproctol 11:1–6

    Article  CAS  PubMed  Google Scholar 

  4. Giordano P (2011) Outcome of stapled haemorrhoidopexy versus doppler-guided haemorrhoidal artery ligation for grade III haemorrhoids. Tech Coloproctol 15:257–2578

    Article  CAS  PubMed  Google Scholar 

  5. Roka S, Gold D, Walega P et al (2013) DG-RAR for the treatment of symptomatic grade III and grade IV haemorrhoids: a 12-month multi-centre, prospective observational study. Eur Surg 45:26–30

    Article  PubMed Central  PubMed  Google Scholar 

  6. Ammaturo C, Tufano A, Spiniello E (2012) Stapled haemorrhoidopexy vs. Milligan–Morgan haemorrhoidectomy for grade III haemorrhoids: a randomized clinical trial. G Chir 33:346–351

    CAS  PubMed  Google Scholar 

  7. Pernice LM, Bartalucci B, Bencini L, Borri A, Catarzi S, Kröning K (2001) Early and late (ten years) experience with circular stapler hemorrhoidectomy. Dis Colon Rectum 44:836–841

    Article  CAS  PubMed  Google Scholar 

  8. Shalaby R, Deskoy A (2001) Randomized clinical trial of stapled versus Milligan–Morgan haemorrhoidectomy. Br J Surg 88:1049–1053

    Article  CAS  PubMed  Google Scholar 

  9. 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

    Article  CAS  PubMed  Google Scholar 

  10. Avital S, Inbar R, Karin E, Greenberg R (2012) Five-year follow-up of Doppler-guided hemorrhoidal artery ligation. Tech Coloproctol 16:61–65

    Article  CAS  PubMed  Google Scholar 

  11. Szmulowicz UM, Gurland B, Garofalo T, Zutshi M (2011) Doppler-guided hemorrhoidal artery ligation: the experience of a single institution. J Gastrointest Surg 15:803–808

    Article  PubMed  Google Scholar 

  12. Felice G, Privitera A, Ellul E, Klaumann M (2005) Doppler-guided hemorrhoidal artery ligation: an alternative to hemorrhoidectomy. Dis Colon Rectum 48:2090–2093

    Article  PubMed  Google Scholar 

  13. Walega P, Romaniszyn M, Kenig J, Herman R, Nowak W (2012) Doppler-guided hemorrhoid artery ligation with Recto-Anal-Repair modification: functional evaluation and safety assessment of a new minimally invasive method of treatment of advanced hemorrhoidal disease. Sci World J 2012:324040

    Article  Google Scholar 

  14. Ratto C (2014) THD Doppler procedure for hemorrhoids: the surgical technique. Tech Coloproctol 18:291–298

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Moringa 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 90:610–613

    Google Scholar 

  16. Hussein AM (2001) Ligation–anopexy for treatment of advanced hemorrhoidal disease. Dis Colon Rectum 44:1887–1890

    Article  CAS  PubMed  Google Scholar 

  17. Farag AE (1978) Pile suture: a new technique for the treatment of haemorrhoids. Br J Surg 65:293–295

    Article  CAS  PubMed  Google Scholar 

  18. Block IR (1985) Obliterative suture technique for internal hemorrhoidectomy. Dis Colon Rectum 28:679–680

    Article  CAS  PubMed  Google Scholar 

  19. Gupta PJ, Kalaskar S (2008) Ligation and mucopexy for prolapsing hemorrhoids—a ten year experience. Ann Surg Innov Res 2:5

    Article  PubMed Central  PubMed  Google Scholar 

  20. Serdev N (1990) The surgical treatment of hemorrhoids. Their suturing ligation without excision. Khirurgiia 43:65–68

    CAS  PubMed  Google Scholar 

  21. Awojobi OA (1983) Modified pile suture in the outpatient treatment of hemorrhoids. A preliminary report. Dis Colon Rectum 26:95–97

    Article  CAS  PubMed  Google Scholar 

  22. Dal Monte PP, Tagariello C, Sarago M et al (2007) Transanal haemorrhoidal dearterialisation: nonexcisional surgery for the treatment of haemorrhoidal disease. Tech Coloproctol 11:333–338

    Article  CAS  PubMed  Google Scholar 

  23. Lyer VS, Shrier I, Gordon PH (2004) Long term outcome of rubber band ligation for symptomatic primary and recurrent internal hemorrhoids. Dis Colon Rectum 47:1364–1370

    Article  Google Scholar 

  24. Hetzer FH, Demartines N, Handschin AE, Clavien PA (2002) Stapled vs excision hemorrhoidectomy. Arch Surg 137:337–340

    Article  PubMed  Google Scholar 

  25. Qureshi S, Aziz T, Afzal A, Maher M (2009) Rubber band ligation of symptomatic Internal haemorrhoids; result of 450 Cases. J Surg Pak 14:19–22

    Google Scholar 

  26. 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

    Article  PubMed  Google Scholar 

  27. Bronstein M, Issa N, Gutman M, Neufeld D (2008) Ligation under vision of haemorrhoidal cushions for therapy of bleeding haemorrhoids. Tech Coloproctol 12:119–122

    Article  CAS  PubMed  Google Scholar 

  28. 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

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. 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 15:439–444

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Colorectal Unit, Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt

    W. G. Elshazly, A. E. Gazal, K. Madbouly & A. Hussen

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  1. W. G. Elshazly
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  2. A. E. Gazal
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  3. K. Madbouly
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  4. A. Hussen
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Correspondence to W. G. Elshazly.

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Elshazly, W.G., Gazal, A.E., Madbouly, K. et al. Ligation anopexy versus hemorrhoidectomy in the treatment of second- and third-degree hemorrhoids. Tech Coloproctol 19, 29–34 (2015). https://doi.org/10.1007/s10151-014-1235-8

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  • DOI: https://doi.org/10.1007/s10151-014-1235-8

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