Abstract
Purpose
Haemorrhoidal disease is a frequently occurring entity in the western world. The Procedure for prolapse and haemorrhoids (PPH) and transanal haemorrhoidal dearterialisation (THD) are the most important surgical treatments that respect normal anal anatomy. This is the first randomized trial that compares both techniques in the treatment of grade III and IV haemorrhoids.
Methods
Patients with grade III or IV haemorrhoids were randomized between PPH and THD. Patients were seen after 1 week, 3 weeks and 6 weeks postoperatively. Primary endpoint was resolved symptoms 6 weeks postoperatively. Secondary endpoints were pain, measured with a visual analogue scale (VAS) after 1 day, 1 week and 3 weeks, and complications
Results
Eighteen patients were allocated to PPH versus 23 to THD. Success rates after 6 weeks were 83% in the PPH group versus 78% in the THD group. VAS scores were significantly lower after 1 day and 1 week in the THD group, but equalled out after 3 weeks. Twelve percent of the patients after PPH and 4% after THD needed an urgent readmission to treat an acute bleeding. Overall complication rates did not differ significantly.
Conclusion
Both PPH and THD are safe treatments for grade III and IV haemorrhoids with acceptable complication rates and good short-term results. THD might be the preferred treatment because it carries the similar complication rate and short-term results, but results in less postoperative pain when compared with PPH. Moreover, it is a less invasive, more easily learned and less costly procedure.
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Reference
Kaidar-Person O, Person B, Wexner SD (2007) Hemorrhoidal disease: a comprehensive review. J Am Coll Surg 204(1):102–117
Thomson WH (1975) The nature of haemorrhoids. Br J Surg 62(7):542–552
MacRae HM, McLeod RS (1997) Comparison of hemorrhoidal treatments: a meta-analysis. Can J Surg 40(1):14–17
Longo A (2002) Stapled anopexy and stapled hemorrhoidectomy: two opposite concepts and procedures. Dis Colon Rectum 45(4):571–572
Pescatori M, Aigner F (2007) Stapled transanal rectal mucosectomy ten years after. Tech Coloproctol 11(1):1–6
Ganio E, Altomare DF, Milito G, Gabrielli F, Canuti S (2007) Long-term outcome of a multicentre randomized clinical trial of stapled haemorrhoidopexy versus Milligan-Morgan haemorrhoidectomy. Br J Surg 94(8):1033–1037
Tjandra JJ, Chan MK (2007) Systematic review on the procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy). Dis Colon Rectum 50(6):878–892
Goldstein SD, Meslin KP, Mazza T, Isenberg GA, Fitzgerald J, Richards A et al (2007) Stapled hemorrhoidopexy: outcome assessment. Am Surg 73(7):733–736
Giordano P, Gravante G, Sorge R, Ovens L, Nastro P (2009) Long-term outcomes of stapled hemorrhoidopexy vs conventional hemorrhoidectomy: a meta-analysis of randomized controlled trials. Arch Surg 144(3):266–272
Thaha MA, Campbell KL, Kazmi SA, Irvine LA, Khalil A, Binnie NR et al (2009) Prospective randomised multi-centre trial comparing the clinical efficacy, safety and patient acceptability of circular stapled anopexy with closed diathermy haemorrhoidectomy. Gut 58(5):668–678
Bona S, Battafarano F, Fumagalli RU, Zago M, Rosati R (2008) Stapled anopexy: postoperative course and functional outcome in 400 patients. Dis Colon Rectum 51(6):950–955
Ceci F, Picchio M, Palimento D, Cali B, Corelli S, Spaziani E (2008) Long-term outcome of stapled hemorrhoidopexy for Grade III and Grade IV hemorrhoids. Dis Colon Rectum 51(7):1107–1112
Fueglistaler P, Guenin MO, Montali I, Kern B, Peterli R, von Flue M et al (2007) Long-term results after stapled hemorrhoidopexy: high patient satisfaction despite frequent postoperative symptoms. Dis Colon Rectum 50(2):204–212
Kanellos I, Zacharakis E, Kanellos D, Pramateftakis MG, Tsachalis T, Betsis D (2006) Long-term results after stapled haemorrhoidopexy for third-degree haemorrhoids. Tech Coloproctol 10(1):47–49
Zacharakis E, Kanellos D, Pramateftakis MG, Kanellos I, Angelopoulos S, Mantzoros I et al (2007) Long-term results after stapled haemorrhoidopexy for fourth-degree haemorrhoids: a prospective study with median follow-up of 6 years. Tech Coloproctol 11(2):144–147
Brown S, Baraza W, Shorthouse A (2007) Total rectal lumen obliteration after stapled haemorrhoidopexy: a cautionary tale. Tech Coloproctol 11(4):357–358
Brusciano L, Ayabaca SM, Pescatori M, Accarpio GM, Dodi G, Cavallari F et al (2004) Reinterventions after complicated or failed stapled hemorrhoidopexy. Dis Colon Rectum 47(11):1846–1851
Cipriani S, Pescatori M (2002) Acute rectal obstruction after PPH stapled haemorrhoidectomy. Colorectal Dis 4(5):367–370
Filingeri V, Gravante G (2005) The last images. Pneumoretroperitoneum, pneumomediastinum and subcutaneous emphysema of the neck after stapled hemorrhoidopexy. Tech Coloproctol 9(1):86
Pescatori M, Gagliardi G (2008) Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures. Tech Coloproctol 12(1):7–19
Ripetti V, Caricato M, Arullani A (2002) Rectal perforation, retropneumoperitoneum, and pneumomediastinum after stapling procedure for prolapsed hemorrhoids: report of a case and subsequent considerations. Dis Colon Rectum 45(2):268–270
Sileri P, Stolfi VM, Franceschilli L, Perrone F, Patrizi L, Gaspari AL (2008) Reinterventions for specific technique-related complications of stapled haemorrhoidopexy (SH): a critical appraisal. J Gastrointest Surg 12(11):1866–1872
Wong LY, Jiang JK, Chang SC, Lin JK (2003) Rectal perforation: a life-threatening complication of stapled hemorrhoidectomy: report of a case. Dis Colon Rectum 46(1):116–117
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(4):610–613
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(4):333–338
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(6):945–949
Wilkerson PM, Strbac M, Reece-Smith H, Middleton SB (2009) Doppler-guided haemorrhoidal artery ligation: long-term outcome and patient satisfaction. Colorectal Dis 11(4):394–400
Walega P, Scheyer M, Kenig J, Herman RM, Arnold S, Nowak M et al (2008) Two-center experience in the treatment of hemorrhoidal disease using Doppler-guided hemorrhoidal artery ligation: functional results after 1-year follow-up. Surg Endosc 22(11):2379–2383
Jayaraman S, Colquhoun PH, Malthaner RA (2007) Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery. Dis Colon Rectum 50(9):1297–1305
Schmidt J, Dogan N, Langenbach R, Zirngibl H (2009) Fecal urge incontinence after stapled anopexia for prolapse and hemorrhoids: a prospective, observational study. World J Surg 33(2):355–364
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Festen, S., van Hoogstraten, M.J., van Geloven, A.A.W. et al. Treatment of grade III and IV haemorrhoidal disease with PPH or THD. A randomized trial on postoperative complications and short-term results. Int J Colorectal Dis 24, 1401–1405 (2009). https://doi.org/10.1007/s00384-009-0803-2
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DOI: https://doi.org/10.1007/s00384-009-0803-2