Distal Doppler-guided transanal hemorrhoidal dearterialization with mucopexy versus conventional hemorrhoidectomy for grade III and IV hemorrhoids: postoperative morbidity and long-term outcomes

Trenti, Loris; Biondo, Sebastián; Gálvez, Ana; Bravo, Alejandro; Cabrera, Juan P.; Kreisler, Esther

doi:10.1007/s10151-017-1620-1

Cited by 34 publications

(24 citation statements)

References 26 publications

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“…Results showed lower early postoperative pain in THD group, but although the grade of hemorrhoids was significantly reduced after 1 year for both methods, there was a trend to more patients with remaining grade II hemorrhoids in THD group ( p = 0.06). The recent studies of Trenti et al, 2017 [5] and De Nardi et al, 2014 [6] with relatively long follow-up (about 24 months), showed similar postoperative pain and morbidity, and a similar long-term cure rate of THD and CH. Meta-analysis of Xu et al (2016) including 4 randomized trials, reported that there are no statistically significant differences in total complications, recurrence and reoperation rates.…”

Section: Discussionmentioning

confidence: 98%

“…In order to reduce them, a Doppler-guided transanal hemorrhoidal dearterilization (THD) has been introduced as an effective alternative since the 90’s [1–4]. There is an increasing number of studies comparing THD and CH, but the focus of most of them is the early postoperative results [5–7]. The data about long-term outcomes and recurrence rates is still limited [5, 6].…”

Section: Introductionmentioning

confidence: 99%

“…There is an increasing number of studies comparing THD and CH, but the focus of most of them is the early postoperative results [5–7]. The data about long-term outcomes and recurrence rates is still limited [5, 6].…”

Section: Introductionmentioning

confidence: 99%

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Doppler-guided transanal hemorrhoidal dearterilization versus conventional hemorrhoidectomy for treatment of hemorrhoids – early and long-term postoperative results

et al. 2019

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BackgroundA variety of effective methods for treatment of hemorrhoids has been proposed. In recent years, there has been an increasing number of studies comparing transanal hemorrhoidal dearterilization (THD) and conventional hemorrhoidectomy (CH), but the focus of most studies has been about the early postoperative results. The data about long-term outcomes is still limited. We aimed to compare Doppler-guided THD and CH with regard to early and long-term postoperative results.MethodsThe conducted prospective research included 287 patients who underwent CH (167 cases) or Doppler-guided THD with mycopexy (120 patients) between November 2010 and December 2015. Information on hemorrhoidal stage, demographic data, presenting symptoms, complications, duration of hospital stay, postoperative pain, patients’ satisfaction and follow-up were obtained. Statistical tests were performed by SPSS 19.0.ResultsThere was no significant difference between the studied groups according to gender, mean age, preoperative prolapse, pain and pruritus, hemorrhoidal stage and postoperative complications. Preoperative bleeding was more frequent in THD group (p = 0,002). The mean visual analog scale (VAS) pain scores in CH and THD groups on days 1, 2 and 7 were 7.01 vs 5.03, 5.07 vs 2.98, 2.39 vs 0,57 (p = 0,000). Practically, there was no difference in VAS on day 30 and patients’ satisfaction at the 18th month. Mean hospital stay was 5,13 (CH) and 3,38 days (THD), p = 0,000. The postoperative follow-up was between 18 and 78 months (mean 46 ± 16 months). During this stage, 5 patients (2,99%) in CH group required surgery for recurrence. In THD group, 3 patients (2,5%), all with 4th-degree hemorrhoids underwent additional procedures (p 0,802).ConclusionsDoppler-guided THD seems to be an efficient and safe option for treatment of hemorrhoids, related to lower postoperative pain and excellent, similar long-term outcomes compared to CH. For advanced grades of hemorrhoids, Doppler-guided THD could be a valuable alternative, but there is a need for patients’ selection.Trial registration(retrospectively registered) researchregistry3090.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Doppler-guided transanal hemorrhoidal dearterilization versus conventional hemorrhoidectomy for treatment of hemorrhoids – early and long-term postoperative results

et al. 2019

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“…Trenti et al (2017) 21 evaluated 83 patients, of whom 49 underwent Doppler-guided dearterialization and 34, CH. It was observed that the 30-day postoperative surgical morbidity was 26.5% in the patients submitted to Doppler-guided dearterialization, vs. 8.82% in those who underwent CH.…”

Section: Discussionmentioning

confidence: 99%

Postoperative results of 407 patients submitted to Doppler-guided transanal hemorrhoidal dearterialization

Rotta

Machado

Uwada

et al. 2019

Journal of Coloproctology

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Introduction The treatment of hemorrhoidal disease by conventional technique is associated with significant morbidity, mainly represented by the postoperative pain and the late return to daily activities. A technique of hemorrhoidal dearterialization associated with rectal mucopexy is a minimal invasive surgical option that has been used to treat the hemorrhoidal disease and reduce its inconveniences. Objective To analyze the seven-year results of hemorrhoidal dearterialization associated with rectal mucopexy in the treatment of hemorrhoidal disease. Methods This study analyzed 407 patients with hemorrhoids grade II, III and IV, who underwent the technique of hemorrhoidal dearterialization in the Luzia de Pinho Melo Hospital, during the period between December 2010 and December 2017. Twenty-seven patients (6.6%) had hemorrhoidal disease of the grade II, 240 (59.0%) grade III, and 117 (28.8%) grade IV. In 23 patients (5.7%), the grade was not found. All patients were operated by the same surgeon under spinal anesthesia. The 407 patients underwent dearterialization, with a varying ligation of one to six arterial branches followed by rectal mucopexy by uninterrupted suture. Eighty-two (20.14%) required removal of concomitant perianal piles or external hemorrhoids and/or fibrosed. In the postoperative follow-up the following parameters were evaluated: pain, tenesmus, bleeding, prolapse, thrombosis, and recurrence. Results The tenesmus was postoperative complaint reported by 93.6% of patients. Forty-three (10.5%) presented intense tenesmus and 44 (22%), moderate to intense pain. Four (0.98%) patients presented more intense bleeding in postoperative follow up; none of the patients required blood transfusions. The prolapse occurred in 18 (4.42%) patients, thrombosis in 11 (2.7%), and there were 19 (4.67%) recurrences that were reoperated in this period. Conclusion The hemorrhoidal dearterialization technique presents good results, with light and easy-to-resolve complications and little postoperative pain.

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“…However, SH had a lower recurrence rate compared with THD. Trenti et al (19) conducted a randomized controlled study of THD and TS, suggesting that THD is not inferior to conventional excisional hemorrhoidectomy for advanced hemorrhoidal disease in terms of postoperative complications and long-term recurrence of symptoms.…”

Section: Discussionmentioning

confidence: 99%

Segmental resection combined with anoplasty for the treatment of circumferential mixed hemorrhoids

et al. 2019

Braz J Med Biol Res

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Circumferential mixed hemorrhoids are very difficult to treat non-surgically. Therefore, it is important to explore the surgical methods for its complete resolution as well as maintenance of normal anal anatomy and function. The present study was designed to evaluate the effect of segmented and plastic hemorrhoidectomy (SPH) on patients with circumferential mixed hemorrhoids. A total of 300 patients with circumferential mixed hemorrhoids were divided into experimental group (n=150) undergoing SPH and control group (n=150) undergoing Milligan-Morgan hemorrhoidectomy. There were no differences in cure and effectiveness rates between two groups. Compared with the control group, patients in the experimental group had shorter healing time (15.7±1.3 vs 12.5±0.7 days) and recovery to normal activity (18.5±2.7 vs 14.7±1.2 days). In addition, anal function of all patients in the experimental group was normal during short- and long-term follow-up. However, more cases in the control group showed anal dampness and itching, and poor control of intestinal liquid. Compared with the control group, patients in the experimental group had better outcomes in overall anal function and smoothness at 6, 12, and 18 months after operation as well as patient satisfaction. Furthermore, the rating in the visual analogue scale for defecation pain and edema in the experimental group was less than that in the control group. SPH was more effective, had fewer complications, better protection of anal function, and a better cosmetic result.

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Distal Doppler-guided transanal hemorrhoidal dearterialization with mucopexy versus conventional hemorrhoidectomy for grade III and IV hemorrhoids: postoperative morbidity and long-term outcomes

Abstract: Our results showed that Doppler-guided THD is not inferior to conventional excisional hemorrhoidectomy for advanced hemorrhoidal disease in terms of postoperative complications and long-term recurrence of symptoms.

Cited by 34 publications

References 26 publications

Doppler-guided transanal hemorrhoidal dearterilization versus conventional hemorrhoidectomy for treatment of hemorrhoids – early and long-term postoperative results

Doppler-guided transanal hemorrhoidal dearterilization versus conventional hemorrhoidectomy for treatment of hemorrhoids – early and long-term postoperative results

Postoperative results of 407 patients submitted to Doppler-guided transanal hemorrhoidal dearterialization

Segmental resection combined with anoplasty for the treatment of circumferential mixed hemorrhoids

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