Prospective randomized multicentre study comparing stapler haemorrhoidopexy with Doppler‐guided transanal haemorrhoid dearterialization for third‐degree haemorrhoids

Abstract

Both THD and SH techniques are effective for the treatment of third-degree haemorrhoids in the medium term. THD has a better cost-effective ratio and lower (not significant) pain compared with SH. Postoperative pain and recurrence did not differ significantly between the two groups.

Stapled haemorrhoidopexy: is it time to move on?

“…The only proclaimed advantage for stapled haemorrhoidopexy of reduced early postoperative pain is not supported any more as Doppler guided transanal haemorrhoidal artery ligation has reduced postoperative pain scores (though not significantly) compared with stapled haemorrhoidopexy. 6 Critical analysis of the literature confirms that there is no advantage for stapled haemorrhoidopexy that cannot be offered by other techniques.…”

“…13 Lastly, stapled haemorrhoidopexy is less cost effective than other treatment options. 6 Although rare serious complications have been reported with all treatment options for haemorrhoids, 19 no other haemorrhoid procedure is associated with such a combination of serious complications similar to those for stapled haemorrhoidopexy. 11,12,[14][15][16][17]19 Of more concern is the tendency for underreporting such serious complications, which is demonstrated by Naldini, who found 46 serious unusual and life threatening complications by writing to surgeons who perform the procedure at 23 units in Italy.…”

“…His aim was not excision of the haemorrhoidal tissue but rather restoring anatomical and physiological aspects of the haemorrhoidal plexus. 6 As early as 2001, there were several studies to confirm that stapled haemorrhoidopexy is a safe procedure that is associated with a shorter operative time, less postoperative pain, a shorter hospital stay and a quicker return to normal activities compared with standard haemorrhoidectomy. 7 Several subsequent randomised controlled trials and reviews confirmed these findings, with some studies claiming that stapled haemorrhoidopexy is the most effective and safe procedure for haemorrhoids.…”

“…10 Stapled haemorrhoidopexy is not more effective in preventing recurrent haemorrhoidal disease than excision haemorrhoidopexy 13,18 or newer treatment options such as Doppler guided transanal haemorrhoidal artery ligation. 6 A meta-analysis of 1,200 patients with a minimal follow-up duration of 12 months demonstrated that long-term outcomes showed a significant increase in recurrent prolapse after stapled haemorrhoidopexy versus conventional haemorrhoidectomy, evident for all degrees of haemorrhoids. 13 The incidence of recurrences among studies varied from 0% to 53.3%.…”

“…It has been suggested that the ideal treatment of haemorrhoids should be minimally invasive, painless, safe and effective with minimal cost. 6 On critical analysis of the available literature, it could be argued that stapled haemorrhoidopexy does not meet any of these criteria.…”