Transanal Hemorrhoidal Dearterialization With Mucopexy Versus Vessel-Sealing Device Hemorrhoidectomy for Grade III to IV Hemorrhoids: Long-term Outcomes From the THDLIGA Randomized Controlled Trial

Trenti, Loris; Biondo, Sebastiano; Espín‐Basany, Eloy; Barrios, Oriana; Sánchez, José Luis; Landaluce, Aitor; Bermejo, Elena; Garcia-Martinez, Maite T; Alías, David; Jiménez, Fernando; Alonso, A Gomez; Manso, Maria B; Kreisler, Esther

doi:10.1097/dcr.0000000000002272

Cited by 4 publications

(3 citation statements)

References 25 publications

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“…Several meta-analyses comparing DG-HAL with SH draw the same conclusions, that DG-HAL is superior in terms of postoperative pain, immediate or delayed, bleeding and surgical site infection rates[ 12 ]. A few studies did not, however, find any significant differences between DG-HAL and SH[ 74 , 75 ].…”

Section: Resultsmentioning

confidence: 99%

Ten-year multicentric retrospective analysis regarding postoperative complications and impact of comorbidities in hemorrhoidal surgery with literature review

Moldovan¹,

Rusu²,

Cochior³

et al. 2023

World J Clin Cases

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BACKGROUND Hemorrhoidal disease (HD) is considered a low-severity pathology by both general population and physicians, but the lengthy conservative therapy and postoperative complications suggest otherwise. AIM To assess the effectiveness of different treatment options, both conservative and surgical, in contrast with some preexisting comorbidities. METHODS We conducted a retrospective, 10-yearlong study between January 2011 and December 2021 in two surgical centers, a private and a state-owned hospital. We compared the efficacy and safety of several treatment options, such as open hemorrhoidectomy, stapled hemorrhoidopexy, rubber band ligation and infrared coagulation in terms of complication rates and types and their correlation with different preexisting comorbidities such as inflammatory bowel disease (IBD), use of anticoagulant medication (AM) and liver cirrhosis. We also conducted a 20-years long PubMed research (1.263 articles) for relevant comparisons. RESULTS Our study recorded 10940 patients with HD, 10241 with conservative and 699 with surgical treatment. Out of these, the male-to-female ratio of 1.3, and a peak in age distribution between 59 and 68 years old (32% of patients). For the entire study, we recorded a 90% incidence of immediate pain, immediate bleeding in 1.5% (11 cases), delayed bleeding in 1.0% (7 cases), and 0.6% surgical site infections. Urinary retention was also present, with 0.2% of patients, anal stricture in 1% and fecal incontinence for 0.5% of patients (4 cases). We recorded no severe complications such as Fournier`s gangrene or rectovaginal perforations. IBD accounted for 6% of the patients, with ulcerative colitis in 12% and Chron`s disease in 10.5%. 6.6% of the patients had AM, determining 4% immediate and 2% delayed bleeding, in surgically treated patients. CONCLUSION Our study determined that most common complications (pain, urinary retention, bleeding, and stricture) are correlated with each surgical technique and pre-existing comorbidities.

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Section: Resultsmentioning

confidence: 99%

Ten-year multicentric retrospective analysis regarding postoperative complications and impact of comorbidities in hemorrhoidal surgery with literature review

Moldovan¹,

Rusu²,

Cochior³

et al. 2023

World J Clin Cases

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show abstract

“…At 2 years after surgery, there remained no differences in recurrence, complications, quality of life, or patient satisfaction between the groups. 51 A separate RCT of 98 patients, also comparing HAL to EH, found no difference in the symptom score at a 1-year follow-up between the groups, but the HAL group had a significantly higher rate of recurrent prolapse 1 year postoperatively (59% vs 31%; p = 0.008). 52…”

Section: Operative Treatmentmentioning

confidence: 94%

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids

Hawkins,

Davis,

Bhama

et al. 2024

Diseases of the Colon &Amp; Rectum

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“…Thus, efforts continue to develop operative techniques with less postoperative pain and faster recovery. Development of ultrasound scalpel, circular stapler, electro-thermal devices, and ligature vessel-sealing systems are all on this effort [10]. Non-operative interventions such as sclerotherapy, rubber band ligation, and laser hemorrhoidectomy are used as out-patient procedures for 1st and 2nddegree hemorrhoids [11,12].…”

Section: Introductionmentioning

confidence: 99%

Comparison between Ligation and Cauterization of Hemorrhoidal Pedicle with Milligan-Morgan Hemorrhoidectomy

Shareef

Ameen

Ismaeel

et al. 2023

Preprint

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Background: Currently, several therapies are used for symptomatic hemorrhoidal disease with various degrees of accepted treatment modality, but information on long-term outcomes is limited. Objectives: This study aimed to compare ligation and cauterization of hemorrhoidal pedicles with Milligan-Morgan hemorrhoidectomy. Patients and methods: This prospective cohort study was conducted on 200 patients with symptomatic hemorrhoidal disease in Sulaimani Surgical Teaching Hospital from January 2014 to January 2021. Patients were divided into 2 groups of 100 patients each. Group A underwent ligation and cauterization, while group B underwent Milligan-Morgan hemorrhoidectomy. Then, postoperative pain, urinary retention, and bleeding were collected. Patients were followed up for one year and data were collected regarding incontinence, anal stenosis and recurrence. Results: The mean age of patients was 37.19±9.7 years, and most were females. The most common symptom was mucosal prolapse, followed by bleeding per rectum, then discharge, pruritis, and perianal pain/discomfort. Patients in group A experienced less pain than those in group B. Regarding the postoperative complications, surgical site infection was the most common one in both groups (34%), followed by bleeding per rectum (26%), then urinary retention (20%), incontinence (15%), and recurrence (11%). In comparison, anal stenosis was only found in 3% of group B patients. Conclusions: The ligation and cauterization technique was safer, less costly, less painful, and had lower postoperative complication rates compared to the Milligan-Morgan procedure for the treatment of hemorrhoids.

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Transanal Hemorrhoidal Dearterialization With Mucopexy Versus Vessel-Sealing Device Hemorrhoidectomy for Grade III to IV Hemorrhoids: Long-term Outcomes From the THDLIGA Randomized Controlled Trial

Cited by 4 publications

References 25 publications

Ten-year multicentric retrospective analysis regarding postoperative complications and impact of comorbidities in hemorrhoidal surgery with literature review

Ten-year multicentric retrospective analysis regarding postoperative complications and impact of comorbidities in hemorrhoidal surgery with literature review

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids

Comparison between Ligation and Cauterization of Hemorrhoidal Pedicle with Milligan-Morgan Hemorrhoidectomy

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