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A Randomized Trial of Transanal Hemorrhoidal Dearterialization With Anopexy Compared With Open Hemorrhoidectomy in the Treatment of Hemorrhoids

Elmér, Solveig E. M.D.; Nygren, Jonas O. M.D., Ph.D.; Lenander, Claes E. M.D., Ph.D.

Diseases of the Colon & Rectum: April 2013 - Volume 56 - Issue 4 - p 484–490
doi: 10.1097/DCR.0b013e31827a8567
Original Contribution: Anorectal Disease

BACKGROUND: Doppler guidance in hemorrhoidal surgery has become more frequent during the past decade. The method is mainly studied in nonrandomized trials. Data from randomized controlled trials are lacking.

OBJECTIVE: The aim of this study was to compare early and midterm results of transanal hemorrhoidal dearterialization with anopexy to open hemorrhoidectomy.

DESIGN, SETTINGS, PATIENTS, AND INTERVENTIONS: Forty patients with grade 2 to 3 hemorrhoids were randomly assigned to transanal hemorrhoidal dearterialization with anopexy (group A, n = 20) or open hemorrhoidectomy (group B, n = 20). A diary was used during the first 2 postoperative weeks. A self-reported symptom questionnaire was answered, and a clinical examination was performed preoperatively, after 2 to 4 months, and after 1 year.

MAIN OUTCOME MEASURE: The main outcome measure was postoperative pain.

RESULTS: Postoperative peak pain was lower in group A during the first week than in group B (p < 0.05), whereas no difference in overall pain was noted. More patients expressed normal well-being in group A (p = 0.045). Pain, bleeding, and the need for manual reduction of the hemorrhoids were all improved in both groups after 1 year (p < 0.05). Soiling had decreased after both methods at early follow-up. After 1 year, soiling was significantly decreased only after open hemorrhoidectomy. The grade of hemorrhoids was significantly reduced after 1 year for both methods, but there was a trend to more patients with remaining grade 2 hemorrhoids in group A (p = 0.06).

LIMITATIONS: There was no blinding, the sample size was small, and follow-up was for only 1 year. The questionnaire was not validated.

CONCLUSION: The difference in postoperative pain between transanal hemorrhoidal dearterialization with anopexy and open hemorrhoidectomy may be less than expected based on previous literature.

Department of Surgery, Ersta Hospital, Institute of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden

Funding/Support: This study was supported financially by the Stockholm Council Public Health and Medical Services Committee R&D Department.

Financial Disclosure: Dr Lenander has demonstrated the surgical technique on 1 occasion at a scientific meeting at Karolinska University hospital (without reimbursement) and on 3 occasions to smaller groups of surgeons in smaller hospitals. During those latter occasions, he was reimbursed from the THD Company for the loss of income on that day only (leave without pay from his employer). All this was after the completion of this study and after collection of the data. Drs Elmér and Nygren have no conflicts of interest or financial ties to disclose.

Presented at the meeting of the European Society of Coloproctology, Nantes, France, September 24 to 27, 2008. Published as an abstract in Colorectal Dis. 2008;10(suppl2).

Clinical Trial Registration: Karolinska Clinical Trial Registry CT200918.

Correspondence: Solveig Elmér, M.D., Department of Surgery, Ersta Hospital, Box 4622, S-11691, Stockholm, Sweden. E-mail:

© The ASCRS 2013