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Short-term Outcomes of Transanal Hemorrhoidal Dearterialization With Mucopexy Versus Vessel-Sealing Device Hemorrhoidectomy for Grade III to IV Hemorrhoids

A Prospective Randomized Multicenter Trial

Trenti, Loris M.D., Ph.D.1; Biondo, Sebastiano M.D., Ph.D.1; Kreisler Moreno, Esther M.D., Ph.D.1; Sanchez-Garcia, Jose L. M.D., Ph.D.2; Espin-Basany, Eloy M.D., Ph.D2; Landaluce-Olavarria, Aitor M.D., Ph.D3; Bermejo-Marcos, Elena M.D.4; Garcia-Martinez, Maria T. M.D., Ph.D.5; Alías Jiménez, David M.D., Ph.D.6; Jimenez, Fernando M.D., Ph.D.3; Alonso, Adolfo M.D., Ph.D.4; Manso, Maria B. M.D.6 on behalf of the THDLIGA-RCT Study Group

Diseases of the Colon & Rectum: August 2019 - Volume 62 - Issue 8 - p 988–996
doi: 10.1097/DCR.0000000000001362
Original Contributions: Anorectal
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BACKGROUND: Transanal hemorrhoidal dearterialization with mucopexy and vessel-sealing device hemorrhoidectomy seem to reduce postoperative pain compared with classic excisional hemorrhoidectomy, but whether one of them is superior remains unclear.

OBJECTIVE: We compared transanal hemorrhoidal dearterialization with mucopexy and vessel-sealing device hemorrhoidectomy.

DESIGN: This was a multicenter, randomized controlled trial.

SETTING: The study was conducted at 6 Spanish centers.

PATIENTS: Patients aged ≥18 years with grade III to IV hemorrhoids were included.

INTERVENTIONS: Patients were randomly assigned to transanal hemorrhoidal dearterialization with mucopexy (n = 39) or vessel-sealing device hemorrhoidectomy (n = 41).

MAIN OUTCOME MEASURES: Primary outcome was the mean postoperative number of days in which patients needed nonsteroidal anti-inflammatory drugs. Secondary outcomes were postoperative pain, 30-day morbidity, patient satisfaction, Vaizey score, hemorrhoid symptoms score, return to work, and quality of life.

RESULTS: More patients were still taking analgesia in the vessel-sealing device hemorrhoidectomy group during the second postoperative week compared with the transanal hemorrhoidal dearterialization with mucopexy group (87.8% vs 53.8%; p = 0.002). For the transanal hemorrhoidal dearterialization with mucopexy group, analgesia consumption continued until day 10.1 (mean; SD = 7.22 d), whereas in the vessel-sealing device hemorrhoidectomy group it continued until day 15.2 (mean; SD = 8.70 d; p = 0.006). The mean daily average pain was similar during the first (p = 0.900) and second postoperative weeks (p = 0.265). Mean operative time was higher for the transanal hemorrhoidal dearterialization with mucopexy group versus the vessel-sealing device hemorrhoidectomy group (45 min; range, 40–60 vs 20 min; range, 15–41 min; p < 0.001). Postoperative complications rate, use of laxatives, patient satisfaction, Vaizey score, hemorrhoids symptoms score, return to work, and quality of life at 1 month after surgery were similar between groups.

LIMITATIONS: The main limitation of this study was that the 2 groups did not contain equal numbers of grade III and IV hemorrhoids.

CONCLUSIONS: Transanal hemorrhoidal dearterialization with mucopexy is associated with a shorter need for postoperative analgesia compared with vessel-sealing device hemorrhoidectomy. See Video Abstract at http://links.lww.com/DCR/A915.

TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT02654249.

1 Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona and Bellvitge Biomedical Reaserch Institut (IDIBELL), Barcelona, Spain

2 Department of General and Digestive Surgery, Colorectal Unit, Vall d’Hebron University Hospital, Barcelona, Spain

3 Department of Surgery, Galdakao Usansolo Hospital, Vizcaya, Spain

4 Department of Surgery, La Princesa University Hospital, Madrid, Spain

5 Department of Surgery, Valdeorras Hospital, Ourense, Spain

6 Department of Surgery, Rey Juan Carlos University Hospital, Móstoles, Madrid, Spain

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.dcrjournal.com).

Funding/Support: This study has been supported by a grant from the Fundación de la Asociación Española de Coloproctología.

Financial Disclosure: Dr Biondo is a trainer for the transanal hemorrhoidal dearterialization associated with mucopexy procedure.

Presented at the meeting of the European Surgical Association, Trieste, Italy, May 11 to 12, 2018 and at the XXXII Congreso Nacional de Cirugía, Madrid, Spain, November 12 to 15, 2018.

Correspondence: Sebastiano Biondo, M.D., Ph.D., Bellvitge University Hospital Department of General and Digestive Surgery, C/ Feixa Llarga s/n, L’Hospitalet de Llobregat, 08907 Barcelona, Spain. E-mail: sbn.biondo@gmail.com

© 2019 The American Society of Colon and Rectal Surgeons