A prospective randomized trial of transanal hemorrhoidal dearterialization with mucopexy versus ultrasonic scalpel hemorrhoidectomy for grade III hemorrhoids

Tech Coloproctol. 2017 Aug;21(8):657-665. doi: 10.1007/s10151-017-1673-1. Epub 2017 Sep 4.

Abstract

Background: The aim of the present study was to compare short- and medium-term results of transanal Doppler-guided hemorrhoidal dearterialization with mucopexy (DM) versus hemorrhoidectomy using an ultrasonic scalpel (US) for third-degree hemorrhoids.

Methods: Forty-four patients were randomly assigned to undergo either DM or US. The patients were followed up at 1, 2, 3 months at our clinic, and by telephone interview when the study was completed in May 2017. The primary endpoint was postoperative pain with quality of life, length of stay, return to normal activities, and incontinence among secondary endpoints.

Results: Postoperative pain was less intense in the DM group than in the US group during week 1 (p < 0.05), but no difference was seen after 2 weeks. More DM patients returned to normal daily activities within 3 days (p < 0.05). There were no between-group differences in quality of life. One patient in each group developed postoperative hemorrhage requiring readmission. No differences were found between the groups in postoperative incontinence, obstructed defecation scores, or SF-36. During a median 33-month follow-up (range 12-46 months), two patients in the DM group and one patient in the US group underwent further surgery for residual hemorrhoid related problems. Two patients in the DM group required further rubber band ligation.

Conclusions: Medium-term results demonstrated that DM and US have similar effects on quality of life in the treatment of third-degree hemorrhoids. However, DM was associated with less early postoperative pain than US and a faster return to normal activities.

Keywords: Hemorrhoidectomy; Hemorrhoids; Prolapse; Transanal hemorrhoidal dearterialization; Ultrasonic scalpel.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Activities of Daily Living
  • Adult
  • Aged
  • Aged, 80 and over
  • Anal Canal
  • Constipation / etiology
  • Fecal Incontinence / etiology
  • Female
  • Follow-Up Studies
  • Hemorrhoidectomy / adverse effects*
  • Hemorrhoidectomy / instrumentation
  • Hemorrhoidectomy / methods*
  • Hemorrhoids / surgery*
  • Humans
  • Length of Stay
  • Ligation / methods
  • Male
  • Middle Aged
  • Pain, Postoperative / etiology*
  • Prospective Studies
  • Quality of Life
  • Ultrasonic Therapy / adverse effects*