2013

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


Elmér E., Nygren J. O., Lenander C. E.
Diseases of the Colon & Rectum, Volume 56: 4 (2013)

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.

OBJECTIVES:
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.

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