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Prospective evaluation of stapled haemorrhoidopexy versus transanal haemorrhoidal dearterialisation for stage II and III haemorrhoids: three-year outcomes.

Giordano P, Nastro P, Davies A, Gravante G - Tech Coloproctol (2011)

Bottom Line: Patient satisfaction ("excellent/good outcome", THD 89 vs.Short-term results although similar seem to suggest SH may result in increased morbidity while return to work is quicker after THD.Medium-term results demonstrate that THD and SH have similar effectiveness.

View Article: PubMed Central - PubMed

Affiliation: Department of Colorectal Surgery, Whipps Cross University Hospital, Whipps Cross Road, London E11 1NR, UK. pasquale.giordano@whippsx.nhs.uk

ABSTRACT

Introduction: The aim of the study was to compare short- and medium-term outcomes of transanal haemorrhoidal dearterialisation (THD) versus stapled haemorrhoidopexy (SH) for the treatment of second- and third-degree haemorrhoids.

Methods: Patients with second- or third-degree haemorrhoids who failed conservative treatment were randomly allocated to THD or SH. Preoperative and postoperative symptoms, postoperative pain, time until return to normal activities, complications, patient satisfaction and recurrence rates were all assessed prospectively. Patients were followed up at 2, 8 months and when the study was completed.

Results: Twenty-eight patients (43% third degree) underwent THD and 24 (38% third degree) underwent SH. There were no significant differences in terms of postoperative pain, expected pain and analgesia requirements, but more THD patients returned to work within 4 days (P < 0.05). One THD patient developed a sub-mucosal haematoma after surgery, one SH patient occlusion of the rectal lumen and two rectal bleeding. At 8-month follow-up, two SH patients complained of faecal urgency. At 38-month follow-up (range 33-48 months), all short-term complications resolved. Patient satisfaction ("excellent/good outcome", THD 89 vs. SH 87%) and recurrence rate (THD 14 vs. SH 13%) were similar in the two groups.

Conclusions: Short-term results although similar seem to suggest SH may result in increased morbidity while return to work is quicker after THD. Medium-term results demonstrate that THD and SH have similar effectiveness.

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Related in: MedlinePlus

Flow diagram of patients at each stage of treatment THD transanal haemorrhoidal dearterialisation, SH stapled haemorrhoidopexy
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Fig1: Flow diagram of patients at each stage of treatment THD transanal haemorrhoidal dearterialisation, SH stapled haemorrhoidopexy

Mentions: Between September 2004 and December 2005, 64 consecutive patients were evaluated. Twelve patients were excluded from this group (Fig. 1), leaving 52 patients for analysis. Demographic and preoperative clinical data are summarised in Table 2. THD and SH groups were homogeneous for age, sex, previous haemorrhoidal surgery, degree of prolapse and preoperative symptom score. All patients had previously received at least one injection of sclerotherapy, 7 had undergone haemorrhoidal banding.Fig. 1


Prospective evaluation of stapled haemorrhoidopexy versus transanal haemorrhoidal dearterialisation for stage II and III haemorrhoids: three-year outcomes.

Giordano P, Nastro P, Davies A, Gravante G - Tech Coloproctol (2011)

Flow diagram of patients at each stage of treatment THD transanal haemorrhoidal dearterialisation, SH stapled haemorrhoidopexy
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3046344&req=5

Fig1: Flow diagram of patients at each stage of treatment THD transanal haemorrhoidal dearterialisation, SH stapled haemorrhoidopexy
Mentions: Between September 2004 and December 2005, 64 consecutive patients were evaluated. Twelve patients were excluded from this group (Fig. 1), leaving 52 patients for analysis. Demographic and preoperative clinical data are summarised in Table 2. THD and SH groups were homogeneous for age, sex, previous haemorrhoidal surgery, degree of prolapse and preoperative symptom score. All patients had previously received at least one injection of sclerotherapy, 7 had undergone haemorrhoidal banding.Fig. 1

Bottom Line: Patient satisfaction ("excellent/good outcome", THD 89 vs.Short-term results although similar seem to suggest SH may result in increased morbidity while return to work is quicker after THD.Medium-term results demonstrate that THD and SH have similar effectiveness.

View Article: PubMed Central - PubMed

Affiliation: Department of Colorectal Surgery, Whipps Cross University Hospital, Whipps Cross Road, London E11 1NR, UK. pasquale.giordano@whippsx.nhs.uk

ABSTRACT

Introduction: The aim of the study was to compare short- and medium-term outcomes of transanal haemorrhoidal dearterialisation (THD) versus stapled haemorrhoidopexy (SH) for the treatment of second- and third-degree haemorrhoids.

Methods: Patients with second- or third-degree haemorrhoids who failed conservative treatment were randomly allocated to THD or SH. Preoperative and postoperative symptoms, postoperative pain, time until return to normal activities, complications, patient satisfaction and recurrence rates were all assessed prospectively. Patients were followed up at 2, 8 months and when the study was completed.

Results: Twenty-eight patients (43% third degree) underwent THD and 24 (38% third degree) underwent SH. There were no significant differences in terms of postoperative pain, expected pain and analgesia requirements, but more THD patients returned to work within 4 days (P < 0.05). One THD patient developed a sub-mucosal haematoma after surgery, one SH patient occlusion of the rectal lumen and two rectal bleeding. At 8-month follow-up, two SH patients complained of faecal urgency. At 38-month follow-up (range 33-48 months), all short-term complications resolved. Patient satisfaction ("excellent/good outcome", THD 89 vs. SH 87%) and recurrence rate (THD 14 vs. SH 13%) were similar in the two groups.

Conclusions: Short-term results although similar seem to suggest SH may result in increased morbidity while return to work is quicker after THD. Medium-term results demonstrate that THD and SH have similar effectiveness.

Show MeSH
Related in: MedlinePlus