Solveig E Elmér1, Jonas O Nygren, Claes E Lenander. 1. Department of Surgery, Ersta Hospital, Institute of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden. solveig.elmer@erstadiakoni.se
Abstract
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.
RCT Entities:
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.
Authors: B Vinson-Bonnet; T Higuero; J L Faucheron; A Senejoux; F Pigot; L Siproudhis Journal: Int J Colorectal Dis Date: 2014-11-28 Impact factor: 2.571
Authors: M B Tempel; E G Pearson; M Page; D Pollock; K Gilmore-Lynch; W Peche; B Sklow; M Snyder Journal: Tech Coloproctol Date: 2013-12-19 Impact factor: 3.781