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.

Autor:	Trenti L; Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona and Bellvitge Biomedical Reaserch Institut (IDIBELL), Barcelona, Spain., Biondo S; Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona and Bellvitge Biomedical Reaserch Institut (IDIBELL), Barcelona, Spain., Kreisler Moreno E; Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona and Bellvitge Biomedical Reaserch Institut (IDIBELL), Barcelona, Spain., Sanchez-Garcia JL; Department of General and Digestive Surgery, Colorectal Unit, Vall d'Hebron University Hospital, Barcelona, Spain., Espin-Basany E; Department of General and Digestive Surgery, Colorectal Unit, Vall d'Hebron University Hospital, Barcelona, Spain., Landaluce-Olavarria A; Department of Surgery, Galdakao Usansolo Hospital, Vizcaya, Spain., Bermejo-Marcos E; Department of Surgery, La Princesa University Hospital, Madrid, Spain., Garcia-Martinez MT; Department of Surgery, Valdeorras Hospital, Ourense, Spain., Alías Jiménez D; Department of Surgery, Rey Juan Carlos University Hospital, Móstoles, Madrid, Spain., Jimenez F; Department of Surgery, Galdakao Usansolo Hospital, Vizcaya, Spain., Alonso A; Department of Surgery, La Princesa University Hospital, Madrid, Spain., Manso MB; Department of Surgery, Rey Juan Carlos University Hospital, Móstoles, Madrid, Spain.
Jazyk:	angličtina
Zdroj:	Diseases of the colon and rectum [Dis Colon Rectum] 2019 Aug; Vol. 62 (8), pp. 988-996.
DOI:	10.1097/DCR.0000000000001362
Abstrakt:	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.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu