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: | Sebastiano Biondo, Elena Bermejo-Marcos, David Alias Jiménez, Loris Trenti, Maria B Manso, Aitor Landaluce-Olavarria, Esther Kreisler Moreno, Jose Luis Sanchez-Garcia, Fernando Jimenez, Eloy Espin-Basany, Maria T Garcia-Martinez, Adolfo Alonso |
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| Rok vydání: | 2019 |
| Předmět: |
Hemorrhoidectomy
Male Natural Orifice Endoscopic Surgery medicine.medical_specialty Time Factors Anal Canal Hemorrhoids law.invention Transanal hemorrhoidal dearterialization 03 medical and health sciences Postoperative Complications 0302 clinical medicine Patient satisfaction Randomized controlled trial Quality of life law Multicenter trial medicine Humans Prospective Studies Prospective cohort study Ligation business.industry Incidence Rectum Gastroenterology Arteries Equipment Design General Medicine Middle Aged Anal canal medicine.disease Surgery Treatment Outcome medicine.anatomical_structure Patient Satisfaction Spain 030220 oncology & carcinogenesis Female 030211 gastroenterology & hepatology business Follow-Up Studies |
| Zdroj: | Diseases of the Colon & Rectum. 62:988-996 |
| ISSN: | 0012-3706 |
| DOI: | 10.1097/dcr.0000000000001362 |
| Popis: | 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: | OpenAIRE |
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