A Randomized Trial of Transanal Hemorrhoidal Dearterialization With Anopexy Compared With Open Hemorrhoidectomy in the Treatment of Hemorrhoids
Department of Surgery, Ersta Hospital, Institute of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden. Diseases of the Colon & Rectum
(Impact Factor: 3.75).
04/2013; 56(4):484-90. DOI: 10.1097/DCR.0b013e31827a8567
: 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.
: 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.
: The main outcome measure was postoperative pain.
: 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).
: There was no blinding, the sample size was small, and follow-up was for only 1 year. The questionnaire was not validated.
: The difference in postoperative pain between transanal hemorrhoidal dearterialization with anopexy and open hemorrhoidectomy may be less than expected based on previous literature.
Available from: Beatrice vinson bonnet
- "La DGHAL a pour avantage d'atténuer considérablement la douleur postopératoire et de réduire le risque hémorragique. Une étude prospective randomisée publiée récemment montre que la douleur postopératoire n'a pas disparu après DGHAL, même si elle est inférieure à celle observée après hémorroïdectomie . La douleur après la première selle n'est pas rapportée dans les études consacrées à la technique de DGHAL. "
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ABSTRACT: Malgré une forte incitation, la chirurgie hémorroïdaire ambulatoire est incomplètement développée.
La douleur postopératoire, la possibilité de rétention d’urines postopératoire et le risque hémorragique dont l’incidence varie en fonction de la technique chirurgicale, sont effectivement des difficultés à surmonter lors de la prise en charge en ambulatoire.
Outre le respect des règles de bonnes pratiques concernant la chirurgie ambulatoire, la chirurgie hémorroïdaire nécessite une prise en charge attentive de la douleur postopératoire, notamment par l’usage des blocs pudendaux, une adaptation de la technique anesthésique au contexte et un suivi postopératoire organisé.
La Presse Médicale 03/2014; 43(3). DOI:10.1016/j.lpm.2013.11.006 · 1.08 Impact Factor
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ABSTRACT: The purpose of this study was to demonstrate the distribution of hemorrhoidal arteries and the relationship between vascularity and growth of haemorrhoids.
One hundred and three patients with haemorrhoids were studied. Using Power Doppler Imaging (PDI) transanal ultrasonography and three-dimensional power Doppler angiography (3D-PDA), the course of the arteries supplying the haemorrhoids were identified. Measurement of the PDI-area was made using the cursor to outline the power Doppler signal of the haemorrhoid, approximately 1 cm above the dentate line.
The haemorrhoidal arteries were seen as branches of the superior rectal artery and were detected in 75.7, 71.8, 68.0 and 62.1 per cent of the 11, 7, 3 and 1 o'clock positions in the lithotomy position. The median number of haemorrhoidal arteries significantly increased from three to six with progression of the Goligher classification from grade 1 to grade 4 (p<0.0001). The PDI-areas in grades 1, 2, 3 and 4 were 0.04±0.03 cm(2) , 0.18±0.07 cm(2) , 0.38±0.18 cm(2) and 0.96±0.32 cm(2) (p<0.05).
The distribution of haemorrhoidal arteries varies widely in both the number and position. Using PDI transanal ultrasonography and 3D-PDA, it was possible to visualize the haemorrhoid plexus and the course of hemorrhoidal artery in vivo. This article is protected by copyright. All rights reserved.
Colorectal Disease 08/2013; 15(11). DOI:10.1111/codi.12406 · 2.35 Impact Factor
Journal de Chirurgie Viscerale 09/2013; 150(4):321–322. DOI:10.1016/j.jchirv.2013.07.003
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