Premium
Doppler‐guided haemorrhoidal artery ligation with suture mucopexy compared with suture mucopexy alone for the treatment of Grade III haemorrhoids: a prospective randomized controlled trial
Author(s) -
Aigner F.,
Kronberger I.,
Oberwalder M.,
Loizides A.,
Ulmer H.,
Gruber L.,
Pratschke J.,
Peer S.,
Gruber H.
Publication year - 2016
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.13280
Subject(s) - medicine , randomized controlled trial , surgery , hemorrhoids , ligation , fibrous joint , prospective cohort study
Aim Novel minimally invasive techniques aimed to reposition the haemorrhoidal zone have been established for prolapsing haemorrhoids. We present a prospective randomized controlled trial to evaluate the efficacy of additional Doppler‐guided ligation of submucosal haemorrhoidal arteries ( DG ‐ HAL ) in patients with symptomatic Grade III haemorrhoids. The trial was registered as ClinicalTrials.gov identifier NCT 02372981. Method All consecutive patients with symptomatic Grade III haemorrhoids were randomly allocated to one of the two study arms: (i) Group A, DG ‐ HAL with mucopexy or (ii) Group B, mucopexy alone. End‐points were postoperative pain, faecal incontinence, bleeding, residual prolapse and alterations of the vascularization of the anorectal vascular plexus. Vascularization of the anorectal vascular plexus was assessed by transperineal contrast enhanced ultrasound. Patients recorded their symptoms in a diary maintained for a month. Results Forty patients were recruited and randomized to the two study groups. Patients in Group A had less pain in the first two postoperative weeks. At the 12‐month follow‐up, two patients in Group A (10%) and one in Group B (5%) showed recurrent Grade III haemorrhoids ( P = 0.274). No significant morphological changes were observed in the transperineal ultrasound findings between the preoperative assessment and the assessment at 1 and 6 months in either group ( P > 0.05). Conclusion Mucopexy techniques for treating prolapsing haemorrhoids are effective, but DG ‐ HAL does not add significantly to the results achieved by mucopexy. Repositioning the haemorrhoidal zone is the key to success, and mucopexy should be placed at the sites of the largest visible prolapse.