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Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Marco VENTURI 1, 2, Giovanni SALAMINA 3, Contardo VERGANI 1, 2
1 Department of General and Emergency Surgery, Maggiore Polyclinic Hospital, Ca’ Granda Foundation and Institute for Research and Care, Milan, Italy; 2 Section of Surgery, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; 3 ASST Ovest Milanese, Department of General Surgery, Ospedale Nuovo, Legnano, Milan, Italy
BACKGROUND: This randomized study compared the medium-term results of stapled anopexy (SA) and transanal hemorrhoidal dearterialization with anopexy (THD) in 4 homogeneous groups of patients, 2 with third- and 2 with fourth-degree hemorrhoids.
METHODS: Forty patients with third-degree and 30 with fourth-degree hemorrhoids were randomly submitted to SA (N.=20+15) and THD (N.=20+15), respectively. Clinical controls were done every 6 months from 1 to 42 months after the operation, with incidence of recurrent hemorrhoids as primary outcome measure. Operative time, complications, pain, time to return to normal activity, costs, Short Form-36, and overall patient satisfaction were also evaluated.
RESULTS: Frequencies of preoperative obstructed defecation symptoms and prolapse recurrence were higher in patients with fourth-degree hemorrhoids, and SA was more effective than THD in reducing the risk of recurrence at 36±6 months follow-up (P=0.049). Operative time, complications, pain, and time of return to normal activity were similar in the 4 groups. Costs were significantly higher for SA in patients with fourth-degree hemorrhoids (P>0.01). A significant improvement of quality of life was observed in all groups, and no significant difference was found in overall patient satisfaction.
CONCLUSIONS: Both techniques are safe and effective in the mid-term period. SA is more effective in reducing prolapse and obstructed defecation symptoms in fourth-degree hemorrhoids, with the disadvantage of higher costs. Prolapse size and presence of obstructed defecation symptoms could be predictive criteria for choice of the best surgical technique.