Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Techniques in Coloproctology
Published in: Techniques in Coloproctology 1/2012

01-02-2012 | Review

A systematic review comparing transanal haemorrhoidal de-arterialisation to stapled haemorrhoidopexy in the management of haemorrhoidal disease

Authors: M. S. Sajid, U. Parampalli, P. Whitehouse, P. Sains, M. R. McFall, M. K. Baig

Published in: Techniques in Coloproctology | Issue 1/2012

Login to get access

Abstract

Background

The aim of this study was to systematically analyse the clinical trials on the effectiveness of transanal haemorrhoidal de-arterialisation (THD) and stapled haemorrhoidopexy (SH) in the management of haemorrhoidal disease (HD).

Methods

Clinical trials on the effectiveness of THD and SH in the management of HD were analysed systematically using RevMan®, and combined outcomes were expressed as risk ratio (RR) and mean difference (MD).

Results

Three randomised, controlled trials encompassing 150 patients were analysed systematically. There were 80 THD patients and 70 SH patients. There was no significant heterogeneity (P = 0.40) among included trials. Therefore, in the fixed effects model, THD and SH were statistically equivalent in terms of treatment success rate (P = 0.19), operation time (P = 0.55), postoperative complications (P = 0.11) and recurrence (P = 0.46) of HD. THD was associated with significantly less postoperative pain (MD, −2.00; 95% CI, −2.06, −1.94; z = 63.59; P < 0.00001) compared to SH.

Conclusions

Both THD and SH are equally effective and can be attempted for the management of HD. However, THD is associated with significantly lesser postoperative pain and therefore may be considered a preferred procedure. This conclusion is based only on treating 150 patients by THD or SH in three moderate-quality randomised trials. A major, multicenter, randomised trial is required to validate this conclusion and investigate other variables like hospital stay, cost-effectiveness and health-related quality of life measurement.
Literature
1.
Dal Monte PP, Tagariello C, Saragò M et al (2007) Transanal haemorrhoidal dearterialisation: nonexcisional surgery for the treatment of haemorrhoidal disease. Tech Coloproctol 11:333–338PubMedCrossRef
2.
Jayaraman S, Colquhoun PH, Malthaner RA (2007) Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery. Dis Colon Rectum 50:1297–1305PubMedCrossRef
3.
Carapeti EA, Kamm MA, McDonald PJ, Phillips RK (1998) Double-blind randomised controlled trial of effect of metronidazole on pain after day-case haemorrhoidectomy. Lancet 351:169–172PubMedCrossRef
4.
Ortiz H, Marzo J, Armendariz P (2002) Randomized clinical trial of stapled haemorrhoidopexy versus conventional diathermy haemorrhoidectomy. Br J Surg 89(11):1376–1381
5.
Wrobleski DE, Corman ML, Veidenheimer MC, Coller JAL (1980) Long-term evaluation of rubber ring ligation in hemorrhoidal disease. Dis Colon Rectum 23:478–482PubMedCrossRef
6.
7.
Awojobi OA (1983) Modified pile suture in the outpatient treatment of haemorrhoids: a preliminary report. Dis Colon Rectum 26:96–97CrossRef
8.
Serdev N (1990) The surgical treatment of haemorrhoids: their suturing ligation without excision. Khirusgiia 43:65–68
9.
Schulte T, Fändrich F, Kahlke V (2008) Life-threatening rectal necrosis after injection sclerotherapy for haemorrhoids. Int J Colorectal Dis 23:725–726PubMedCrossRef
10.
Marques CF, Nahas SC, Nahas CS, Sobrado CW Jr, Habr-Gama A, Kiss DR (2006) Early results of the treatment of internal hemorrhoid disease by infrared coagulation and elastic banding: a prospective randomized cross-over trial. Tech Coloproctol 10:312–317PubMedCrossRef
11.
Ricci MP, Matos D, Saad SS (2008) Rubber band ligation and infrared photocoagulation for the outpatient treatment of hemorrhoidal disease. Acta Cir Bras 23:102–106PubMedCrossRef
12.
Gupta PJ (2007) Infra red photocoagulation of early grades of hemorrhoids—5-year follow-up study. Bratisl Lek Listy 108:223–226PubMed
13.
Tajana A, Chiurazzi D, De Lorenzi I (1995) Infrared photocoagulation, cryosurgery and laser surgery in hemorrhoidal disease. Ann Ital Chir 66:775–782PubMed
14.
Longo A (1998) Treatment of haemorrhoidal disease by reduction of mucosa and haemorrhoidal prolapse with circular suturing device: a new procedure. In: Proceedings of the 6th world congress of endoscopic surgery, Monduzzi Editore, Bologna, pp 777–784
15.
Ortiz H, Marzo J, Armendáriz P, De Miguel M (2005) Stapled hemorrhoidopexy vs. diathermy excision for fourth-degree hemorrhoids: a randomized, clinical trial and review of the literature. Dis Colon Rectum 48:809–815PubMedCrossRef
16.
Sakr MF, Moussa MM (2010) LigaSure hemorrhoidectomy versus stapled hemorrhoidopexy: a prospective, randomized clinical trial. Dis Colon Rectum 53:1161–1167PubMedCrossRef
17.
Gravié JF, Lehur PA, Huten N et al (2005) Stapled hemorrhoidopexy versus milligan-morgan hemorrhoidectomy: a prospective, randomized, multicenter trial with 2-year postoperative follow up. Ann Surg 242:29–35PubMedCrossRef
18.
19.
20.
Morinaga K, Hasuda K, Ikeda T (1995) A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter. Am J Gastroenterol 90:610–613PubMed
21.
Sohn N, Aronoff JS, Cohen FS, Wernstein MA (2001) Transanal hemorrhoidal dearterialization is an alternative to operative hemorrhoidectomy. Am J Surg 182:515–519PubMedCrossRef
22.
Faucheron JL, Poncet G, Voirin D, Badic B, Gangner Y (2011) Doppler-guided hemorrhoidal artery ligation and rectoanal repair (HAL-RAR) for the treatment of grade IV hemorrhoids: long-term results in 100 consecutive patients. Dis Colon Rectum 54:226–231PubMedCrossRef
23.
Ratto C, Donisi L, Parello A et al (2010) Evaluation of transanal hemorrhoidal dearterialization as a minimally invasive therapeutic approach to hemorrhoids. Dis Colon Rectum 53:803–811PubMedCrossRef
24.
Theodoropoulos GE, Sevrisarianos N, Papaconstantinou J et al (2010) Doppler-guided haemorrhoidal artery ligation, rectoanal repair, sutured haemorrhoidopexy and minimal mucocutaneous excision for grades III-IV haemorrhoids: a multicenter prospective study of safety and efficacy. Colorectal Dis 12:125–134PubMedCrossRef
25.
Pol RA, van der Zwet WC, Hoornenborg D et al (2010) Results of 244 consecutive patients with hemorrhoids treated with Doppler-guided hemorrhoidal artery ligation. Dig Surg 27:279–284PubMedCrossRef
26.
Infantino A, Bellomo R, Dal Monte PP et al (2010) Transanal haemorrhoidal artery echodoppler ligation and anopexy (THD) is effective for II and III degree haemorrhoids: a prospective multicentric study. Colorectal Dis 12:804–809PubMedCrossRef
27.
Wilkerson PM, Strbac M, Reece-Smith H, Middleton SBL (2009) Doppler-guided haemorrhoidal artery ligation: long-term outcome and patient satisfaction. Colorectal Dis 11:394–400PubMedCrossRef
28.
Greenberg R, Karin E, Avital S, Skornick Y, Werbin N (2006) First 100 cases with Doppler-guided hemorrhoidal artery ligation. Dis Colon Rectum 49:485–489PubMedCrossRef
29.
Scheyer M, Antonietti E, Rollinger G, Mall H, Arnold SL (2006) Doppler-guided hemorrhoidal artery ligation. Am J Surg 191:89–93PubMedCrossRef
30.
Narro JL (2004) Hemorrhoid therapy with Doppler guided hemorrhoidal artery ligation via proctoscope KM-25. A new alternative to hemorrhoidectomy and rubber band ligation? Zentralbl Chir 129:208–210PubMedCrossRef
31.
Lienert M, Ulrich B (2004) Doppler-guided ligation of the hemorrhoidal arteries. Report of experiences with 248 patients. Dtsch Med Wochenschr 129:947–950PubMedCrossRef
32.
Tagariello C, Dal Monte PP, Saragò M (2004) Doppler-guided transanal haemorrhoidal dearterialisation. Chir Ital 56:693–697PubMed
33.
Arnold S, Antonietti E, Rollinger G, Scheyer M (2002) Doppler ultrasound assisted hemorrhoid artery ligation. A new therapy in symptomatic hemorrhoids. Chirurg 73:269–273PubMedCrossRef
34.
Festen S, van Hoogstraten MJ, van Geloven AA, Gerhards MF (2009) Treatment of grade III and IV haemorrhoidal disease with PPH or THD. A randomized trial on postoperative complications and short-term results. Int J Colorectal Dis 24:1401–1405PubMedCrossRef
35.
Giordano P, Nastro P, Davies A, Gravante G (2011) Prospective evaluation of stapled haemorrhoidopexy versus transanal haemorrhoidal dearterialisation for stage II and III haemorrhoids: three-year outcomes. Tech Coloproctol 15:67–73PubMedCrossRef
36.
Ramirez JM, Gracia JA, Aguilella V et al (2005) Surgical management of symptomatic haemorrhoids: to cut, to hang or to strangulate? A prospective randomized controlled trial. Colorectal Dis 7:52
37.
Higgins JPT, Green S (eds) (2011) Cochrane handbook for systematic reviews of interventions version 5.0.0 (updated February 2008). The Cochrane Collaboration, 2008; http://​www.​cochrane-handbook.​org. Accessed 15 April 2008
38.
Review Manager (RevMan) (2008) [Computer program]. Version 5.0. The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen
39.
40.
DeMets DL (1987) Methods for combining randomized clinical trials: strengths and limitations. Stat Med 6:341–350PubMedCrossRef
41.
Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558PubMedCrossRef
42.
Egger M, Smith GD, Altman DG (2006) Systematic reviews in healthcare. BMJ Publishing, London
43.
Deeks JJ, Altman DG, Bradburn MJ (2001) Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis. Systemic reviews in health care: meta-analysis in context, 2nd edn. BMJ Publication group, London
44.
Jadad AR, Moore RA, Carroll D et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12PubMedCrossRef
45.
Chalmers TC, Smith H Jr, Blackburn B et al (1981) A method for assessing the quality of a randomized control trial. Control Clin Trials 2:31–49PubMedCrossRef
46.
47.
Giordano P, Overton J, Madeddu F, Zaman S, Gravante G (2009) Transanal hemorrhoidal dearterialization: a systematic review. Dis Colon Rectum 52:1665–1671PubMedCrossRef
48.
Bursics A, Morvay K, Kupcsulik P, Flautner L (2004) Comparison of early and 1-year follow-up results of conventional hemorrhoidectomy and hemorrhoid artery ligation: a randomized study. Int J Colorectal Dis 19:176–180PubMedCrossRef
49.
Lewis AAM, Rogers HS, Leighton M (1983) Trial of maximal anal dilatation, cryotherapy and elastic band ligation as alternatives to haemorrhoidectomy in the treatment of large prolapsing haemorrhoids. Br J Surg 70:54–56PubMedCrossRef
50.
Metadata
Title
A systematic review comparing transanal haemorrhoidal de-arterialisation to stapled haemorrhoidopexy in the management of haemorrhoidal disease
Authors
M. S. Sajid
U. Parampalli
P. Whitehouse
P. Sains
M. R. McFall
M. K. Baig
Publication date
01-02-2012
Publisher
Springer Milan
Published in
Techniques in Coloproctology / Issue 1/2012
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI
https://doi.org/10.1007/s10151-011-0796-z

Other articles of this Issue 1/2012

Techniques in Coloproctology 1/2012 Go to the issue

Abstracts

4th National Congress of the Italian Society of Colorectal Surgery

Original Article

A transanal procedure using an endoscopic linear stapler for obstructed defecation syndrome: the first Chinese experience

Original Article

Focus on abdominal rectopexy for full-thickness rectal prolapse: meta-analysis of literature

Original Article

Five-year follow-up of Doppler-guided hemorrhoidal artery ligation

Review

The Italian Society of Colo-Rectal Surgery Annual Report 2010: an educational review

Multimedia Article

Laparoscopic extralevator abdominal perineal excision of the rectum: the best of both worlds