Prospective Multicenter Randomized Trial About Transanal Hemorrhoidal Dearterialization With Mucopexy (THD) Versus Ligasure Hemorrhoidectomy for Grade III and IV Hemorrhoids
Overview
- Phase
- N/A
- Intervention
- Not specified
- Conditions
- Hemorrhoids
- Sponsor
- Hospital Universitari de Bellvitge
- Enrollment
- 80
- Locations
- 10
- Primary Endpoint
- Post-operative pain
- Status
- Completed
- Last Updated
- 5 years ago
Overview
Brief Summary
The study evaluates postoperative pain, morbidity, recurrence and quality of life, comparing two different strategies in the treatment of grade III and IV hemorrhoids: transanal hemorrhoidal dearterialization with mucopexy (THD) versus hemorrhoidectomy by Ligasure™.
Detailed Description
Transanal hemorrhoidal dearterialization (THD) uses a specially developed anoscope combined with a Doppler transducer to identify the hemorrhoidal arteries. A suture ligation is performed to effectively decrease the blood flow to the hemorrhoidal plexus. In case of redundant prolapse, the prolapsed mucosa is lifted (mucopexy). THD procedure is performed without any incisions or removal of the hemorrhoidal tissue and moreover the suture line is above the dentate line, so post-operative pain and morbidities seem to be minimized in these patients. This technique differs from Ligasure hemorrhoidectomy, which focuses on excising the hemorrhoidal tissue. This prospective, randomized, multicenter and controlled trial compares post-operative pain, morbidities, quality of life, fecal incontinence and recurrence rate in patients treated for grade III and IV hemorrhoids with THD with mucopexy versus Ligasure hemorrhoidectomy.
Investigators
Sebastiano Biondo
MD, PhD
Hospital Universitari de Bellvitge
Eligibility Criteria
Inclusion Criteria
- •Patients with grade III and IV hemorrhoids according to Goligher classification
- •Patients ASA I, II or III and adequate hematological, renal and hepatic function
- •Patients who signed informed consent
Exclusion Criteria
- •Altered cognitive state that prevents collaboration in the study or patients who can neither read nor write
- •Fecal incontinence
- •Anal sphincter lesions
- •Recurrent hemorrhoids after previous surgical tratment
- •Previous anorectal surgery except banding, botulinum toxin injection and thrombectomy for hemorrhoid thrombosis
- •Injection sclerotherapy during the last five years
- •Concomitant anorectal disease (anal fistula, anal fissure, anal stenosis, rectocele, enterocele, anal condilomatosis).
- •Concomitant diagnosis of functional pelvic floor disease, inflammatory bowel disease and previous pelvic radiotherapy
- •Concomitant diagnosis of colorectal neoplasia or other neoplasia
- •Patients ASA IV, V
Outcomes
Primary Outcomes
Post-operative pain
Time Frame: within the first 30 days after surgery
Post-operative pain by simple verbal numerical scale (0-10), the Andersen scale (0-5) and the taken pain medicacions will be recorded by the patients on a specific book during the first thirty days after surgery.
Secondary Outcomes
- Quality of life(At 1 month and at 1 and 2 years after surgery)
- Specific disabilities (fecal incontinence and costipation)(At the day 15, 30 and at 1 and 2 years after surgery)
- Post-operative morbidity(within the first 30 days after surgery)
- Hemorrhoid recurrence(At 1 and 2 years after surgery)
- Satisfaction after surgery(At the day 15, 30 and at 1 and 2 years after surgery)