부산대학교 도서관

BACKGROUND:: Both transanal hemorrhoidal dearterialization and vessel sealing device hemorrhoidectomy are safe and well tolerated for grade III-IV hemorrhoid treatment. The first is associated with a shorter need of postoperative analgesia than vessel sealing device hemorrhoidectomy. Whether one of them is superior regarding long-term results remains unclear. OBJECTIVE:: The objective was to compare long-term results after transanal hemorrhoidal dearterialization and vessel sealing device hemorrhoidectomy. DESIGN:: A multicenter randomized clinical trial was conducted. SETTING:: This study was conducted at 6 centers. PATIENTS:: Patients aged ≥18 years with grade III-IV hemorrhoids were included in the study. INTERVENTIONS:: Patients were randomly assigned to transanal hemorrhoidal dearterialization (n=39) or vessel sealing device hemorrhoidectomy (n = 41). MAIN OUTCOME MEASURES:: The primary outcome was hemorrhoid symptom recurrence assessed by a specific questionnaire 2 years postoperatively. Secondary outcomes included long-term complications, reoperations, fecal continence, patient’s satisfaction, and quality of life. RESULTS:: Five of the 80 patients included in the study were lost to follow-up. Thirty-six patients randomized to transanal hemorrhoidal dearterialization and 39 randomized to vessel sealing device hemorrhoidectomy were included in the long-term analysis. The differences between mean baseline and mean 2-year score in the two groups were similar (-11.0, SD 3.8 vs -12.5, SD 3.6; p = 0.080). Three patients in the transanal hemorrhoidal dearterialization group underwent supplementary procedures for hemorrhoid symptoms, compared with none in the vessel sealing device hemorrhoidectomy group (p = 0.106). Four patients in the vessel sealing hemorrhoidectomy group and none in the transanal hemorrhoidal dearterialization group experienced chronic opened wound (p = 0.116). No differences were found in terms fecal continence (p = 0.657), patient’s satisfaction (p = 0.483) and quality of life. LIMITATIONS:: No stratification for hemorrhoid grade and power calculation based on the main outcome trial but not on the end-point of this long-term study. CONCLUSIONS:: Transanal hemorrhoidal dearterialization with mucopexy is associated with similar hemorrhoid symptom recurrence than vessel sealing device hemorrhoidectomy at two years. See Video Abstract at http://links.lww.com/DCR/B933. TRIAL REGISTRATION:: clinicaltrials.gov (NCT02654249).